Okay, how about THIS for a health care plan for the United States?

[xiphias]

A five-part plan:

1) The government pays for really basic stuff. Basically, if you feel ashamed when you hear about someone dying from a lack of this, it's paid for. If it's cheap and does a hell of a lot of good, that's the stuff we're talking about. Basic checkups without significant tests, tooth cleanings, real basic stuff.

If I hear about someone dying because they couldn't get open heart surgery, that makes me sad, but not ashamed. I'm aware of how expensive that is. Or not getting a transplant -- again, sad, but not embarrassed. So those sorts of things wouldn't be covered.

This would just be a billing code. A hospital or doctor's office could just bill this stuff to the government, and it would be paid promptly.

2) People could form into negotiation blocs who could negotiate lower rates from drug companies, hospitals, doctors, and so forth. If you wanted to, you could sign up for whatever bloc or blocs you wanted to be in, for a small fee (which would basically cover administration and negotiators' salaries), and, if you were a doctor or hospital or whatever, you could sign up for the same bloc which would mean that you'd agree to the rates they negotiated. As a doctor, your benefit would be that there would be a group of people who would count you as a preferred doctor.

Actually, I don't know how necessary this part is. After all, if you were a doctor and WEREN'T part of the bloc, you could still agree to take whatever fee the bloc charged, in order to poach customers. Which would also be fine.

3) There would be health insurance. As in, you pay a monthly fee, and, if something bad happens, they pay whatever your insurance coverage pays for. It wouldn't pay for routine stuff, although the insurance plan could give lower rates for people who demonstrated that they did take care of the routine stuff routinely.

This insurance could be "we pay 80% of your charges, up to a limit, and you pay 20%", it could be, "we pay 100% after a deductible", y'know, whatever. These health insurance plans might be associated with negotiation blocs, but need not be. If they started to pay for routine stuff as well, you begin to run into exactly the same problems we have right now, but, well, if they WANTED to do exactly the things that we have now, sure, they could. Why not?

4) Drug patents would expire seven years after they were approved for sale. That number is somewhat negotiable, if drug companies could prove that they couldn't make a profit in seven years, but whoever was doing the negotiation should be DAMN skeptical.

I mean that we could argue that drug patents should expire ten years, or twelve years, or whatever, as the law. I'm not a financial analyst -- I don't KNOW that drug companies can make a profit, in general, in seven years. But I really, really suspect so. I DON"T mean that an individual drug could be patented longer. Because, if you did that, with negotiations all the time, the negotiators would be corrupt. It just would happen.

5) And the gaps would be filled by private charities. And doctors and hospitals doing pro-bono work. I don't think, in the United States, you could do it any other way. I don't think it would be possible for the government to pay for everything that really ought to be done, and I think that you'd need charity to fill in.

What do people think?

Comments

[(Anonymous)]

The other problem is the negotiated rates. When I had cancer and was in the hospital, I only saw one bill. It was for about $22,000; the insurance company paid about $3,500 leaving the hospital to write off the rest. Now something there is out of whack. Did the hospital overcharge or the insurance company underpay? Or something in between? With that much of a discrepancy, it is easy for me to understand why the medical facilities run so tight and toss you out so fast.

[quietann.livejournal.com]

yep, reminds me of my $6000 tubal ligation (which I almost ended up having to pay for out of pocket because student health insurance didn't cover it, but then it turned out that I had the procedure done *2 days* before the COBRA coverage from my husband's employer ran out. That insurance paid $1600 for it and I payed only a $50 copay for outpatient surgery.)

[redknight.livejournal.com]

"Nobody pays list price!" Well, nobody but the uninsured. Medical pricing seems designed to allow for deep discounts for insurers and taking advantage of the people who can least afford to pay list price (the uninsured).

The Wall Street Journal had an article on the subject a few years ago (http://online.wsj.com/article/SB109571706550822844.html?), unfortunately things don't seem to have changed much since then.

[felis-sidus.livejournal.com]

A lot depends on where you live. In some states, if you're uninsured it's easy to arrange a significant discount or free care, because of state statutes. In others, you're on your own.

[vvalkyri.livejournal.com]

Yeah. That's one thing that really disturbs me. For the most part Medicare and some of the other big insurers simply state a price they'll pay for any given procedure, regardless of how much it costs the hospital. ("we don't care if he stays in the hospital 2 days or 20 - we're paying X for that surgery") One of the major ROI on my product is it reminds/guides clinicians into using the 'magic words' to document comorbidities. Medicare etc recognize that the guy who had a heart attack 2 months ago is more likely to be in hospital longer after the surgery. But if you just document "Previous MI" but not "Previous MI w/in 6 mos" you don't get the extra cash.