HES
08-16-09, 17:12
I didnt want to derail the thread about Obama caving, but my wife and I gave this some thought and here are our ideas for health care reform:
1.Stop mandatory coverage - Allow consumers to custom tailor their plan. For example, a woman who has had menopause. She should be able to trim down on their OBGYN coverage. Allow folks to get catastrophic only if they want.
2.Require everyone to have coverage. Only the sick and lame get subsidized care. The lazy are fined.
3.Community care - Right now Medicaid does one of two things. They either allow to live in your home or if that becomes impractical will only pay for the patient to live in a nursing home (SNiF, Skilled Nursing Facility), after you have exhausted every penny and you are destitute. This is a phenomenal waste of money. So many cost savings could be realized if A) You move this to Medicare and B) if you institute Community Care. CC would enable patients to stay in their home and provide for a home health aid to come in once a day and check on you or pay for your care in an assisted living facility. The end result is that patients only spend a small amount of time in a SNif which means the government saves an ass load of money.
4.Allow statistical coverage - Look we already do this with car insurance (shitty drivers pay more) and life insurance. So if you have a pre-existing condition, you can get insurance, but you will be paying more. Surcharges would not not to exceed 100%. For unusual cases, create an assigned risk pool to distribute risk evenly among insurers. For statistically exceptional costs arising from these cases, allow insurers a compensating tax deduction. Allow for pooling of coveage
5a.Emergency Care - Ok lets be serious. How many ****ers go to the ER and abuse it? The answer; a shit load of em. Allow hospital ERs to turn non emergency patients away - Actaully they can already, but are fearful of doing so. Make sure the hospitals know they can do this. Possible part of tort reform.
.................AND.................
5b.Discourage poor practices - Allow people to be peanlized / fined for abusing ERs or life style choices that affect their health. I.e. the diabetic who refuses to take their insulin and then winds up at the ER. Yeah this can lead to a special soda tax, but the legislation can be crafted to avoid this.
6.Widen the field of practitioners - Elevate the roles of ARNPs / DNPs. Right now MDs fight tooth and nail to keep nurse practitioners from doing more for, as far as I can tell, self preservation. Thats all fine and well until we need to bring the cost of health care down. There is no reason for this.
7.Eliminate the restriction of health care plans to one state - Down side to this is that the states would have to surrender their ability to set minimums for coverage.
8.Increase the reliance of home health care agencies - Right now Medicare / Medicaid is set up to discourage HHC in favor of keeping patients in hospitals. This makes no ****ing sense since hospitalization costs a shit load more than HHC (when its appropriate medically).
9.Fraud crack down - Create an agency / task a part of the FBI to do nothing but investigate and prosecute the living shit out of perpatrators of fraud under Medicare / Medicaid.
10a.Taxes - Either get rid of the employer tax break for providing health care or make all health care costs tax deductiable
.................OR.................
10b.Disallow Employer insurance - Allow folks to get their insurance like they do with their auto insurance. Pool it.
11a.Drug costs - Get rid of the prohibitons on importing drugs from other countries. That will be self correcting soon enough
.................OR .................
11b.refuse the US from subsidizing the cost of drugs to nations that have a per capita GDP > than 50% of the US'.
12.Congress, **** em - Bar congress from having any sort of special health care program. They have to deal with the same system that we do.
13.Reimbursement rates - Get Medicare and Medicaid to reimburse actual expenses, not the stupidly low rates that they do now.
14.Evidence Based Practice - This provides a "Safe harbor" for physicians who run the necessary tests with out blowing the budget. This is an attempt to prevent MDs from using tests as a money making vehicle
15.End of Life care - Keep in mind that a majority of our health care expenses are spent on a minority of patients who are terminal. Doctors expend an inordinate amount of resources not so much to keep the patient alive, but to protect themselves from law suits. Tort reform has to address this.
16.Establish a "Health Care Court" - Medical cases are heard by Judges and arbitrators with medical backgrounds. The intent is that jury awards are commensurate with the actual damages done and the impact to someones life. Keep in mind that if a patient is harmed for life (I.e. the doc screws up so bad that someone is left a quad for the rest of their life), then the courts would not be restrained from allowing an award that recognizes this.
