Journal Roblimo's Journal: A Simple, Sane Health Care Reform Package That Will Never Happen 15
I have a simple approach to fixing our health care system that will piss off both Republicans and Democrats, not to mention insurance, hospital, pharma, and other health care executives whose huge incomes are dependent on major profits from the current system. Trial lawyers won't like it, either. Therefore, treat this as a fantasy -- but one that, if it came true, would save money and provide better medical care to Americans of all income levels.
Item One: Encourage Health Insurance Competition
This is a Republican idea, and a good one. Health insurance companies should not only be allowed but encouraged to sell their policies across state lines. And, as long as they don't turn down people with pre-existing conditions or sell insurance that has unrealistic deductibles (no more than, say, $2000 per year per policy) or copay provisions (perhaps capped at 20% of all bills up to $5000 or $10,000, with 100% coverage beyond those levels), they should not be forced to cover routine medical care. In other words, I'm talking about a shift -- entirely voluntary, only for those who want it -- from today's typical all-inclusive, HMO-type plans to old-fashioned major medical and hospitalization coverage. This would create a simple health insurance option that would keep people from going bankrupt because of medical emergencies. Let the free market dictate exact rates -- again, within broad limits, with perhaps a 3:1 maximum rate difference based on age and other risk factors.
The free enterprise component will piss off serious socialists. Fine. Let them be angry. And they will be, even though I believe we should subsidize health insurance premiums for people who can't otherwise afford to pay them. With tax dollars. Naturally, we'll put the subsidized insurance plans out for public bid. The least-expensive insurance companies (that meet basic plan standards) get the contracts. Less-efficient insurers don't. And, as an additional measure to keep quality high, Members of Congress, their staffs, and other federal employees will be insured under the same low-bid plans available to the rest of us.
Note that I am not stopping any insurance company from offering higher-priced plans with more than the minimum mandated benefit levels. Individuals and employers who want to pay more -- and hopefully get more services in return -- should be free to do so.
Item Two: Encourage More Non-Profit Routine Health Care Delivery
There are many low-cost alternatives to the mainstream medical system, such as this non-profit group where I live in Manatee County, Florida, that make routine doctor visits and prescription drugs affordable for even the poorest patients. Our local Gulf Coast Discount Medical Plan is not free. It's just a lot less expensive than any other local health care option we've found. Those who run to a doctor every time they sneeze pay every single time, which discourages excess use. Prescriptions are heavily discounted, too, but like doctor visits, they are not free. Once again, excess use is discouraged.
Gulf Coast has a sliding-scale fee structure. For those who can't afford even the lowest sliding-scale rate, let's have government subsidies, paid out of our taxes. On the other hand, I see nothing wrong with someone spending an hour or two cleaning bathrooms or picking up litter in the parking lot in return for a doctor visit or prescription. Or making phone calls to remind patients of their appointments. Or something. Anything. Naturally, it is only right to waive the service requirement for people who are so disabled or decrepit that they can't do much of anything, but I suspect that in the spirit of voluntarism many church groups and individuals would step up and do "their" service for them. (I surely would.)
As a personnel recruitment aid, perhaps we could offer partial or full tuition reimbursement for doctors, nurses and administrators who agree to spend a set number of years as salaried clinic employees. I also suspect that a large number of experienced doctors and nurses who are tired of dealing with insurance company forms and the other hassles that have become part of our current medical non-system would be drawn to this kind of practice.
If nothing else, a good system of non-profit clinics can help keep patients who don't belong in emergency rooms out of them. Yes, I've heard the Yowler yammer about how anyone who is seriously ill can go to the ER and get "free" treatment, but that treatment is not free. It's subsidized by the rest of us through higher hospital charges. Real, budgeted subsidies to non-profit clinics would not only be more honest than the current system, but would be easier to track and control.
Once again, I am not forcing anyone to do anything. If your local clinics (and I see no reason why there can't be many competing ones) don't suit your needs, and you can afford to go to a fee-for-service provider, go ahead. I also don't see why there can't be for-profit clinics competing with the non-profit ones either on price or by offering shorter wait times, free marijuana (sort-of kidding about this one) or other perqs to their patients. Choice is good, right?
Item Three: Tort Reform
Malpractice judgments are a tiny fraction of total medical expenses, and without public-spirited lawyers who often allow the damaged parties to keep 50%, even 60% or 70%, of court-awarded malpractice judgments, we would have nothing but drunk barber-surgeons in filthy hospitals. Let's give all those heroic lawyers plaques for having performed their valuable public service, and let them keep on suing for-profit physicians' groups, medical labs, hospitals, and pharmaceutical companies that don't participate in discount medical plans or otherwise make their services available, at least part of the time, to people unable to pay full tab for their services.
