Some ( I hope) relatively non-political musings on Health Care Reform
News report today:
Death, taxes and now health insurance? Having a medical plan or else paying a fine is about to become another certainty of American life, unless the Supreme Court says no.
People are split over the wisdom of President Barack Obama's health care overhaul, but they are nearly united against its requirement that everybody have insurance.
No one seems willing to embrace the whole problem and develop a set of integrated solutions.
As long as we have a medical system that by judicial fiat or medical practice delivers services to those unwilling/unable to pay, those of us with Health Insurance will be picking up the tab. One way or another, Health Care providers must meet costs! Anytime a patient does not pay the full cost of his care (either because he is an uninsured indigent or his provider pays less than true cost - Like some Medicare and virtually all Medicaid - or hard-boiled Insurance Companies that negotiated tight contracts, the “lost” costs are recovered from the deeper pockets (The Insurance companies who than pass these costs along as higher premiums).
The above results in a convoluted system of cost accounting that is hostile to attempts by others to instigate cost control/containment measures.
The system needs changes that enable providers to bill true coasts – any costs not reimbursed from patients and their coverers should be reimbursed from a Federal Fund established for that purpose. (how that fund is financed is a separate issue).
Address the un-reimbursed care problem. Clearly codify what services hospitals are required o provide indigent/un-insured patients. County Hospital in LA was providing free dental care as part of their Emergency Unreimbursed care. In many Hospitals, walk-in indigents get more extensive treatment then do patients with chintzy health plans. Is there no reason we can not treat the “needy” in 12 bed wards rather than private or Semi-private rooms?
Bring the issue of Healthcare Rationing out of the closet and deal with it.
We already have Healthcare rationing – read your Insurance Policy!
12-month waiting lists are a form of rationing.
Transplant waiting lists are a form of rationing
Non-Formulary prescription drug denial is a form of rationing.
There are neither the physical assets nor the funds to provide “the best Health Care money can buy” to everyone who presents themselves for treatment.
Aggregate data to provide a complete picture of the problem:
Assuming everyone is “covered” what services will be provided that are not now being provided? (It’s nonsense to look at “who will be covered” who is not currently covered when many of the “not currently covered” are still receiving treatment.
Evaluate the current Medical Delivery system to ascertain what will be the future needs based on universal coverage and set plans in place to provide it. Where is the master chart that shows all current physicians, by specialty, projected need for all physicians by specialty, and training programs to meet those needs.
Do the above for non-MD Health workers and facilities (hospitals, rehabs, labs, etc.)
Since the issue of Mandatory Insurance seems argumentative, I suggest we take a Medicare-like approach:
Determine the cost of a minimum approved Health Care plan; devise a payroll tax to collect that amount; and provide for a short-form tax credit for anyone who has qualified insurance (purchased or employer provided) – dedicate these funds to the fund discussed above for unreimbursed hospital costs.
(I would prefer a consumption tax rather than a wage tax, but that’s a different story).
I am still waiting for the Government to define a minimum acceptable Health Insurance policy (one that will be listed on the soon to be exchanges.
Whatever these requirements are become the minimum acceptable employer provided health plans. (We obviously won’t let an employer get away with a plan that has a $9000/year deductable , 90% co-pays, and does not cover heart or liver problems – so we need to define what is the minimum acceptable plan). We’ve already seen the problem with mandating inclusion of birth-control – imagine how many other pitfalls lay ahead – alternative medicine, chiropractors, experimental treatments, etc
It’s sure tough to argue details of solutions when we can not agree on the details of the problem.
der Brucer
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Topic: RAIN (Read 15972 times)