Suggestions on Healthcare
Anyone who knows me knows that it irritates the hell out of me when people complain about something and don't have any suggestions for how to make it better. In my last blog, I listed four reasons why we haven't been able to have a decent discussion on healthcare. I essentially blamed America's short attention span, Congress's complete inability to address facts, and the collossal failure of the people who should be speaking to speak loud enough for people to hear.
I also said that I had read good suggestions, so I'm going to talk about a few of them for your consideration:
Suggestion #1: Get rid of the lawyers
Everyone (even the lawyers) understand that they're essentially vultures in our society. They feed off of the misfortune of others. When a doctor screws up and injures a patient, the lawyer files a suit and takes 1/3 of the settlement plus fees. Juries in the past two decades have been increasingly generous to plaintiffs, enticing more lawyers to try and get their chunk of more and more windfall settlements, to the point where the courtroom has become a casino. The House (doctors) don't like to lose, so they insure themselves against losses at enormous expense, and pass the 'savings' on to their patients who pass the bill to their insurance companies, who then generous distribute that cost to everyone in the form of higher premiums.
Here's the thing. Everyone is human, including doctors. Doctors occasionally make mistakes. It's not out of malicious intent. It's because they, like the rest of us, haven't attained Messiah status. Britain does not allow doctors to sue patients. If a doctor makes a mistake, deal with it and move on. If he was grossly negligent or just a 'bad doctor,' he gets his license revoked and his career ended, just like what happens in the US when a doctor's license is revoked. The only difference is you don't have the casino.
Charles Krauthammer of the Washington Post suggested that we create a government run pool, sort of like welfare, to pay for the care of victims of medical mistakes. We would then create a panel of doctors who would review cases of iatrogenic injury, and determine whether re-education, temporary suspension, or revoking a doctor's license was the most appropriate course of action. This would reduce strain on our court system, remove the middlemen from the equation, and significantly reduce healthcare costs by eliminating the institution of medical malpractice insurance.
Suggestion #2: Learn from mutual funds
Mutual funds are like stocks for the poor. When you don't have enough money to successfully manage a diversified stock portfolio, you buy into a fund with a bunch of other people in the same boat and let someone else manage your collective portfolio for you with less risks and greater access to those with lower incomes.
An article in the NEJM (New England Journal of Medicine) suggested creating 'exchanges' for private health insurance in much the same way. These exchanges would filter various plans available, group them according to cost and benefits, filter the least cost-effective, and offer a reasonable number (6-10) choices at rates previously only offered to large companies who could promise insurers many new subscribers. As it stands, buying a single policy or a small number of policies for a family or small business is the most expensive way to buy health insurance. By lumping all of these people into a group through an exchange and offering larger numbers of subscribers to insurers, they could offer better rates to everyone.
Suggestion #3: Unlink health insurance from employers
Employers complain that their largest cost is incurred in health insurance premiums they offer their employees. Employees complain that even if they hate their jobs, they're forced to stay with a company because they don't have another option to get health insurance. Many elderly cannot afford to retire at the age of 65 because the loss of insurance would mean future care would bankrupt them. Charles Krauthammer suggests that if all insurance were carried privately without employer involvement, people would be more free to leave a job to find one that better suits them knowing they would maintain their coverage regardless of which company they moved from or to.
Now, before you go around screaming about how this is just an argument to reduce cost for big business, simmer down. The catch is that employers would have to pay higher salaries to match the cost of health insurance premiums, or employers could be asked to pay into a government pool of funds that would provide a supplement to all taxpaying citizens towards the purchase of healthcare. If you wanted, you could take this from a national health subsidy to a fully single-payer system. I personally believe that private management of health insurance within the confines of stiff competition is the best way to ensure quality of care at a reasonable cost, but the idea is applicable to either private or a public option.
Suggestion #4: Mandatory legal documents
Wait, what? You want more legal involvement, Jon? Yes, and after we get the tort reform I suggested passed, then we can hire back those lawyers to help people write legal documents defining what patients want doctors to do for them in the case of an emergency. Only 20% of Americans have a durable Power of Attorney, a Living Will, or Advanced Directive documents. These documents are used to guide healthcare teams when a patient cannot make decisions for themselves (unconsciousness, judgement impairing drugs given, lack of mental capacity, etc). Our healthcare system defaults to assume everyone would want everything possible done to save their lives without having thought through the possibilities.
Would you want to die with tubes coming out of every hole in your body you were born with and some that you weren't? Would you want to be kept alive in a persistant vegetative state after brain trauma? Would you want to spent $5000/day for months in an ICU if your heart and lungs were too weak to ever work without mechanical assistance? If you had a terminal cancer, would you want an expensive chemotherapy drug that would give you six more months to live but had horrible side effects? If you were badly injured and could not make decisions regarding your medical care, who would you want to speak for you? These are the types of questions that must be answered by these documents. They require thought, consideration, time, and frank discussion with family, friends, and your doctor. And they have to be written when we least want to think about these scenarios - when we're perfectly healthy.
