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

[pocketnaomi.livejournal.com]

The biggest gap I see in your plan is that it ignores the question of preventive care, which IMO the government REALLY needs to pay for as a matter of basic collective self-interest. It is a hell of a lot cheaper to pay for routine prenatal care than to pay for the care of a badly premature baby, f'rex, or for routine cholesterol monitoring and medications than for the number of cases of additional bypass surgery that would be unnecessary if the problem was caught early. That isn't even counting the overall social, economic and morale benefits of having as low a needlessly-disabled population as possible. I would go VERY far in having the government pay altogether for regular checkups, tests and maintenance, because people who have to pay for these themselves usually just *won't*, and I think it's so much in our interests as a society to encourage that kind of care to happen that it's worth bribing people to do it by making it free.

[(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.

[wildcard9.livejournal.com]

The only problem I can foresee is people being shut out of the blocs that are the most benefitial. It could be financial (they can not afford it) or societal (i.e. discrimination). I am not sure what you could really do for the financial issue since there are different levels of income across the country. Social exclusure can be avoided via regulation but even that can be circumvented. Either way, not all blocs will give equal treatment, and there-in lies the problem.

[rebmommy.livejournal.com]

Did you see the NECN article about the "Mobile Access to Care" (MAC) Van that is sponsored by the Massachusetts Dental Society and the Boys and Girls Club? It provides free dental care for children from low-income families and gets them connected with dentists who will give them free or less expensive follow-up care. You Papa Tuny (Dr. Norman Becker) is very proud of this program, which he helped to develop. Your cousin Todd (Dr. Todd Belf-Becker) is the featured volunteer dentist in the news article.

[happybat.livejournal.com]

I suppose, what I mainly think is that cultural relativity is very interesting - I would be not only ashamed but ANGRY if I heard about a fellow citizen dying because of their lack of ability to pay for open heart surgery.

[ckd]

I say we just reduce drug patent lifetimes by 1 month for each month in which the company does any direct-to-consumer advertising. (So if you have 5 years left in January, advertise every month and by next January you'll have 3 years left.)

[yardlong.livejournal.com]

I agree entirely with happybat, and of the things you mention should be provided, I'd say that the routine dental care should top that list. That does do a hell of a lot of good, but whatever else you mean by basic care without extensive/expensive testing is of questionable value. Illness needs to be diagnosed and treated. Check-ups that do not provide a product (treatment, cure) are a waste, but it is not known until after the fact. Full care should be provided to every citizen, definitely to include heart surgery which is an expensive cost but often not a continuing and repetitive cost for one patient. Two people in our family have died for lack of heart-related medical care, and I fear for my husband because he can't get preventive treatment before things get to a very threatening level.

There may be something I'm not aware of, but free mammograms for women who can't get care for breast cancer makes me question the purpose. But then, I did go for one myself, and was sent a bill for over $800.

[mightydoll.livejournal.com]

Sounds somewhat similar to Canada's plan. Though we don't cover teeth or eyes, for reasons I can't fathom.

As far as drug patents go, I like it in theory, but what I would be worried about is drug companies using addictive additives to "hook" people before their patent ran out. Kinda like Effexxor does. They claim it's so you won't forget to take pills...and it works in the capacity, if I forget a day, I get SICK!!!

but that's not really nice when I'm somewhere where I can't get access to these precious (and expensive - - my dosage is about $3 a day) little red pills.

That said, here in Canada, as long as a drug company holds a patent (before the generic version of the drug comes out) the company has to make available "compassionate doses", which is how I get my drugs, free, through my doctor.

Since Effexxor is about to go generic, I'll probably do what I did when Zoloft went generic and switch to something newer and less well tested...just call me a working class guinea pig.

[vvalkyri.livejournal.com]

Oddly enough, someone randomly responded today to something from a year or so ago in my journal (http://vvalkyri.livejournal.com/616246.html) that reminded me about your post here.


I think you've got a lot of good ideas, and I like your way of stating, "if it's embarrassing for it to happen" - my way of putting it had been in terms of it being shameful.