04-05-06 - 1


Fixing health care is really damn easy. First of all "Health Savings Accounts" are a red herring. The whole tax-deductibility nonsense is a mole hill which is being made into a mountain. The really big issues are 1) profiteering by various parts of the the health-industrial complex, particularly insurers and pharma, 2) the growth of a small segment of super-high-cost patients, 3) massive growth of new disorders and treatments which are expensive and didn't even exist 10 years ago (eg. Viagra, Prozac, etc. etc.)

My solution is pretty simple. First of all health care is divided into three parts :

Urgent care. Urgent care is provided by the government 100% free of charge. This covers emergency room visits due to trauma, heart attack, things like that. Also short-term continuing care related to these problems. This also covers preventive surgeries for things like tumor removal, etc. when an approved doctor has ruled that such a procedure is warranted. Doctors and hospitals that provide urgent care would not be paid based on the amount of services provided, rather they would be paid a flat annual rate, which would have to be competetive and generous to attract good doctors. There are a lot of tricky aspects here, like figuring out how to pay enough to get good doctors but not pay too much, also how to decide what therapies are necessary and which are optional, etc. but the current Medicare system actually does a decent job of all that.

Necessary care. Necessary care is also provided by the government, but with a small deductible. The deductible is simply to discourage people from using visits frivolously. This covers 1 checkup per year, problems like flu or bacterial infections, etc. This would include care for severe mental problems like schizophrenia, as well as chronic "lifestyle" problems that could cause severe health problems, like diabetes, etc.

Optional care. Optional care includes most lifestyle problems, as well as long-term care for things like pain, scoliosis, repetetive stress, etc. etc. As many things as possible will be classified under "Optional". Basically anything that won't kill you or make you a danger to society (or lead to future disease or problems which would be Urgent and very expensive) go into Optional. Optional care would be paid out of your pocket, but of course you could buy Optional Care Insurance, which is what most people would do. There could be a wide range of insurance plans that cover more or less services, it would be entirely private business. (presumably states would also provide some small amount of optional coverage for the poor, perhaps something like $500/year if you're below the poverty line)

Another key component is cost limitation in the government part of the plan. I think the simplest and fairest way to do this is simply to limit health care spending per person to something like $1 million per person. Once you reach that cap, you no longer are covered for Urgent or Necessary care by the government plan. You can either pay for those services yourself, or you can die.

Another element that I think could be very reasonable would be change the patent duration to something far shorter, something like 5 or 10 years. This would drastically reduce profiteering in pharma and the invention of problems that people need the new cure for.

Obviously there a lot of other issues and some of them I've written about before. The big piece for me is this idea of separating coverage into basic care which is free and covered for everyone, and optional care which is completely privately insured. The idea is to keep the average cost per person in the government plan quite low, perhaps $500/year per person or less. (current total spending per capita is around $4000/person). Another crucial aspect is that as new problems and treatments are found, they are not generally covered in the government plan, but you could still get them as optional care. Thus costs do not continue to balloon as technology advances.

BTW part of the goal here is also to *improve* care!! By cutting the very expensive care for the very few, we can provide a lot of cheap necessary care for many more people.

this report is full of good figures.

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old rants