How would you fix the health care problem in the US?

Discussion in 'Economics' started by Eliot Hosewater, Jul 22, 2009.

  1. I see a lot of well deserved criticism of Obama's plan(s), but not a lot of constructive alternatives. Almost everyone agrees that the current system is broken and unsustainable, with insurance costs rising so fast, deductibles increasing, etc.

    What would you offer as a solution?

    I think allowing states to implement single-payer plans, and/or promoting health care cooperatives might help. There was a doctor in NYC in the news a few months ago who wanted to offer a direct payment plan for his patients, for something like $100 per month he said he could treat most people for most problems. I believe the state health insurance-oriented laws put a stop to that. The health insurance companies couldn't stand the competition. Also, I heard about a coop in the northeast that has been in operation for decades and offers care at a reasonable cost. Why are there not more of those?
  2. The health care situation, much like the government run amok, is the way it is because certain people with big money and power LIKE things the way they are and are resistant to change.
  3. Tom B

    Tom B

    Bobby Jindal made some good points in a WSJ opinion article today.

    How to Make Health-Care Reform Bipartisan


    In Washington, it seems history always repeats itself. That’s what’s happening now with health-care reform. This is an unfortunate turn of events for Americans who are legitimately concerned about the skyrocketing cost of a basic human need.

    In 1993 and 1994, Hillary Clinton’s health-care reform proposal failed because it was concocted in secret without the guiding hand of public consensus-building, and because it was a philosophical over-reach. Today President Barack Obama is repeating these mistakes.

    The reason is plain: The left in Washington has concluded that honesty will not yield its desired policy result. So it resorts to a fundamentally dishonest approach to reform. I say this because the marketing of the Democrats’ plans as presented in the House of Representatives and endorsed heartily by President Obama rests on three falsehoods.

    First, Mr. Obama doggedly promises that if you like your (private) health-care coverage now, you can keep it. That promise is hollow, because the Democrats’ reforms are designed to push an ever-increasing number of Americans into a government-run health-care plan.

    If a so-called public option is part of health-care reform, the Lewin Group study estimates over 100 million Americans may leave private plans for government-run health care. Any government plan will benefit from taxpayer subsidies and be able to operate at a financial loss—competing unfairly in the marketplace until private plans are driven out of business. The government plan will become so large that it will set, rather than negotiate, prices. This will inevitably lead to monopoly, with a resulting threat to the quality of our health care.

    Second, the Democrats disingenuously argue their reforms will not diminish the quality of our health care even as government involvement in the delivery of that health care increases massively. For all of us who have seen the Federal Emergency Management Agency’s response to hurricanes, this contention is laughable on its face. When government bureaucracies drive the delivery of services—in this case inserting themselves between health-care providers and their patients—quality degradation will surely come. House Democrats seem willing to accept that problem to achieve their philosophical aim—the long-term removal of for-profit entities from the health-care landscape.

    Third, Mr. Obama’s rhetoric paints a picture of a massive new benefit that will actually cost average Americans less than what they pay today. The Democrats want middle-class taxpayers to believe they won’t feel the pinch of this initiative, even as their employers are assessed massive new taxes. They might as well try to argue that up is down. The analysis of the Democrats’ proposal by the Congressional Budget Office shows that it will not reduce government spending on health care, and that it will substantially increase the federal deficit—and this despite all the tax increases.

    I served in the U.S. House with a majority of the current 435 representatives, and I am confident that if given the proper amount of legislative review, they will not accept the flawed Pelosi plan that is currently stuck in committee. Yet there is general agreement among Republicans and Democrats that we need health-care reform to bring costs down. This agreement can be the basis of a genuine, bipartisan reform, once the current over-reach by Mr. Obama and Mrs. Pelosi fails. Leaders of both parties can then come together behind health-care reform that stresses these seven principles:

    •Consumer choice guided by transparency. We need a system where individuals choose an integrated plan that adopts the best disease-management practices, as opposed to fragmented care. Pricing and outcomes data for all tests, treatments and procedures should be posted on the Internet. Portable electronic health-care records can reduce paperwork, duplication and errors, while also empowering consumers to seek the provider that best meets their needs.

