Welcome to my Healthcare Reform Blog. This is arguably the most important piece of legislation of my lifetime and I have yet to hear a single decent proposal thus far. My proposal is not meant to be a finished product: I wrote this proposal and created this blog in the hopes of sparking some debate.
Please know that I will not use your email addresses for any reason without your permission. Also, please be respectful of all ideas and opinions that are shared. Thank you for being part of the solution!
- Erik Marquis, President/E Billing Solutions LLC
My complete proposal is posted above. Here are the details: Rather than use tax payer money to create a government monopoly that will either provide low-quality healthcare or overpriced adequate care, I propose we base reform along the following guidelines:
1. Pass insurance reform to guarantee all Americans the right to healthcare.
2. Allow the free markets to work by requiring insurance carriers to base premiums on an individual’s health rather than on age or genetic predispostion.
3. Implement the use of Electronic Medical Records.
For more details, please read my proposal. Thanks for being part of the debate.
Your moderator,
Erik Marquis
First of all, I firmly support your stance on insurance reform. It is unconscionable that any health care provider can cherry pick their patients or throw people out of a plan if they might cost too much. But I cannot get behind your proposal. More free market fundamentalism will not be able cure our broken health care system. It is precisely this philosophy which has created the problems we have today.
You are proposing that we wring cost savings out of information technology. That is a good idea. I think it’s even part of most of the bills floating around Congress right now. You also suggest that we link the cost over coverage to a person’s healthiness. What happens when you are running a triathlon and a drunk runs you over? Or your employer exposes you to a hazardous material then goes out of business? The point of insurance coverage is to spread the cost and the risk out over a large pool of participants. What if the skinny fit dudes with ponytails plan starts to overrun their costs? Is it fair you start taking money from the fat guy plan? Plus, you are presupposing that healthy people cost less. I’m not sure that reality bears that out. Obese people have heart attacks at 65. Healthy people go doctor’s appoints into their 90s and have lots of prescriptions.
We have the world’s most expensive health care system in the world and by all quantitative measurements, we fall far behind other countries’ health metrics. Projections say our health care costs are only going up from here. Why should we prop up this system any longer? I think health care should be considered part of the commons. Like the police force and fire department, some things are so vital to the community that they need to run by the government. I think the best solution is a single payer health care insurance run by the government. There are plenty of capitalistic benefits to this. First off, employers no longer need to have the cost of health care hanging over them. This will put them on more equal footing with international companies that already do not have this expense. Also, government-run health care will actually spur the creation of more small businesses. A large impediment to entrepreneurship is the cost of health care.
Why does the U.S. has such exorbitant health care costs in the first place? There are many reasons, but one that stands out in front are the millions of uninsured Americans that receive medical services and simply cannot or will not pay the bill. Ask yourself this, what happens to those unrecouped expenses for the health care providers? Answer, it gets passed on to those that can afford to pay. Of course hospitals and doctors have to profitable to survive. So whether its tax dollars, or increased premiums and copays, the average American has been (secretly) paying the bill.
The US Government is rushing to a solution to a three decades old problem because the President needs to get this done while he has the approval rating to do so? Let’s look at the other government run entitlement programs to see if they have the track record to get it done. First, Social Security. Ok, that’s a Ponzi scheme that defrauded the elderly while they were employed 50 years ago and now uses paycheck dollars from young workers who likely will never see a dollar back when it goes bankrupt in 2015 (depending on what you read). Second, how about Medicare? Also bankrupt, just don’t tell the Senior Citizens or you’ll get a [fierce argument]. So if history is any predictor of future performance, a government mandated insurance program is a good concept that will not be executed well. Essentially, we would be trading one giant faceless, heartless conglomerate (Aetna, Blue Cross, etc) for a government administered giant faceless, heartless conglomerate (think IRS…)
Now on to the idea of Electronic Records. I don’t see this ending up being some kind of collaborative, grass roots effort that (only works in Lifetime Movies) will generate the savings that Obama is proposing. Here we are looking at billions of dollars and ultimately the government deciding on how this process will be carried out and who will administer it, still a little light on detail, I may add. But I do agree that in a modern world where everyone knows instantly when Ashton Kutcher tweets himself, the healthcare industry just plainly and simply missed the importance of electronic data communication. But I think this is an entirely separate issue.
