Thursday, July 16, 2009


Our current system for providing and paying for health care as it looks to a rational outsider (I'm talking to you, Canada!)

Dear Editor:

For the first time I can recall, I agreed with both the USA Today editorial and the opposing view (from the Chamber of Commerce) on a subject- in this case, the health care reform efforts underway in Congress. However, although the editorial board's comment that "no one ever thought [health care reform] bills would be works of elegance or simplicity" is accurate, that doesn't mean that complexity is better in this context. True reform would be a work of simplicity, but it would take courage and leadership, qualities presently lacking in both the White House and the Congress. There are reforms available which would vastly reduce costs to the government, to the consumer, and to the medical industry, but politicians so far have lacked the guts to cut the Gordian knot. Here are three suggestions that would accomplish the goals of a better system for all while reducing costs:

(1) End the multi-tiered system of paying for services, which at present includes government funded Medicare, Medicaid, and the Veterans Administration, private funded insurance, and no insurance-no pay patients funded by the general public. Replace all of those with a government funded catastrophic insurance which would pay all annual medical expenses for each person which exceed $2,400 a year ($200 a month). In addition, provide free pre-natal care and free pediatric care for all children under 12, and free preventive medicine for all. Fund these programs with a national sales tax that would be less than five percent. Ending Medicare and Medicaid programs and substituting the foregoing will save hundreds of billions of dollars starting on day one. Using a national sales tax will equitably share costs without burdening any businesses, large or small, or unfairly piling the costs onto wage earners or the super rich. Ending employer provided health insurance will reduce overhead and make all American businesses more competitive with foreign companies whose workers have a national health insurance. Providing government funded catastrophic insurance will allow Americans to switch jobs regardless of pre-existing conditions or availability of health insurance, and it would end the sad state of affairs where too many parents of diseased children are literally begging for donations in penny jars put out in retail stores to pay for life saving operations. Having the system paid for in full by a national sales tax (the percentage will be adjusted as the costs are calculated and re-adjusted over the years) will ensure fairness, including the fairness of having foreign residents, the retired rich, and illegal aliens all helping fund the program.

(2) End all medical malpractice insurance costs by replacing the system with a no-fault system similar to worker's compensation programs that do not require lawsuits or lawyers for recovery. Any person injured by any medical product or medical procedure will be entitled to recover set amounts based on the degree of injury, without regard to fault. This provision will save tens of billions of dollars in overhead for all physicians, hospitals, and pharmaceutical and medical equipment companies, both directly in the form of insurance premiums and indirectly in reducing the amount of defensive medicine. And a no-fault system will compensate far more injured patients than the current tort system which requires expensive lawsuits available only to the few who have suffered serious injuries or death.

(3) Require all medical providers to publicly post the following information: all costs for all procedures, services, and products. Currently, the average patient never sees a specific cost for anything until long after the service is provided- and sometimes never in the case of patients with good insurance. Also, require all recoveries under the no-fault system to be publicly posted (on the internet and elsewhere) with names and identifiers of patients removed to protect their privacy. This will inform and alert the public to defective products or bad doctors far more effectively than the occasional malpractice lawsuit, many of which result in confidential settlements. These public disclosure requirements will allow price shopping among patients, promote price competition between doctors and between hospitals, while allowing patients to avoid dangerous doctors, dangerous hospitals, and dangerous drugs. This proposal would be an adjunct to FDA regulations and inspections and state licensing agencies for physicians and hospitals which are already in place and already supposed to protect medical consumers.

So the ideas exist. They are elegant, simple, would cut government costs, patient costs, and costs of the medical industry, all while improving services to all. Now who has the courage to see that they are enacted?


Anonymous Anonymous said...

You are right about the need for Health Care reform. To cut costs we need to means test it.

10:33 AM  

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