Friday, March 06, 2009


It's time to save the wasted billions of dollars while providing better health care- and here's how to start...

As the old joke goes, a camel is a horse designed by a committee. Unfortunately, if President Barack Obama intends to reform the nation's health system by that method, the odds are against him. Unlike budget compromises where it is possible to find a middle ground, health care reform requires an Alexander willing to cut the Gordian Knot without wasting countless months trying to unentangle it. If he is serious about improving services while cutting costs, there are a few simple- but bold- moves that President Obama can and should initiate as soon as possible without waiting for compromise from those fighting to maintain the status quo.

First and foremost, we need a national health insurance that will cover catastrophic illnesses. Pick an arbitrary figure- say $5,000- and every family's annual medical bills that exceed that amount will be paid in full by the government. In one stroke this will free Americans from the fear that an illness or accident will swallow a lifetime of savings, cause them to lose their homes, and ultimately bankrupt the breadwinner(s). It will also free employees and persons with pre-existing illnesses from the fear of losing employer provided group health insurance at the same time that it tremendously reduces the overhead for businesses which are paying billions for it. To pay for the system, a national sales tax as low as one or two percent would ensure that all Americans (we all consume goods) are paying into the system without the political baggage of the ugly sounding "mandated coverage" that predominated the debates between Hillary Clinton and Barack Obama during the primaries.

Second, we need to institute a single payer system that will ensure that doctors, hospitals, and other medical providers are paid promptly, in full, and from one source. There is simply no excuse for having a health care payment system which is so complicated that doctors offices and hospitals have to hire numerous clerical employees just to negotiate the current overlap of Byzantine insurance plans and government benefit programs. Every American citizen will be issued a health payment card to use for all medical services, including prescription medicine, and the government will be the middle man making the payment to the provider. Medicare and Medicaid will be eliminated. If any person doesn't have insurance, then he or she will be responsible for paying the bill in full, in one payment or over time, with low interest rates. Any unpaid bills would be recouped from the following year's tax refunds and by replacing the current medicare tax in payroll withholding with payments on the card. This would be similar to an ordinary credit card system-- except that the government won't be summarily jacking up interest rates or flooding your mailbox with more credit card applications.

Third (and this is coming from a plaintiffs' trial lawyer), we need to eliminate all medical malpractice lawsuits and replace the current tort system-- which requires proof of negligence which caused harm to the patient-- with a no-fault system that will not require lawyers or lawsuits. The system will be similar to Workers Compensation insurance, which pays workers injured on the job preset amounts for certain injuries regardless of fault. All medical malpractice and liability insurance for doctors, hospitals, and drug companies will be eliminated, freeing doctors to practice in any specialty, including ob-gyn, without the crushing overhead of insurance premiums which have far outstripped settlements and awards paid by insurance companies. The no-fault system will be financed by a one percent tax on all medical services and goods, most of which are currently untaxed. The analogy is to the old flight insurance where a passenger paid $1.00 for $100,000 in flight insurance. If the plane went down and the passenger died, his heirs got $100,000 without having to prove fault of the airline or airplane manufacturer. Instituting a national no fault system would result in tremendous savings from the tens of billions of dollars currently spent on insurance costs and unnecessary defensive medicine.

These are three simple, yet effective ideas with virtually no downside. To the naysayers who shout "Socialism" (much like Marty Feldman invoked the name of Frau Blucher in the movie Young Frankenstein): we already have socialized medicine in this country in the form of Medicare, Medicaid, and hospital emergency rooms which have to treat all injured or ill who show up. These ideas, if implemented, would still leave people free to choose their doctor, their medical provider, and the course of treatment they deem best, without having to be overseen by avaricious HMO's or insurers which restrict access to certain physicians, hospitals, or life saving courses of treatment.


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