So is there a simple answer? Perhaps we should reduce the cost of healthcare by reducing the amount of unpaid treatment. If you speak to anyone that works in the E.R., they will tell you that the uninsured have no choice but to come in for the most basic of care. The cost of E.R. visit is on the order of 10 fold greater than a typical doctor visit. Perhaps then instead, the government should not get into the insurance or insurance regulation business, but instead open strategically placed clinics, in lower income areas especially. The uninsured would then have a government facility to obtain care, even preventative if they chose to do so. The concept would allow the insurance industry to be out of the equation and allow them to price premiums based upon risk pools as they have done. There costs should go down and so should the average insured American’s premium costs. This will be the only true way to keep the insurance carriers financially sound. If you don’t believe the government intervention hurts the process, you should move to Florida where the state government regulated homeowners insurance and all but the most insolvent left the state. Where will the money come from? Well taxpayers of course, but this suggestion will likely cost a fraction of what the current plans on the table will cost. And much like welfare and other need based institutions is a fact of life, not likely to ever go away, here in the good old USA.
Very well done, and very well thought-out responses so far. Overall, I agree with the basic tenets of your proposal, as I too am infuriated at the thought of having to pay for the health care of someone who sees fit to make bad individual choices with the knowledge that there will be no financial accountability for putting down that fruit and picking up that bag of chips. That’s a cop-out within that context.
However, I do not have a problem with the government providing competition to these disgusting insurance companies. Regulation will only go so far – you need to make these companies make choices based on their own bottom line and not what the regulations say, as I’d know from personal experience that hiring and paying a team of in-house attorneys whose mission it would be to get around these regulations will likely result in a better margin than simply following these regulations.
The US Post Office is in the shipping business, and it doesn’t seem to harm UPS or FedEx. Those private companies are thriving not because of laws and regulations, but because of competition, which is the ultimate regulator. If you introduce a competitor who does not have profit as a motivation, then you’re going to only ramp up the levels at which the private entities need to perform. That’s not a bad thing.
I’d also like to see, as part of this reform, some different norms be established in terms of the average consumer’s choices. Junk food should cost a lot more than fresh produce, but it doesn’t. If an individual wants to continue to make bad choices, they have the freedom to do so, but only if they’re willing to pay out of their own pockets to continually do so.
As said, though, I think this is a very sound proposal in terms of its fundamental approach. We need to be more accountable for our own actions, and it starts with how we manage our own health.
Erik Marquis is obviously knowledgeable and deeply informed about this subject. His health reform proposal is thought through and relatively comprehensive – very well done. But depressing to me is the fact that in the third line of his proposal he rejects the “public option”. Considering the profound mess that the “for profit” health insurance industry has made in the United States as well as the success of Medicare, the VA health program, national health programs in the United Kingdom, Canada and France leaviing out a public option strikes me as a serious mistake. It is somewhat comparable to leaving your star player on the bench at the start of the game.
All Hail Slovenia! If it wasn’t for Slovenia we would have the #38th rank on the World Health Organization list of efficient health care systems instead of #37. It is telling that our heavily privatized system, where the Government picks up the poor and the elderly and the insurance companies get the cream of the working crop, compares so unfavorably with those European systems where there is heavy public sector intervention. Health care is eating up 15% of our GDP currently and will rise to 34% by 2040 if changes are not initiated. By comparison even those countries with successful systems, such as France (#1), spend less than 10% of their GDP on health care. In the last ten years there has been an 85% increase in premiums; that is the major reason why the army of the uninsured is growing, not layoffs.
The costs of health care are slowing economic growth, eating up discretionary income and having a devastating impact on U.S. competitiveness in the global economy, especially in the area of manufacturing. The auto makers shift operations to Ontario, Canada for the simple reason that health care costs average somewhere around $600 a worker versus $6500 in the U.S.
But free markets in themselves are only part of the answer. I think there is an extraordinary mythology regarding free markets in this country, as though these are self-sustaining, self-regulating entities that operate autonomously and always reach optimal outcomes. This is a peculiarly American belief. But as the near collapse of the world economy (thanks to the free market fundamentalism of the GOP which weakened the Federal regulatory apparatus; $15 trillion in household assets went down the drain as a result. Ooops!) demonstrates, this is not always the case. Markets are created and sustained by the public sector, as is private property in general. A market economy is contingent upon continuous public intervention to ensure transparency, accountability, fairness, to adjudicate claims, and to address the negative externalities associated with the conduct of business, everything from pollution to unemployment to injured workers. We are a long ways from the free markets that Adam Smith wrote about centuries ago.
Much of your own proposal describes what a disaster the “free market” health system is, the lack of transparency, accountability, the abuses of the insurance industry etc; I am surprised that you draw the conclusion that we need more market and less government involvement when your own analysis seems to point in the opposite direction.