    •Aligned consumer interests. Consumers should be financially invested in better health decisions through health-savings accounts, lower premiums and reduced cost sharing. If they seek care in cost-effective settings, comply with medical regimens, preventative care, and lifestyles that reduce the likelihood of chronic disease, they should share in the savings.

    •Medical lawsuit reform. The practice of defensive medicine costs an estimated $100 billion-plus each year, according to the American Academy of Orthopaedic Surgeons, which used a study by economists Daniel P. Kessler and Mark B. McClellan. No health reform is serious about reducing costs unless it reduces the costs of frivolous lawsuits.

    •Insurance reform. Congress should establish simple guidelines to make policies more portable, with more coverage for pre-existing conditions. Reinsurance, high-risk pools, and other mechanisms can reduce the dangers of adverse risk selection and the incentive to avoid covering the sick. Individuals should also be able to keep insurance as they change jobs or states.

    View Full Image
    Martin Kozlowski

    •Pooling for small businesses, the self-employed, and others. All consumers should have equal opportunity to buy the lowest-cost, highest-quality insurance available. Individuals should benefit from the economies of scale currently available to those working for large employers. They should be free to purchase their health coverage without tax penalty through their employer, church, union, etc.

    •Pay for performance, not activity. Roughly 75% of health-care spending is for the care of chronic conditions such as heart disease, cancer and diabetes—and there is little coordination of this care. We can save money and improve outcomes by using integrated networks of care with rigorous, transparent outcome measures emphasizing prevention and disease management.

    •Refundable tax credits. Low-income working Americans without health insurance should get help in buying private coverage through a refundable tax credit. This is preferable to building a separate, government-run health-care plan.

    These steps would bring down health-care costs. They would not bankrupt our nation or increase taxes in the midst of a recession. They are achievable reforms with bipartisan consensus and public support. All they require is a willingness by the president to slow down and have an honest discussion with Americans about the real downstream consequences of his ideas. Let’s start there.

    Mr. Jindal is governor of Louisiana.
  4. spinn


    Cut DRs pay by 75% and find a way to pay them bonuses to a) cure people and b) prevent illnesses in the first place. The good DRs will make more, the bad ones will say they deserve it because they went to med school and society owes them, while posting on ET.

    Currently, DRs are paid more if their patients are unhealthy and even more than that if the DR prescribes medications which do not work....or make the patient sicker.
  5. Before the ENTIRE system can be overhauled, data storage and billing technologies MUST be upgraded and implemented.

    This small (and inexpensive, relatively speaking) step by itself would save 10's of billions of dollars of waste and fraud, and becomes the backbone of whatever new, improved, and streamlined overhaul of the entire system.
  6. slacker


    Increase Medical School enrollments

    Decrease regulation

    Cap Tort Judgements

    Will it happen? Not a chance.

    Would it improve health care? No doubt in my mind.
  7. Mnphats


    Hand health care over to the government. They continue to run excellent programs FEMA, IRS, and the postal service to name a few.
  8. 1.) remove state mandates which drive up the cost of insurance and limit choice.

    2.) Remove the prohibition on buying insurance from other states. This prohibition also creates the "pre-existing condition" issue because moving to a neighbouring state constitutes a break in coverage because of the state regulations.

    3.) Remove most insurance regulation - they mostly serve to decrease competition for insurance providers and doctors and to raise costs and lower choice for consumers.

    4.) Let Walgreens and Walmart set up more clinics where simple inexpensive screenings can be performed by less expensive nurse practitioners and expensive doctors' time will only be occupied when a problem is discovered.

    All of these things will increase choice and decrease costs.

    4.) Then, give people who are truly poor and qualify for public assistance health care vouchers so that they may choose a private, competitive insurance plan they like and aren't obligated to churn through the humiliating government medicare.

    In other words, give health care choice back to the people who consume health care services instead of enslaving the population to the state.
  9. You forgot Social Security and Medicaid (which is running at $66 Billion instead of the projected $9 billion - which makes the claim that government run health service will cost less a sad sad joke)
  10. I remember when Medicare was signed into law... with the comment, "Probably would never exceed $1Billion per year"... HA!
    #10     Jul 22, 2009