Patients harmed by medical care gone awry should still be able to collect some reasonable amount, surely enough to cover additional treatment they might require, plus compensation for lost income and general suffering, but let's have compensation set by competent boards made up of carefully-selected doctors and citizens, not random juries. And let's put a severe cap on the amount of punitive damages any one patient can get. And while we're at it, let's severely limit legal fees in class-action lawsuits, which all too often leave the actual damaged parties with little or nothing while the lawyers end up with millions.
Come to think of it, why limit tort reform to health care? I live in Florida, where defending against groundless lawsuits routinely bankrupts small businesses. Our entire civil litigation system is as nutsy as our current health care system. But for the moment, on the medical front, let's just take malpractice matters out of the court system for all doctors and others who accept any public funding for their services, and require patients who use doctors and other services that accept government money to sign away at least part of their "right" to sue if their toes start aching six years after they got their gall bladders removed. Once again, freedom-loving doctors and patients are 100% free to opt out of all this and stick with the current way of doing things.
Item Four: A Public Option If and Where One is Needed
What if, in some parts of the U.S., there are no low-cost non-profit medical clinics or private, for-profit companies willing to go into the discount medical care business? Why not allow government-sponsored health care in underserved areas? Said areas might be remote rural counties and they might be poverty-stricken inner city neighborhoods. Would even the nastiest, Glenn Beck-ist Republicans really deny medical treatment to Indians on remote reservations or children born in the worst parts of Detroit? Well... yes. They would. So let's ignore them. They're going to complain no matter what. We should let them yowl while the rest of us work not only to make our country's health care system better, but work in every way we can to promote the general welfare and make life in America better for everyone, rich or poor.
That's the Whole Plan
Socialists, libertarians, and trial lawyers will all line up to make sure this plan never happens. So will everyone at the top of the health care income hierarchy. In a lot of ways, my plan is closer to the Republican Small Health Bill (pdf) than to current Democratic proposals, even though it contains a "public option" provision that will raise as many Republican hackles as its free-choice provisions will raise among the most liberal Democrats. Still, my modest proposal would serve more people better than any alternative yet advanced by a major political party, while preserving more personal freedom for both doctors and patients than any other proposal I have seen so far.
Common sense is in short supply in this country, though, so whatever "health reform" we get will almost certainly be expensive, bloated, stupid, and designed to preserve health care industry profits more than to provide the most medical care, to the greatest number of people, at the lowest possible cost.
That (sigh) is 21st Century America for you. We haven't descended totally into Idiocracy yet, but we're working on it as hard as we can.
That's not simple at all (Score:1)
Medicare for everybody... Now that's simple. HR 676 (with only a couple of major issues) approaches that simplicity.
Skimmed (Score:2)
Busy today, just skimmed, but apart from the public option, this doesn't seem to be something that would piss Republicans off; further, since it would only be in places where it is "needed," there's no reason it needs to be controlled by the federal government, which means there's even less reason it would piss off Republicans.
In Washington, we already have such a "public option" for people who "need" it. No need for the feds to stick their nose in.
(I put "need" in quotes not because it is not needed, but b
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Whatever. I've met too many Yowlers here who *would* deny anything to anyone not white or of a level of prosperity similar to their own. After the hundredth time I heard the idea that schools and libraries in Newtown (black neighborhood in Sarasota) are a waste of money because "they don't want to learn anyway," you sort of get the idea that these are not good people. And Florida lican party chairman Jim Greer likes to make his little racist cracks now and then, hah hah hah.
In this part of the country, a "S
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Whatever. I've met too many Yowlers here who *would* deny anything to anyone not white or of a level of prosperity similar to their own.
First, this has nothing to do with Glenn Beck, who has no racist or class-ist tendencies that I've ever detected. Quite the opposite.
Second, again, you gave examples of NOT GIVING things to people, which is not the same as DENYING them those things.
Sorry, but your principled stand against federal intrusion into what you regard as matters that should be left to the states leaves an awful lot of people out of America
That's a lie, roblimo. There's no truth in it whatsoever, and you cannot possibly demonstrate it. I don't even know how you could possibly TRY to demonstrate it, because you'd have to argue that the people of the individual states are incapable of taking care o
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If you wish to believe Glenn Beck and his followers have no racist tendencies, I will not argue with you. It is like trying to explain that the sun is yellow, not purple. If you wish to believe it is purple, than obviously our definitions of color don't match.