In the area of health care, there is a wide consensus among economists that markets simply don’t operate efficiently in this area as health services are not a conventional good or service. Buying health insurance is not like buying a TV, where one can price comparable products, look for sales, see what features the TV has or does not have. With health insurance, no one knows when or how much coverage they will need, or what is the appropriate treatment, or the most cost effective treatment for a condition such as breast cancer. Studies have shown that even most physicians don’t have the available stats and data on such matters to inform their decision making.
Consumers are also insulated from the costs of their care. And because health care is expensive, a third party (insurance companies) is required to manage ones coverage, further muddying the waters. Your interests, in turn, are diametrically opposed to theirs, as your utilization of care represents a loss for them, unlike the win-win situation of purchasing a consumer good. In short, there are substantial asymmetries of information in the health field, between the providers and the patient, which impede the achievement of optimal outcomes. That is why substantial government involvement is necessary, as markets simply don’t function efficiently or fairly in this unique area of health care providing.
As for the health test as the determinant of health care costs, I do not believe that it is operational, practical, or desirable. I cannot imagine many people willingly (would they be forced to participate?) undertaking the associated risks that come with it, gambling that one’s health will stay in tact over the long run, or in the event that it does not, face a lifetime of backbreaking premiums. Better to stay in the relative security of the shallow risk pool rather than wade out alone into uncharted waters without a life vest. It also assumes that we have more control over our health situation than I believe is warranted. We can tilt the odds in our favor a bit, but that is about it.
I also cannot see what such a system has to do with a “free market” as it would apparently be a government mandated system (even if privately run), coercive and punitive in nature. Nothing is being bought or sold here, there is no choice of policies, one is simply forced to participate. An insurance company today could voluntarily set up such a policy with this health test if it so desired (well, if it was legal), but I cannot imagine that many people, even those who consider themselves healthy, would partake because of the risks. A commitment to health and exercise is not going to spare one from life’s random misfortunes. Moreover, this feature of the proposal seems to address the issue of moral hazard, not free markets and competition.
If I am reading the “health test” criteria correctly, it penalizes people for simply being unhealthy or sick; if you develop high blood pressure, cancer, kidney stones, Afib, neurological disorders, lupus,a bad back – for whatever reason – you are penalized. As the etiology of disease is in most cases unknowable (environmental, lifestyle, biological inheritance, iatrogenic, or often some multiple combination of the latter), it would simply punish people for having the misfortune of contracting a disease or developing a condition. Just when you need help the most it may be denied because you may not be able to afford it, which is not entirely unlike the current situation. In 2008 the government paid out $43 billion to reimburse providers for uncompensated care. I suspect the proposed new standard would, by essentially separating the “healthy” from the “unhealthy” into different pools, make this figure look small by comparison. For if the healthy people (at least healthy at the moment) are paying the low premiums, the sick will get hammered and have to drop out.
A subsidiary point is that I cannot imagine how a physician could possibly appraise someone’s “personal commitment” to health, except in the most extreme cases. Such an effort would constitute little more than a general guesstimate; it would be impossible to establish any kind of agreed scientific standards and viable benchmarks in such an area, with different physicians throwing around different numbers, as they do today in workers compensation cases, where two doctors will examine the same patient and attribute entirely different causes to the injury, one will determine it was due to the car accident five years ago, the other to lifting a heavy object in the warehouse. The trial lawyers would have a field day.
The health test proposal would also reinforce existing class distinctions and devastate the poorest elements of the community, such as the black community, as the latter’s health status is partly related to their socioeconomic status, which includes lower income, less access to quality physicians and facilities, and higher environmental risks(including crime) associated with living in an urban environment.
As for the suggestion that those who pay less should receive lower quality care, I would strongly oppose it on ethical grounds, as it would assign a value to a human life based upon financial considerations. One person is considered more valuable than another simply because, in most instances, they have more money to shell out. I suspect that a purposive attempt to provide substandard care would also violate the professional rules of ethics that are operative for all institutions (hospitals) and care givers as well as violate our commitments under the WHO charter.
I think your point on moral hazards is well taken, in that individuals who destroy their health through smoking, over eating, etc, are transferring the potential financial costs of their risky behavior to the rest of us. But outside of the obvious one, smoking, I am not sure how you can assess all the moral hazards that individuals partake in (and how would a physician know) and integrate them into an insurance policy, especially the less obvious ones – young women that spend hours in tanning beds, binge drinkers and drug users, bikers who ride without helmets, athletes – young and old – that participate in a range of physical activities which translates into a huge financial drain on the system, with endless visits to orthopedists, physical therapists, and “sports medicine” institutes. If there is money to be saved in the health care area, I would vote to target the latter, where money goes to keep a 50 year old jogger jogging or a 60 year old golfer on the greens (quality of life stuff) while funding for primary health care for children is starved.