If we had a system where these documents were mandatory for every adult and where all of these legal documents could be made available to hospitals in the case of an emergency, we could reduce costs while at the same time providing a higher quality of care that was more consistant with the wishes of each individual patient.
I also said that I had read good suggestions, so I'm going to talk about a few of them for your consideration:
Suggestion #1: Get rid of the lawyers
Everyone (even the lawyers) understand that they're essentially vultures in our society. They feed off of the misfortune of others. When a doctor screws up and injures a patient, the lawyer files a suit and takes 1/3 of the settlement plus fees. Juries in the past two decades have been increasingly generous to plaintiffs, enticing more lawyers to try and get their chunk of more and more windfall settlements, to the point where the courtroom has become a casino. The House (doctors) don't like to lose, so they insure themselves against losses at enormous expense, and pass the 'savings' on to their patients who pass the bill to their insurance companies, who then generous distribute that cost to everyone in the form of higher premiums.
Here's the thing. Everyone is human, including doctors. Doctors occasionally make mistakes. It's not out of malicious intent. It's because they, like the rest of us, haven't attained Messiah status. Britain does not allow doctors to sue patients. If a doctor makes a mistake, deal with it and move on. If he was grossly negligent or just a 'bad doctor,' he gets his license revoked and his career ended, just like what happens in the US when a doctor's license is revoked. The only difference is you don't have the casino.
Charles Krauthammer of the Washington Post suggested that we create a government run pool, sort of like welfare, to pay for the care of victims of medical mistakes. We would then create a panel of doctors who would review cases of iatrogenic injury, and determine whether re-education, temporary suspension, or revoking a doctor's license was the most appropriate course of action. This would reduce strain on our court system, remove the middlemen from the equation, and significantly reduce healthcare costs by eliminating the institution of medical malpractice insurance.
Suggestion #2: Learn from mutual funds
Mutual funds are like stocks for the poor. When you don't have enough money to successfully manage a diversified stock portfolio, you buy into a fund with a bunch of other people in the same boat and let someone else manage your collective portfolio for you with less risks and greater access to those with lower incomes.
An article in the NEJM (New England Journal of Medicine) suggested creating 'exchanges' for private health insurance in much the same way. These exchanges would filter various plans available, group them according to cost and benefits, filter the least cost-effective, and offer a reasonable number (6-10) choices at rates previously only offered to large companies who could promise insurers many new subscribers. As it stands, buying a single policy or a small number of policies for a family or small business is the most expensive way to buy health insurance. By lumping all of these people into a group through an exchange and offering larger numbers of subscribers to insurers, they could offer better rates to everyone.
Suggestion #3: Unlink health insurance from employers
Employers complain that their largest cost is incurred in health insurance premiums they offer their employees. Employees complain that even if they hate their jobs, they're forced to stay with a company because they don't have another option to get health insurance. Many elderly cannot afford to retire at the age of 65 because the loss of insurance would mean future care would bankrupt them. Charles Krauthammer suggests that if all insurance were carried privately without employer involvement, people would be more free to leave a job to find one that better suits them knowing they would maintain their coverage regardless of which company they moved from or to.
Now, before you go around screaming about how this is just an argument to reduce cost for big business, simmer down. The catch is that employers would have to pay higher salaries to match the cost of health insurance premiums, or employers could be asked to pay into a government pool of funds that would provide a supplement to all taxpaying citizens towards the purchase of healthcare. If you wanted, you could take this from a national health subsidy to a fully single-payer system. I personally believe that private management of health insurance within the confines of stiff competition is the best way to ensure quality of care at a reasonable cost, but the idea is applicable to either private or a public option.
Suggestion #4: Mandatory legal documents
Wait, what? You want more legal involvement, Jon? Yes, and after we get the tort reform I suggested passed, then we can hire back those lawyers to help people write legal documents defining what patients want doctors to do for them in the case of an emergency. Only 20% of Americans have a durable Power of Attorney, a Living Will, or Advanced Directive documents. These documents are used to guide healthcare teams when a patient cannot make decisions for themselves (unconsciousness, judgement impairing drugs given, lack of mental capacity, etc). Our healthcare system defaults to assume everyone would want everything possible done to save their lives without having thought through the possibilities.
Would you want to die with tubes coming out of every hole in your body you were born with and some that you weren't? Would you want to be kept alive in a persistant vegetative state after brain trauma? Would you want to spent $5000/day for months in an ICU if your heart and lungs were too weak to ever work without mechanical assistance? If you had a terminal cancer, would you want an expensive chemotherapy drug that would give you six more months to live but had horrible side effects? If you were badly injured and could not make decisions regarding your medical care, who would you want to speak for you? These are the types of questions that must be answered by these documents. They require thought, consideration, time, and frank discussion with family, friends, and your doctor. And they have to be written when we least want to think about these scenarios - when we're perfectly healthy.
If we had a system where these documents were mandatory for every adult and where all of these legal documents could be made available to hospitals in the case of an emergency, we could reduce costs while at the same time providing a higher quality of care that was more consistant with the wishes of each individual patient.
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