xiphias: (Default)
[personal profile] 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?

(no subject)

Date: 2007-03-14 08:25 pm (UTC)
From: [identity profile] ashnistrike.livejournal.com
The problem is that it is not possible to pay for the best possible care for all people.

Of course it is. We don't make our military go around with inferior technology.

...Okay. We didn't until the current administration. And we correctly think of that as embarrassing. I'm American, and I think it's embarrassing if a fellow citizen dies because of a lack of ability to pay for open heart surgery. I think it's embarrassing when a fellow citizen has cavities because our health care system is broken. The problem isn't resources, it's distribution. Every other civilized country on Earth manages this, and some even seem to do it well. "Embarrassing" is a very good word for our inability to do so.

(no subject)

Date: 2007-03-14 10:52 pm (UTC)
From: [identity profile] felis-sidus.livejournal.com
Actually, speaking as someone who sees what things cost on a daily basis, it really isn't possible to pay for the best possible care for everyone. Nor do I know of any other nation that does that. What is possible is to pay for adequate care for everyone, and there are nations doing that, depending on how you define adequate. The most common problem I've seen in most countries with national health services is the amount of time you have to wait for services that are necessary but not urgent. This can mean that what would have been an elective procedure instead becomes an emergency situation. (Not that we don't also have that problem in this country.)

My own proposal is even simpler. Lock a group of doctors representing all specialties in a room until they come up with the single most important health care benefit to provide to everyone. Now lock a similar group of economists, accountants, and financial analysts in a room until they decide how much it would cost to provide that care to everyone you intend to cover. (Not getting into the citizen versus non-citizen thing at this point.) Okay, everybody gets that. How much money is left in the national budget? Lock the doctors up again, and make them find the second most important health benefit. Repeat until we run out of money. Whatever's left over would be the province of the insurance companies.

Think this wouldn't work? Think again. We did something like it years ago in Massachusetts. It was spearheaded by the doctors in the state. All their professional groups got togther, surveyed their members, and agreed on a set of Relative Value Units that ranked medical services across specialties based on a combination of factors. Then they all agreed to accept a certain payment per relative value unit. It worked. Health care costs, while not cheap, were a lot more affordable than they are today. What happened to this system? The federal government decided it constituted price fixing, and outlawed it.

(no subject)

Date: 2007-03-15 02:26 am (UTC)
From: [identity profile] the-siobhan.livejournal.com
Speaking as s complete outsider, one of the flaws that I see in your system is just how much everything costs. Doctors and hospitals have to pay insane amounts of money for malpractice insurance, the cost of filing paperwork to multiple insurance companies, advertising (because mediciine is free market there), chasing down patients for payment and of course, getting stiffed by patients. Not to mention chasing down insurance companies for payment, I have a friend who is still harrassing companies for payment eight months later, and she has bills to pay in the meantime.

All those things substantially increase the costs. You could afford to spend so much more on actually treating patients if you took all those factors out of the equation.

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