The old Southern Democrats who fought integration, and their children both actual and philosophical, are now almost all Republicans. If you feel better believing that the knee-grows like living on dirt streets while white people live on paved ones, and
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If you wish to believe Glenn Beck and his followers have no racist tendencies, I will not argue with you. It is like trying to explain that the sun is yellow, not purple.
Shrug. If you have any evidence to back up that Glenn Beck has racist tendencies, provide it. I can show that the light emitted from the sun falls into certain wavelengths. As to some of his followers, no doubt: so too with some of Obama's followers, or Olbermann's, or anyone else's.
The old Southern Democrats who fought integration ...
... have nothing to do with Beck.
Look, I don't even particularly like Beck. I think his show is usually quite poor. He's not the brightest bulb. Again, a lot like Olbermann. But to call him racist without evidence is stupi
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If you have any evidence to back up that Glenn Beck has racist tendencies, provide it.
http://foxnewsboycott.com/videos/glenn-beck-admits-to-being-racist/ [foxnewsboycott.com]
'Beck states, “[Obama] is very white in many ways he is. He’s very white.” '
Perhaps you would now like to provide evidence that Glenn Bock is not racist?
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'Beck states, “[Obama] is very white in many ways he is. He’s very white.” '
Sad that you think this is evidence of racism. It quite obviously isn't. Stupidity != racism (if it were, you'd be racist). Discussing race, even falsely attributing certain characteristics to race, is not racism. Racism is explicitly the putting down of one or more races; putting a race in a position of superiority over another, in one or more ways. It's not merely talking about race, it's putting some races down or lifting races up over others. If there's no sense of superiority/inferiority, there's
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Sad that you can deny evidence of racism. It obviously is. Stupidity != racism (if it were, you'd be racist). Although you characterize Beck as stupid, his only stupidity is in making a comment, characteristic of his thinking, that is racist.
Calling out someone's race is an example of racism.
This should be obvious, but I hope it is now clear to you.
But I doubt it.
And, asking for evidence of racism in order to recognize a racist encourages people to be racists, if they can do so without leaving overt evide
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Sad that you can deny evidence of racism.
None was presented.
Although you characterize Beck as stupid ...
He is.
his only stupidity is in making a comment ... that is racist.
False.
Calling out someone's race is an example of racism.
False.
asking for evidence of racism in order to recognize a racist encourages people to be racists
False. But even if true, far worse and much more insidiously evil is assuming racism without evidence. There is no excuse for it. Saying "we don't need to provide evidence because that is a license for people to be racist without leaving evidence" is just plain evil.
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Thank you for your reply above. It really is the perfect ending to the thread for me. So pudgilistic!
But I know you will have to get in the last word, and since allowing you to have "last post!" is the only way to get you to move along, I will let you have it.
Ciao!
James
Selling insurance across state lines (Score:2)
The primary reason why I say this is because of the amount of work required for a hospital, clinic, or other health care provider facility to accept any given health insurance plan. It is a dramatic increase in paperwork, tra
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If insurance companies were encouraged or forced to sell plans "across state lines", then the providers would need to dramatically increase the number of plans they accept for billing
Actually they already do this since people tend to travel and their insurance travels with them. The various Blue Cross/Shields have agreements between each other to pay for out-of-state claims (doctors submit them all to their own state's BC/BS) and Medicare is always filed through the doctor's local subcontractor.
Personally,
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The various Blue Cross/Shields have agreements between each other to pay for out-of-state claims (doctors submit them all to their own state's BC/BS)
Which wouldn't help the people who can't currently afford coverage from the largest of the for-profits; people who are looking to save money by purchasing from other states would likely be looking to buy from the smaller companies who have lower overhead costs.
Allowing insurance companies to "compete" across state lines would probably lead to a massive flurry of consolidation as the not-so-small insurance companies swallow smaller insurance companies whole in order to expand "nationally"
Well, isn't that just an example of the invisible hand of the free market and its incredible ability to solve all our problems in the most benevolent manner possible?
Furthermore, all of the insurance companies will end up relocating to the one state that makes it the hardest for HMOs to be sued for denying claims
See above...
Although that does lead to the more interesting question of why the
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I think you misunderstood, my point was that for various reasons, the whole line of thought regarding cost to the provider is irrelevant. Doctors already submit claims to those smaller insurance companies because some guy on some smaller insurance company in Georgia goes skiing in Utah and breaks their leg. BCBS and Medicare makes this easy for the doctor. Otherwise, the doctor's staff members either have to turn the patient away (or tell them to pay cash now and file the claim themselves) or they have t