There is much in your proposal which I also agree with but I have concentrated on the more provocative, and controversial, points. Your first hand knowledge of billing practices and payments is very helpful to us novices in this area. As you suggest, there is considerable room for cost savings in this and other areas. The Council of Economic Advisors estimates that healthcare costs could be lower by 5% of GDP just through implementation of such measures as you suggest. There is also the interesting research at Dartmouth on regional variations in treatment, some areas of the country spending considerably more than other regions without any discernible impact on health outcomes. There is also the need for tort reform to prevent the practice of defensive medicine.
Personally, the bottom line for me is universal coverage (including catastrophic coverage), as much choice in plans as possible so individuals can tailor their plan to their medical needs and financial situation, with everyone having the option to have the gold standard plan if they can afford it. I am pragmatic about how to achieve this end (a combination of private and public plans would be nice) and pay for it, but I think that nothing less than universal, and portable, coverage should be acceptable. Not everyone will have the same level of coverage, but the poor and unemployed should also participate as the benefits – to the local community, to the labor force, to the economy – would be substantial.
Some thorough, and impassioned, responses so far. I would like to address a few of the issues that have been mentioned.
A few comments regarding some other posts: I like Jay1972’s suggestion of taxing junk food. That could be taken a step further and even tax restaurants that use the giant fryers (e.g. MacDonalds). I also liked the CMoney’s idea of strategically placed government-sponsored clinics near emergency rooms with the purpose of funnelling non-emergencies to them. That would dramatically reduce hospital healthcare costs and improve ER efficiency. Perhaps AlphaDoc could provide some perspective on this.
John O cites Medicare as being a successful program. I will agree that it is successful for patients, as the care they receive is excellent. However, for providers it is a disaster. The payment rates are 50% (or lower) of private insurance carriers. Additionally, the customer service is exactly what you would expect from a government entity: atrocious. Furthermore, right now, if a patient or a provider has an issue with private insurance, we can appeal to our state’s insurance commissioner. If the government takes over, who will watch the watchdog?
Bluescat states that the U.S. has the 38th best healthcare system in the world according to a World Health Organization report released in 2000. (They have not release one since.) For the sake of this argument, I will assume that not much has changed, for better or worse.
The WHO bases this ranking on two factors: goodness and fairness (see http://www.who.int/whr/2000/en/whr00_en.pdf, page 26). The U.S. ranks very highly in terms of “goodness”. The U.S does not rank highly in terms of “fairness”. Fairness is essentially defined as distribution of health services to all citizens. I think we can all agree that is why Healthcare Reform is a priority for the President. The question then becomes: how do we achieve this? By reducing overall costs so the healthcare cost per person is lower.
Currently, our health insurance premiums are based primarily on age and genetic predisposition, both of which are completely out of the control of the individual. With no power to alter these factors, individuals have no reason to lead a healthy lifestyle (but for health itself, which is rarely take in into consideration by people with poor eating and exercise habits). There is no tangible penalty for destroying your own health and passing those costs on to fellow tax payers/premium payers.
Let’s compare health insurance to other forms. With auto insurance, if you drive recklessly then your premiums increase. If you are a safe driver, then they do not (outside of inflationary increases). They can even be reduced in some circumstances (e.g. good grades for high school students). The individual is personally responsible and one’s choices are reflected in one’s premiums. Under a homeowner’s policy (in CA), if you replace your wood shingles, then your premiums are lower. If you have a security system, then they are lower. Again, responsible choices result in lower premiums.
The point of altering how premiums are calculated is to get people personally invested in their own health. I also dispute Sarasotakid’s notion that people that live longer are more expensive in terms of healthcare costs. People who have heart disease don’t always die: often they require multiple surgeries, hospice care, and medication for the remainder of their life. They also cease to be a productive (in terms of working and consuming) member of society. The current method of calculating premiums for health insurance does not account for the choices we make and that is the fundamental problem.
The health of the nation is the nations business
A proposed model for national health care
1) Universal Health Care with a single payer structured as an extension of the Medicare program, abolishing Medicaid. Such care should be affordable but not free. A graduated premium (health care tax) linked to taxable income, W2, Social Security or overall financial status should be set. Wealthy taxpayers should expect to pay more. Poor people may not pay at all. Working people could have their premium withheld from their regular paycheck, as part of the social security withholding. Participation in the program would be optional but within set parameters as with Medicare participation. Choice of physician, hospital, etc. would be determined by the individual.
