A Simple, Sane Health Care Reform Package That Will Never Happen
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.