Friday, April 6, 2012

57 years in the making

We never achieve anything totally on our own.  Somewhere along the way someone planted the seed of whatever accomplishment we may check off our "bucket list".

One item on my list, long in the making was "become a ski instructor".  I am not sure I know why it was important, but it was.  Perhaps I wanted to have at least one thing in my life that could be "certified" top in class.

Sunday, April 1, 2012

On Health Care Reform Try KISS

With any luck, ObamaCare will be defeated in the courts.  Ten we'll have to hope for the next attempt to bring the US into the ranks of civilized wealthy countries that have a minimum of moral backbone to provide for humans at minimum of care as PETA advocates for animals.  Perhaps then we could try a simple a solution with little or no opportunity for "pork" deals: here is a proposal that requires no monumental or structural change and tests an alternative with a failsafe provision:

  1. Open Medicare basic coverage to anyone above age 50 who wants to participate

  2. Charge for that minimal level of coverage the price that would be charged by the California Public Employees medical plan or the Federal Employees plan or any other similarly sized plan. Those plans have no exclusions for pre-existing conditions and by their size should have a customer base similar to the participants to be added to Medicare in 1. above.  Their price would have to be adjusted to reflect the limited coverage  only for Medicare basic services

  3. Set a sunset law that forces re-approval of the plan in 5 years.  At that time if the plan is successful it can be reapproved and potentially extended to include participants over 40 years of age or even participants regardless of age.  If the plan is not re-approved, participants  no longer elegible will have to find private insurance as they do now.

What is to be gained?  Lots:

  1. Put pressure on private insurers to offer more competitive rates (without exclusions for pre-exsting conditions)

  2. Offer what is essentially a national mutual insurance option for basic medical care where proft making is taken out of the equation.

  3. Move the country toward a single medical payments processing system that can be gradually improved to weed out processing inefficiencies.  Medicare already has the system in place and it is the only such system that all medical services providers are already set up to be paid by. Enhance the system with centralized medical records as most other developed countries have. We could save clinics and hospitals millions in administrative overhead and patients the pain of dealing with records transfers and billing.

  4. The insured that want to never fill out another insurance application wil have that option.

  5. The insured that want additional coverage can buy it from private Medicare Supplemental insurance suppliers already in the market

  6. The insured that want only private options will be free to shop as they please and change from plan to plan as they do today.

  7. The indigent can be covered through a system already equipped for  that purpose.  What they pay or what credit they receive for it can be handled the same way as now is done for indigent Medicare recipients.

  8. Employers can be taken completely out of the business of shopping for insurance for third parties (their employees).  They would however cotinue to process payroll deductions just as they do for taxes (the system for all this is already in place).  Citizens should also be able to handle their own payments as they do for other matters in their lives.

  9. The level of minimum services would be finally managed not by sticking ERs with unpaying patients, but based on nationally debated and set budgets and voters preferences as voted at the ballot box. If, as a nation, we want to offer little beyond "stopping the bleeding" or "preventing epidemics" we surely can.  If we want to provide more we can, but it would all be determined by an open debate and allocated budgets.

It may be too much to hope for. The wage controls instituted in WWII, as an unintended consequence  gave our nation the only employer managed health care system in the world.  It was an accident, not a reasoned policy.  Quality regardless of cost became part of the system and now we find we cannot afford it indefinitely.  Any variation that is based on the same unreasoned premises will only continue to benefit the vested interests that have perfected milking the current system.