[JoeRedskin]

Before I go though, I wanted to address something that has been bandied about by both sides of this debate - the accusation that alternatives aren't being offered just nay saying. In light of that, and in part based on much of the information I have garnered here and in Schneed's Health Care thread, I actually have been trying to formulate an alternative to the latest, greatest massive pending entitlement but just haven't the time. But I did want to suggest some things, that might actually lead to discussing constructive creative alternatives in the health care field.

I am not sure whether this or Schneed's Health Care thread is the appropriate place for what I have in mind but I'll post it here in hopes that we can get a little brainstorming going on.

First rule of brainstorming - YOU CANNOT, NO MATTER HOW MUCH YOU HATE IT, CRITICIZE SOMEONE'S ELSE'S IDEA. If you don't like, ignore it. It either falls flat on its own or you (or someone else) find a way to make it work with your idea/scheme - but at this stage ALL ideas are valid. I don't know if we can make it work, some here have a more difficult time questioning/reexamining their basic philosophic stances/principles than others, but if we strive to find what is right with each others ideas maybe we can find something that incorporates the best of both sides of the equation (i.e government action, through wealth transferance alone, can solve the problem v. government action, through wealth transferance alone, cannot solve the problem) (or, if you prefer, CRedskinsRule & Slinging Sammy33's belief in a minimalist government because government is inherently unable to resolve almost any (if not all) social ills v. Saden's belief that an expansive progressive government is capable of resolving almost any (if not all) social ills)(P.S. - anyone notice saden's leap of faith? Notice how he still hasn't owned up to it?).

I made the first rule and now I am going to break it - but only to set the premise for the brainstorming. As to health care, what we need is not more of the same which is, essentially, what the current legislation creates. Same players, same system just enforced payments and the creation of a new public insurer (who plays by the same rules as existing insurers). I think this is doomed to fail b/c it is the healthcare infrastructure that is skewed and pouring money into it does not substantively alter the system in any progressive manner but, to my mind, furthers an ultimately broken and economically "regressive" health care system. Thus, rather debate the rectitude of the current legislation, I suggest we begin from the premise that it is not a true re-imagination of the Health Care System and, as such, should be put on the shelf for now.

Any actual constructive analysis seems to me to require something very basic that we have not done -- A listing of the pros and cons of the current system. Actually, I think the cons have been pretty well fleshed out. Why don't we devote some energy to analyzing just what exactly works about our system. Clearly, something must. Once we have identified the actual positives perhaps we can see ways to enhance those and close some of the gaps. Again, I am trying for a true and practical reinvention of the health care system with concrete thoughts as to how to decrease cost, expand coverage and maintain quality. Given our current national debt status, the premise being that cost to the public is an extremely important point.

As I have previously indicated - To address cost of care, I think one key is to create a Workers Comp type compensation system for injuries occuring as a result of treatment. As part of this, damages would be capped or scheduled much as is done in the WC field (lost a leg on the job - you get x). I recognize that creating such a schedule in the health care is difficult but it is something that can be tweaked along the way. The effect of this system is to remove liability from the litigation equation. The question is not "Did the doctor negligently do something to injure you" to, after the treatment, "Were you injured?". In this system, punitive damages would be excluded and "pain and suffering" be considered as part of the schedule. If a doctor's patients rack up x amount in claims or x amounts of awards to patients of teh doctor, the doctor license is revoked. period. From a societal point of view, it is a statement by the society that (a) We accept that injuries happen in medical treatment even when no one is negligent; and (b) As a society, we are willing to forego the possibility of full compensation (economic damages, pain & suffering damages, and punitive damages) in order to insure that anyone injured due to the provision of medical services will receive some form of compensation even if they would not normally be entitled to compensation because they assumed the risks inherent in to medical treatement. (Think of it - Never having to sign another medical waiver form). This was the justification for WC (employers would invoke assumption of the risk defenses when sued for workplace injuries). I think it's time has come in the medical field.

Also to address costs, in the health care thread, Schneed indicated that competition for patients sometimes drives doctors/hospitals to buy the most cutting edge technology and this, in turn, ends up driving up costs both b/c of the capital outlay and the need to use the technology to justify the outlay. To me this screams for government intervention b/c it is a situation where the free market actually drives up costs. If anyone has any bright ideas on how to correct the market flaw here, I suggest that would be useful (see Schneed's post in the HC thread on this).

Another area of costs is pharmacuticals. Better living through chemicals is the dirty little secret of modern life, R&D in this area have led to phenomenal break throughs that enhance the quality of life for many many americans. It is this very R&D, however, that is used to justify the sometimes exhorbitant costs of the resultant drugs. Perhaps we could limit profits on actual producton runs of drugs in a manner that directly relates to cost of production and find a way to publicly fund the R&D profit incentive. Here's a thought, initial R&D costs can either born by company or granted through a Federal application process. For those borne by the company, if a particular drug eventually comes to the approval phase, the R&D costs could be reimbursed from the public fund. Further, if a particular drug is approved the costs incurred by the company in seeking that approval would be reimbursed from the public fund. If a drug is particular popular and sells en masse, production bonuses from the fund could be paid. (i.e. build in a profit incentive into both the R&D phase and the production phase).

In terms of coverage and levels of coverage, again, to keep the profit motive alive and well, guarranteed coverage cannot be much more than minimums. Anything more and it creates a disencentive to seek better coverage and w/out this incentive, IMO, the drive to improve quality to compete for insureds will cause the quality of care to suffer.

Further, coverage at these minimal levels would be offered to anyone with an income less than twice (or one and half, or some other multiple) times the poverty rate. Over that income, if you incur medical costs and fail to pay them, the hospitals are reimbursed by the public fund BUT the Feds, rather than the hospitals, can collect the debt and do so in the same manner as they pursue unpaid taxes.

Payment for the services of uninsured would operate similar to the existing medicaid system but would be reimbursed at a higher (but not full) percentage rate than under the current system to (a) more adequately reflect costs while (b) keeping a downward public pressure on costs. (Schneed, I don't recall, is the reimbursement for medicaid payment greater or less than the best negotiated rates of insurers?).

In terms funding, I see no other way then a surtax much as we have for SS. Funding would pay for the minimal coverage costs of care of the uninsureds, a beauracracy (ohhh dirty word) would need to be created for the malpractice substitute, for the administration of the pharmaceutical administration, and for managing the access to technology. This, I think, would transfer much of the cost of health care onto the Federal government but, hopefully, still leave room for innovative health technologies to develop.

Those are some of my ideas on rough structures.

In addition to alternatives and other ideas, I really am interested in what people think is right with our system and how we can preserve that while, as saden said at one point, "taking more people into the system."





I REALLY need to get to work.