Big Bailout Will Sink National Health Insurance
With the national financial artery severed due to moronic mortgage mismanagers--even I knew these no interest, no down payment mortgages would result in foreclosures, so why didn't the big salaried?--it seems to me that any chance for a fully funded national health insurance is quickly fading. We are just too broke.
At the same time, with insurance companies increasingly cherry picking and raising premiums through the roof, a pure market system won't work either. Thus, it seems to me we should begin to focus on ways to make private health insurance--subsidized and regulated some by the government, a la the Medicare Drug Plan--more accessible and affordable. Here are a few suggestions:
1. Eliminate state-by-state markets and permit national coverage to facilitate greater spreading of the risk.
2. Create 10 national private plans akin to the Medicare Drug Plan, an approach which I like, to allow freedom of choice, but also set floors of coverage.
3. Have the government guarantee catastrophic care, which should help keep the pressure off of premiums.
4. Permit high deductibles and copays to discourage over utilization.
5. Encourage health savings accounts and permit tax deductions (or perhaps credits) for the price of premiums.
6. Permit people to buy into Medicare at age 60.
7. The basic plan will have to only cover the basics; limited mental health, no dental, no elective abortions, only partial prescription payments. If people want those kinds of elective coverages or greater protection, they should pay for it themselves.
8. Increase the uses of physicians assistants, certified nurse practitioners, and properly licensed midwives--under the direction of a physician--for primary care and obstetrician services.
9. Encourage price competition in both the funder and service provider sectors. This should include increasing the doctor pool to allow the law of supply and demand to click in.
10. Sorry, but to qualify for coverage, someone will have to be a citizen or legal resident.
Of course, that is pie in the sky, since we are so divided politically and culturally from each other that those fights will probably prevent any solution--whether nationalized or primarily privatized--from taking hold. Plus, for even a partially government funded program to work, we will have to triage government and ruthlessly cut in other areas. So, I am not holding my breath.
But the status quo will not hold. So, unless we want a total collapse, we'd better learn to work together and reacquire the ability to compromise.
And as for fighting global warming--if it exists--fuhgataboutit.
Labels: Health Care Crisis. Financial Crisis. Single Payer. Privatized Health Care.
posted by Wesley J. Smith @ 8:05 AM
5 Comments
5 Comments:
I have one point to make here.
"Sorry, but to qualify for coverage, someone will have to be a citizen or legal resident."
If not for humanitarian reasons, then for public health reasons people will have to either get health care or leave the country. We can't have, for instance, a tuberculosis outbreak among a non-cared-for population.
I'm with you on this one, Wesley, with a few minor suggestions:
- Regarding deductibles and co-payments (#4 on your list), it will be a bit of a balancing act to ensure that they are high enough to discourage overuse but not so high as to discourage appropriate care.
- Regarding limited mental health (#7), I'm not sure what's behind that. Mental health is not just middle-class patients lying on a psychiatrist's couch and moaning about how their mother didn't understand them. Properly approached and utilized, mental health services can pay for themselves in terms of reduction of social problems.
- Regarding limited prescription payments (#7 again), it may be otiose to pay for a patient to consult a physician if the patient doesn't have sufficient funds to follow the physician's advice.
National health insurance as in any kind of single-payer plan was always unlikely anyway. Tort reform would be necessary, and the lawyers of both political parties in Washington and the 50 state legislatures would never allow that.
But with serious tort reform, savings to the system might well pay much of the tab. If doctors were freed of the onerous cost of malpractice insurance on the grounds that the federal government would investigate and reimburse true instances of malpractice using mandatory arbitration, that would tend to minimize frivolous claims.
In fact, arbitration could be made contingent upon the doctor being found guilty in a criminal proceeding of malpractice-related charges first. The threat of criminal charges would in turn get the few truly incompetent docs out of the profession. I note that for many patients making malpractice claims it's all about the money, not punishing the doctor at all. You would think that supposed victims would want some sort of professional or criminal punishment, but this rarely appears in the news--only big payoffs instead.
My only concern with single-payer would be the effect on some of the alarming trends in medical care that you note. But maybe here, too, potential criminal charges would save some patients who even now face poor fates in the hospital. Or maybe I'm just dreaming...
"I note that for many patients making malpractice claims it's all about the money, not punishing the doctor at all."
Well, yes. If you've lost your earning capacity and require ongoing care that has to be paid for by somebody, you'd like to get that covered, I would think.
I have a problem with importing a criminal standard of proof (beyond reasonable doubt) into a personal-damages compensation system. Several problems, in fact. First, that bar is probably too high for 99.9% of the cases. Second, the vast majority of medical malpractice cases don't involve actions that amount to criminal acts. Third--and I don't know if it's the case in the US, but it is where I live--if you're going to convict someone of a crime, you have to show intent. What you're proposing, effectively, is a regime in which a patient could be compensated for malpractice only if the treating physician intended to harm him/her.
The big worry I have with any national plan is that certain large employers who don't like to pay benefits (won't name any names, but one rhymes with Gall-Mart) will cut ALL employee health coverage and tell their employees to go on the federal plan. There needs to be some disincentive there; they won't care about high deductibles and co-pays.
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