2) Physicians would be allowed a defined period to opt into or stay out of the program. Patient and physician participation would be strictly voluntary.
3) Undergraduate and graduate medical education should be subsidized to an appreciable extent, depending on financial status and wish of the student. (Presently, a graduating medical student has an educational debt of over $ 200,000.00). In return, graduating physicians would be obligated to serve one to two years in national service. For graduate medical students, such time and service could be structured to count as time spent in specialty training.
4) Pharmaceutical companies should have to compete on a global basis for providing drugs to patients in the program. The health care agency would have the right to negotiate internationally for lowest prices.
5) Medical liability must be brought under control for the system to work. Since participating physicians would in effect be government employees, they should be entitled to protection from excessive litigation and judgments, as other federal employees.
6) Private insurance companies would have only a marginal role in the system, for those who could afford it, and want it. Call it designer health insurance. (Presently a family of four pays up to $14,500.00 for health care insurance). Programs such as “Medicare HMO’s”, Advantage Medicare, etc would not be acceptable in the program.
Dr. Chris
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P.S. R.E. TORT REFORM
Many people, especially doctors, have complained that health care reform, Bill H.R. 3200, contains no provision for tort reform. If the bill did contain such a provision, it would have had to be referred to the Judiciary committee. There the bill would have died. Perhaps that is what some people were hopping for?????
- I liked Dr. Chris’s succinct, bare bones, yet substantive proposals. I doubt that such a major transformation is within the realm of political possibilities, however, given all the competing stakeholders involved combined with a political system where you need a series of majorities to get legislation down the pipeline. We currently have 6 key Senators, who represent a whopping 2.7% of the U.S. population, holding health care reform hostage.
- Erik’s critique of the WHO report is also to the point; the Report is dated and one can challenge the criteria utilized to compare nations. However, I think that an evaluation of a health care system that does not include fairness (which would include access) would also be of questionable utility as access and quality are inseparable.
-Other comparative research on health care systems finds that the U.S has high marks in some areas (cancer screening, cancer care) and lower marks in other areas (asthma deaths, amenable mortality rates). Generally among OECD countries, the U.S. falls somewhere in the pact, excellent in some areas, average in others. Although some politicians like to criticize the Canadian health system, the latter actually exceeds the U.S. in many areas. Also, all the OECD countries insure every person (except Mexico and Turkey) and do so with a considerably lower percent of their GDP. But then you can also argue that if we want to spend more on health, so be it if that is our choice, although of course as long as it is spent wisely and efficiently.
-It is worth reiterating that Medicare is popular and is consistently given higher grades by its enrollees than the grades given to private plans by their enrollees. In 2007 56% of Medicare enrollees scored their plan a 9 or 10 compared to only 40% of Americans enrolled in private plans; and 70% of these enrollees claimed they “always” get access to needed care compared to 51% of those with private insurance. Eighty percent of seniors rated Medicare favorably according to a Kaiser study. This is the horrible “socialized medicine” that Reagan and others railed against in the 1960’s when Medicare was passed. To quote vintage Reagan, “[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”
- Even a cursory glance at the literature indicates one point of consensus among economists:
health care markets are not competitive. In 36 states three or fewer insurers had 65% of the market; 34 states have market concentration (insurers) that exceed federal anti-trust guidelines. Two insurers have at least half the business in almost every metropolitan area in the country. Hospitals/providers in many areas have similar market power. Market entry for new competitors is, in turn exceedingly difficult. Efforts to build new hospitals or clinics, or expand existing ones (which is much more common, hence the crazy architecture of many hospitals), often turns into a bare knuckle brawl between competing health care interests. The FTC is sometimes involved in an effort to prevent market distorting hospital mergers.
-One can devise any criteria one wishes to determine premiums, and redistribute the costs of coverage accordingly, but without some radical change that enhances competition health care costs will continue to rise. Competition (and transparency) would in turn help to eliminate the crazy variations in price, where a colonoscopy in New Jersey can range from $716 to $3717 and where one insurer in California paid 5 different hospitals anywhere from $1800 to $13,700 for an appendectomy. Similar irrationalities were found in the Boston area. It would be wonderful if the Government didn’t have to get involved, but given the dysfunctional nature of health care markets, and the disastrous costs for the U.S. economy, public intervention in some form is inevitable, as it has been for the past century. That is why we have all the patches for the leaks in the system – SCHIPS, COBRA, Medicare, HIPAA, and others. Efforts by insurance companies to cream skim, and avoid adverse selection, are partly the reason for all the patchwork. Insurance companies certainly need to make a profit, but at the same time there is a competing communal and economic interest in ensuring everyone access to the system and pay reasonable premiums in the process.
