Universal Health Care

Universal Health Care
Should it be a government run catastrophe; or an infrastructure core component for a modern society?

The left would say that socialism's time has come. The right would say only a fool would task the government with managing a third of our gross national product and determining our quality of life.As usual, I have to side with the middle on this one. Left to the lefties, our health care system will simply transfer wealth from the people to the government and their minions (politicians, lobbyists, bureaucrats, and lawyers). Right thinkers will transfer the people’s wealth to corporate health care conglomerates and their minions (politicians, lobbyists, bureaucrats, and lawyers). We are already funding all the minions plus health care. We can surely afford just health care. Do we really care about paying the minions?

We’ll discuss this further as part of the solution.

Step back into history and view this problem from a correct vantage point. When the pioneers were settling the west, they gathered up their possessions, tools and energy and headed out in covered wagons. The stopped along the way to fight Indians (my great grandfather and his friends), search for food, water and occasional entertainment. Upon arrival at their destination, they built their barn and maybe a sod or log cabin. They and their livestock could live in the barn if necessary. Each settler was expected to support themselves and build and maintain their own farm or ranch. Unfortunately from time to time, catastrophe could and did strike their barn. Neighbors would arrive in mass to restore and rebuild the barn as best they could to prevent further loss and suffering.

Back to the future, we are no longer an agrarian society. Our endeavors depend on our health and its corresponding labor output to build and maintain our families and wealth. For better or worse, health has replaced the barn. When a catastrophic illness strikes, we need our neighbors. We shouldn’t need them every day or all the time. We need them for the “big one”, the catastrophe.

Problem:Health care costs too much.

Note: Lobbyists and their minions have already won the debate by defining health care as health insurance. Politicians from the left/right, and their minions, have been so successful at shaping this issue that we commonly refer to this problem as the need for universal health insurance or affordable health insurance. The taxpayers need to make up the difference. Minions need to be paid.

Health care in the U.S. is abundantly available. Visit any hospital or clinic and they have spare beds, chairs and service providers. Appointments can be made for this morning, afternoon or evening. Doctors and nurses are first rate. Visit any pharmacy and have your prescription filled in 15 minutes or less.

Abundance and quality of service is not the problem.The problem is that a visit to the doctor for routine care is beyond affordability for the poor and lower middle class. They bypass the $135 doctor visit and head for the “free” emergency room. There the $135 doctor visit is billed by the service conglomerates for $5000-$50,000. The doctor still receives about $60. Minions get the rest. Wouldn’t it be great to be a minion?

Solution:

The solution is to lower the cost of health care and to provide basic wellness services to everyone. A healthy society is far more affordable.

Step one is to empower the people to stop being extorted by minions. Routine health care should be affordable, on the order of $25 or $35 dollars per visit. This can be achieved by not paying two classes of minions: 1) lobbyists, 2 lawyers. We will define a class of service provider called a general/family wellness practitioner. This type of practitioner will not be allowed to perform any type of major surgical procedure. Their practice will treat/diagnose and manage the basic medical needs of the average family/individual and will be limited to procedures/treatment commensurate with meeting those needs. Emergency care, beyond their charters, will not be denied if dictated by extra ordinary circumstances (a heart attack occurs on the sidewalk out side). Doctors and their family practices will be liable for malpractice, but the maximum aggregate fines per doctor will not exceed $10,000(annual) and $30,000 lifetime. After 30,000 in fines the doctor’s license will l be reviewed and possibly revoked. Doctors will be allowed to advertise/publish rates and will be subject to standard business practice complaints/evaluations.

Analogy: medical retail mom and pop….WalMart…enabled by limited tort reform

Step two is to empower the people to stop being extorted by minions. As we explored earlier, the problem won’t be the routine health care issues such as flu, sinusitis, childhood immunizations, etc. The problem is the big one. Once the service conglomerates have you in “their” system, and you have been diagnosed with cancer, heart disease, organ failure, etc.; your barn has just burned down. Bankruptcy, loss of retirement funds, home foreclosure, all the good stuff lawyers, insurance conglomerates, politicians and lobbyists spend their time dreaming about has just fallen on you. We the people allow this, really? Universal health care should be part the national plumbing (as my friend Cuyler so aptly describes it). In the case of the big one (expenses > 50,000 per year for non elective services), a simple system of universal health care should be provided. Each person over the age of 18 should pay into a national health catastrophic insurance fund. Initially the insurance will be the dreaded “Government Option”. The premium will be determined by annual assessment and evaluation. Ideally, the charge should be on the order of $10-15 up to $35-40 per month (needs tested ability to pay). For those who cannot work/afford the minimal monthly fee, their state government will make the contribution on their behalf (i.e., the mentally disabled, physically impaired). Surplus revenue will be carried forward to lower the overall system costs, deficits accrued will be carried forward as charges against future premiums.

Analogy: medical equivalent of automobile liability insurance. Comprehensive and luxury policies may build upon basic liability or the consumer is free to use cash, health savings accounts, etc…States providing their own portable catastrophic plans may opt out of “Government Option”.

Step three is to empower the people to shop for medical services or to purchase health insurance as they wish. Health insurance, Health Savings Accounts (HAS) or simply paying the doctor directly are all now possible. The consumer is back in control and basic wellness services are a market commodity. Should a company and or state/federal government offer health insurance, it would by supplemental. The market can now bind consumer with provider because the elimination of catastrophic loss frees consumers and providers. Let the free market negotiations and competition begin. Health insurance costs will decline since catastrophic insurance is already provided, and basic services are abundant and lower cost. Medical information is the personal property of the consumer. Popular search engines (Google, MSN, etc) will be encouraged to provide services for the recording and, if authorized public search of medical records by authorized medical service providers. Any medical provider may publish the file of their patient, and review what they have published. Only those providers authorized by the patient may search files they did not originate. A patient may search their own information at any time.

Analogy…Google search for health records

Step four is to increase the availability of family practitioners. Medical school scholarships will be available to any academically qualified student, willing to work in a family practice for a minimum of 5 years after graduation (up to 250,000). The goal is to promote a health society. With people now responsible for the cost of their own health, healthy people will become the norm.

Now for the universal coverage part, everyone is now covered for the big one (catastrophic care). All families and individuals should be able to afford basic wellness, except the most impoverished. They will simply be given a coupon book (3 per individual/per year, renewable on demand, available at every emergency room or wellness clinic). Coupons(physical or electronic) can be redeemed at any family practice provider. Generic drugs will be provided as prescribed by the family practitioner, and paid for by the individual, for those to poor to pay a coupon will be provided and reimbursed by surplus catastrophic funds or taxes.

Minions, minions, minions.... they will lose a lot of money. Do we feel bad? Should we grieve for the lawyers, politicians, and lobbyists of the world? I think not, after all they will have lower cost health care.

Availability:
Coverage ~99% (some will do anything not to participate). Even those who dodge, can still get a free coupon and wellness care (needs tested).

Funding:
Self funding via portable, catastrophic health insurance

42 Billion increase in annual marginal revenue(we already subsidize all the catastrophic cost).(140,000,000 * 25 dollars per month(avg) * 12 months)

1 Dollar per month catastrophic health insurance premium surcharge for the wellness clinics/medical education start up costs ~1.6 billion. (140,000,000 * 1 * 12)

Cost reduction:
~7..10 Trillion over the next 5 years. 30 percent of GDP(12 trillion) * .3 reduction in cost.

Eliminates over-prescription of services

Eliminates wasteful emergency room visits

Reduction in mal practice insurance/operating costs.

Reduction in prescription drug costs.

Competitive market place reductions in service pricing for routine care.


George