Wednesday, April 29, 2009

SF Mechanist's Health Care Proposal

Off topic, but I thought I'd throw it out there, since it's making the rounds on the blogs.

I believe that in clinics and hospitals funded by government (county, medicaid/cal, medicare), private insurance (including HMOs and PPOs), and private pay, Americans get good health care. Exceptions abound, here as anywhere, but overall the quality is good. The problem on all levels it is ridiculously expensive and burdened with heavy administrative costs.

"Single-payer" health care does not leave me with any confidence the situation will improve.

So, my system attempts the following: maintain current levels of care and availability for all, dispense with the notion of "free" health care because it isn't and in fact it is valuable, but still maintains high levels of care for people if they can't afford it, and reduces costs overall. It is a return to a fee-for-service system with government subsidies, loans, and backing.

Starting with fee-for-service, free market principles bring its advantages to the efficiency of the system. Health care delivery becomes a negotiation between doctors and patients of what is available and what patients wish to pay for. If it is too expensive, rather than shoving it to government, patients can talk about options, such as generic medications.

But say there is a catastrophic emergency, or one is diagnosed with HIV or cancer, and is unemployed or the working poor. Necessary health care is still rendered regardless of the ability to pay, and then the patient is billed for reasonable costs of services; there needs to be an office that helps patients negotiate such costs like insurance companies now have to assure they are not being gouged. But assuming the bill is reasonable and reflects the market value of services provided, the patient owes it.

If the patient cannot pay, then the government pays it, probably starting with Medicare, but the patient still owes the government for the cost. It is not the kind of bill that is sent to the collection agency, and if the patient remains working poor for life, they might never pay it. But if they win the lottery or come upon a sizable inheritance, then they would have to pay it.

If with job promotions or better education they reach a point where they could start to pay their health care bills off, then deals could be made such that it wouldn't be a serious burden, but over the years some headway could be made toward paying back what they owe.

Medical treatment that serves public health and safety—i.e. immunizations, tuberculosis treatment, and some mental health and substance abuse services—can still be made available by government subsidy.

Insurance savings would be considerable. I believe this system would maintain or even improve current health care standards, greatly reduce costs, and insure that necessary treatment is made available for all.

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