- The patchwork nature of the system, a hybrid mix of private (which includes both pre-paid plans and indemnity insurance) and public, will continue, although providers – under all plans on the table – will (and should) remain in the private sector.
- Hospital/Administrative costs continue to take the largest share of the health care spending pie, even more so than Insurance or Drug costs, so that is an area that needs to be targeted.
I agree with BLUESCAT47. Over the years I have had occasion to see first hand (some times as a patient) the health care system of Germany, Denmark, Norway and Canada. I have found the facilities in these countries up to date and state of the art. Their physicians are every bit as sophisticated as those in the U.S. Their book keeping systems are simpler and certainly easier on the pocket book. It is hard to understand why so many people brand these Health Care Systems as “socialist” and refuse to look at them. The notion that no one in the world can do anything better than us, is arrogant and unjustified
I think most of us will agree that reform of some kind is needed. The question in my mind, is how will we reduce overall healthcare costs? Without cost reduction, no reform plan will work without putting an undue burden on taxpayers. Many cost-cutting strategies have been discussed here already, but I will be creating a separate discussion that will focus strictly on how healthcare costs can be reduced. To proceed to that discussion, please click here.
Generally, I like the proposed reforms you encourage.
The areas that need strengthening are 1) Allow Free Markets to Work and 2) Electronic Medical Records. 3) One area that you didn’t address is tort reforms.
I agree that Free Market Reforms are the way to solve most issues relating to health care.
1. One area that you completely overlooked is allowing competition across state lines. If competition across State Lines, something that Federal Regulations currently prohibit, were allowed, consumers would instantly have much more choice in health coverage – 49 additional choices, state wise, and then however many different choices each state currently has. That is a lot of choice. It would promote much more competition in the industry.
Keeping states’ rights to regulate their own health care systems and allowing them greater freedom in developing their own solutions to healthcare issues is a great way to encourage innovation. Every time states have been allowed to innovate, the results have been good and bad. This allows other states to see what works and follow the lead of the states that are doing things right. Additionally, consumers should be allowed to still buy better coverage across state lines where it exists. “Congress should respect and encourage personal freedom and diversity.”
2. The major concern I have with Electronic Medical Records is the ease with which others can obtain and view your personal information. Criminal penalties for obtaining and/or viewing others personal information should be extremely harsh. First time offenses should be a mandatory minimum of 5 years with more time tacked on in the event the information is released to the public. Otherwise, I prefer to endure the expense and time you state would be saved. I personally have nothing to hide, but I need to know that my information is mine. Also, the government must never be allowed access to this information unless authorized by me or upon a valid writ. This is currently a deal breaker for many who would otherwise want EMR: the security of information is extremely lacking and enforcement of those prying eyes is too lax.
3. Tort Reform for medical malpractice cases needs to occur. I will not dive into this area since you didn’t address it, but it is very necessary. Doctors’ insurance premiums just to practice are a major reason for the high cost of healthcare along with frivolous lawsuits that should have never seen the light of day except some DCPL judge has it in for insurance companies. I believe caps should be placed for most suits with a few exceptions. I can expound with specifics, but not at this time.
As an aside, I disagree with this statement: “People that work pay more taxes and purchase more things, in turn strengthening our economy.” I don’t think government confiscation of Americans’ money, otherwise known as legal theft, strengthens the economy. We are currently overtaxed and in 2010, taxes go up.
I do not like many of the responses, whether thought out or not, on this page. I have not read all of them. Specifically, I do not want the government adding taxes to products and putting companies out of business. It is like saying we need to raise the minimum wage. It [does not make sense]. Why not just raise the minimum wage to $100,000.00 for everyone and then we wouldn’t have these problems – that is sarcasm and an illustration of the stupidity of taxing products more just because you don’t like them for the public. It takes away choice in the long run. It takes away Liberty.
One challenge to those who don’t know much about health care. Try paying cash and shopping around and see how much the cost comes down. If you need an x-ray, ask how much it will cost.
I found that when I was offering my insurance it was $247.00. When I asked why it was so much, there was no answer. I asked how much if I paid cash and the cost plummeted to $137.00 on the spot. Then, I shopped around and found that I could actually get the same x-ray from an independent chiropractor for $28.50 – no insurance needed.
Many problems are arbitrary when it comes to the cost of services. As Erik suggest, most people don’t know or understand their coverage or that of the medical services provided in general.
Most people would never think of paying in cash and assume health care is a right they shouldn’t have to pay for because of the brainwashing DCPLs (democrats, communist, progressives and liberals)have done to Americans. Additionally, they don’t think to shop around, they just accept the price as if there is no competition.
Instituting a fascist system such as Germany, France or Great Britain is not the answer. (These systems are fascist, meaning they are government controlled industries.) While those that have experienced those systems think it is great, the burden on true freedom and innovation in the market of medical services is non-existent. They simply rely on America for new drugs and research and development. Those systems are also extremely expensive – while the individual may not pay as much it is taking a toll on the government. Taxes are twice as high or higher too. If you wish to give up freedom for a fascist system, just move.
Anecdotal evidence is not something to base informed judgment upon. These systems have many more problems than most know or even try to find out about than the current US system. It isn’t arrogant to say this. It is a simple fact. That is why so many come from these countries to get care in the US.
The foolish do not study history or the consequences of giving governments power over choice. Make no mistake about it, the “public option” is a strike against liberty and those who do not think so are ill informed or Marxist at heart. Should it come to pass, in the lives of those who support it will be seen an extreme loss of Liberty and personal freedom. I can expound with historical examples and current examples. In London, a stroke victim was placed on a death list and prescribed morphine because the hospital didn’t want to treat him. That is what those who want this option are unknowingly encouraging here in America and it is just that. http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html
Praise for fascism is what is being espoused here. I say the promise of fascism is a lie.
I love your proposal Erik. We can call it “No fatties” health reform.
Erik,
Love this web site-it’s great!! I haven’t finished reading the whole proposal yet but I will. I know we DO NOT need socialized medicine-I worked with the Canadian Health Care System when I lived in Maine and it was a MESS!! They lost all their specialists.
I also believe that Americans need to place their healthcare as a top priority in their budgets and lives. It seems the big screen TV is much more important than going to the doctor’s and paying a co pay or even the visit. We are a materialistic society and you can’t see healthcare most of the time in our daily lives so it gets put to the bottom of our list of priorities. If people spent as much on their healthcare as they do on their toys and lururies then we would have a better system.
I also feel that something needs to be done about the number of lawsuits that are out there-people are sue happy as you know and this is a bad thing. Sorry to ramble on but this is a pet peeve of mine.
Of course you know if you don’t purchase the proposed legislation as it stands now, you could go to jail for 5 years. Effectively, Obama’s plan, or the house Democrats plan, however you choose to look at it, criminalizes those who do not have health insurance.
http://republicans.waysandmeans.house.gov/News/DocumentSingle.aspx?DocumentID=153583
Anyone who is for this is simply against Liberty. Our citizens have lost the will in many instances to fight for Liberty. When Liberty is taken from our citizenry, many of them simply shrug and let it slip away. Content in their lives, few recognize just how different our country is and how much Liberty we have given up since 1900.
This “Health care reform” is not about health care at all. It is about state control of your lives through a vehicle called reform – something Marxist always use to push a populace into submission to the state.
Everything will be regulated in your lives based on this fallacy we are talking about. The vote is Saturday or Sunday Nov. 7th or 8th. Take action and call, fax and email your elected representatives before more of your Liberty is snatched away from you.
Your proposal has some excellent ideas. I like the electronic medical records idea especially since I frequent the VA and am quite satisfied with there overall service. I’m not to sure of the ‘health score” you propose, on paper it sounds good–what about people with a chronic problem like arthritis or diabetes, would they carry a bad score forever? Never mind the thought of fraud and another bureacracy.
The Public Option is a must to get any meaningful reform especially since the bone-head plan that the GOP recently proposed, a band-aid to the healthcare problems we already have.
This debate can go on forever. I’m all for capitalism and free enterprise which is all about ME! From the private sector to the goverment fraud seems to run rampant so in this reform plan I say keep it simple.
And the people shrugged! Liberty is being washed down the drain for something which isn’t really a huge issue in the USA. Health care in the USA is better than in 95% of the rest of the world. Stirring a lie of how bad it is has caused the first step of more of Liberty’s erosion due to those who are content. The passage of the House bill is a travesty in America. The possibility of being placed in jail for 5 years for not purchasing the mandated insurance is now one step closer to being a reality and that isn’t even the worst part of it – I will not expound because deaf ears are listening. Hopefully this foolishness is found dead in the Senate.
http://www.wnd.com/index.php?fa=PAGE.view&pageId=115277
Roger – excellent question.
Under my proposal, your healthcare preimums would be based solely on how well you take care of yourself. The costs of any disorders or diseases (genetic or otherwise), terminal illnesses, chronic conditions, etc., would be shared proportionately by all health insurance carriers.
Here are some news articles citing research that support my ideas. I do not see how the public option sufficiently addresses these problems.
This article touches on the our culture’s acceptance of children driinking excessive amounts of soda:
http://www3.signonsandiego.com/stories/2009/sep/17/kids-twice-likely-adults-drink-soda-research-says/?metro&zIndex=167265
This article explains the the possible link between being overweight and brain degeneration:
http://www.medicalnewstoday.com/articles/162135.php
This article links obesity with the rising costs of healthcare:
http://www.businessweek.com/lifestyle/content/healthday/629419.html?chan=autos_executive+health+–+lifestyle+subindex+page_health+news
There are a number of issues on the table at the moment, more than one can possibly digest, with the House bill and the Senate bill offering different health care reforms and different ways to fund them. But I guess the reform measures couldn’t come at a better time, given the critical state of our health care system. Wages are not rising because of premium costs (from $6462 in 96’ per family, to $11,941 in 2006), fewer small firms are offering insurance (only 43% of firms with less than 50 workers, and for those with coverage, the coverage quality has deteriorated, and it is anticipated that 54 million will be without insurance in a decade.
More firms are also offering consumer directed health plans, basically low premiums and high deductibles for the brave of heart. GE is now herding all of its employees into such a plan (no other options), with deductibles running as high as $4000 a year. On the positive side, it may reduce moral hazard (which is its purpose) and sensitize the health consumer to the costs of treatment. On the negative side, employees may defer getting care, especially preventive care, and will also pay large deductibles if they get ill. GE employees are apparently not too happy about it.
As far as the two bills, the House bill provides more generous subsidies for low income groups and higher penalties for those who do not get insurance (and penalties for employers also). It also would finance a big chunk of the program with a surtax on high income taxpayers while the Senate version increases the medicare payroll tax on high income workers and also taxes the more generous employer-sponsored health plans. I think the latter tax makes sense, given that these plans are accorded tax deductibility to the employer; as some plans provide services that do not necessarily enhance health care (private rooms, unproven procedures), that seems fair. However, it may be politically impossible to pass.
The CBO projects that both plans would be deficit neutral and reduce the federal deficit over ten years ($138 for the House bill, $130 for the Senate version). Even if these projections were somewhat off and there was some marginal deficit incurred (and the legislative tinkering on these issues, on funding and coverage, will go on for years), the positive elements would be substantial – near universal coverage, no denial because of existing conditions, no termination of benefits. There would be more preventive care/treatment, fewer people out of the workforce, and pre-Medicare eligible workers would be able to participate in the labor force longer. It would also eliminate “job lock,” where people cannot change jobs because of a pre-existing condition.
The public option (PO) is obviously the most controversial element. Both bills would, my understanding is, limit participation in the PO to the uninsured and those working in firms with less than 100 employees. The point of the PO is to introduce more market competition and, if it was a robust PO, produce the clout necessary to negotiate prices down with dominant providers; given that about 86% of metropolitan areas have highly concentrated hospital markets (and hospital rates also increase when there are mergers in an area), it would hopefully help to counter this problem. It should also put pressure on the less competent insurers to shape up or ship out. Senator Grassley has complained that some insurers will go out of business for which I think the appropriate response is – wonderful! A few of the weaker ones should go out of business.
Also, insurers (including the PO) participating in the “exchange” would have to compete on price and quality instead of risk selection, with all getting a mixed selection of healthy and unhealthy applicants. That would be a major, positive change and hopefully there would be new private entrants into the mix as well, hoping to compete for the new clients against the insurance giants.
The major issues in the legislative battle include whether states can opt out of the program, whether it should be open (the PO) for any American to join, whether it should be mandatory for all Americans to sign up for some form of insurance , and whether to set prices (somewhere between Medicare rates and commercial rates) or negotiate prices.
It is complicated, to say the least. But if they gut the PO with all kinds of restrictions, then it will not have the intended effect. Whether a robust plan will succeed as planned in reducing the costs of health care will be determined by a number of as yet unknown factors, although the moral hazard problem – the financial insulation of the health care consumer from many of the services he or she purchases – will remain.
If a PO passes, our system will look a bit like the Netherlands, where a public option is available but private insurance remains available as well. But without some major reform soon, there will be calls for much greater government regulation of the health care stakeholders, as premiums climb and as more employers decide not to offer coverage.
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