17.Digitize patient data - Gee no shit, you can save money by going paperless? Well no shit Sherlock. A few obstacles to this. One, doctors are primmadonas and will fight it. Next, there needs to be draconian consequences for anyone who willfully breeches patient confidentiality. Of course the government is forbidden to access this data. I'm serious when I say this should be a federal death penalty offense. Finally the government sets the data standards and protocols. Medical providers (Hospitals, offices) provide the equipment on their end, insurers provide the equipment on their end and maintain the data.
18.Pro Bono - If ambulance chasers can be required to do it, so can the ambulances. Require medical workers to donate X numbers of hours per year perhaps. Yeah this is one of the prices of tort reform.
19. Post operative care - There was a recent news item on Littleton, CO and how by having home health worker care follow up on patients at their homes after surgery they were able cut down the incidents of re-hospitalization and lost productivity, thus saving everyone time and money.
Anyways those are our ideas. Sure some of it goes against our libertarian philosophies, but we're also realists. So pick this apart. Why cant the government think of this stuff?
1.Stop mandatory coverage - Allow consumers to custom tailor their plan. For example, a woman who has had menopause. She should be able to trim down on their OBGYN coverage. Allow folks to get catastrophic only if they want.
2.Require everyone to have coverage. Only the sick and lame get subsidized care. The lazy are fined.
3.Community care - Right now Medicaid does one of two things. They either allow to live in your home or if that becomes impractical will only pay for the patient to live in a nursing home (SNiF, Skilled Nursing Facility), after you have exhausted every penny and you are destitute. This is a phenomenal waste of money. So many cost savings could be realized if A) You move this to Medicare and B) if you institute Community Care. CC would enable patients to stay in their home and provide for a home health aid to come in once a day and check on you or pay for your care in an assisted living facility. The end result is that patients only spend a small amount of time in a SNif which means the government saves an ass load of money.
4.Allow statistical coverage - Look we already do this with car insurance (shitty drivers pay more) and life insurance. So if you have a pre-existing condition, you can get insurance, but you will be paying more. Surcharges would not not to exceed 100%. For unusual cases, create an assigned risk pool to distribute risk evenly among insurers. For statistically exceptional costs arising from these cases, allow insurers a compensating tax deduction. Allow for pooling of coveage
5a.Emergency Care - Ok lets be serious. How many ****ers go to the ER and abuse it? The answer; a shit load of em. Allow hospital ERs to turn non emergency patients away - Actaully they can already, but are fearful of doing so. Make sure the hospitals know they can do this. Possible part of tort reform.
.................AND.................
5b.Discourage poor practices - Allow people to be peanlized / fined for abusing ERs or life style choices that affect their health. I.e. the diabetic who refuses to take their insulin and then winds up at the ER. Yeah this can lead to a special soda tax, but the legislation can be crafted to avoid this.
6.Widen the field of practitioners - Elevate the roles of ARNPs / DNPs. Right now MDs fight tooth and nail to keep nurse practitioners from doing more for, as far as I can tell, self preservation. Thats all fine and well until we need to bring the cost of health care down. There is no reason for this.
7.Eliminate the restriction of health care plans to one state - Down side to this is that the states would have to surrender their ability to set minimums for coverage.
8.Increase the reliance of home health care agencies - Right now Medicare / Medicaid is set up to discourage HHC in favor of keeping patients in hospitals. This makes no ****ing sense since hospitalization costs a shit load more than HHC (when its appropriate medically).
9.Fraud crack down - Create an agency / task a part of the FBI to do nothing but investigate and prosecute the living shit out of perpatrators of fraud under Medicare / Medicaid.
10a.Taxes - Either get rid of the employer tax break for providing health care or make all health care costs tax deductiable
.................OR.................
10b.Disallow Employer insurance - Allow folks to get their insurance like they do with their auto insurance. Pool it.
11a.Drug costs - Get rid of the prohibitons on importing drugs from other countries. That will be self correcting soon enough
.................OR .................
11b.refuse the US from subsidizing the cost of drugs to nations that have a per capita GDP > than 50% of the US'.
12.Congress, **** em - Bar congress from having any sort of special health care program. They have to deal with the same system that we do.
13.Reimbursement rates - Get Medicare and Medicaid to reimburse actual expenses, not the stupidly low rates that they do now.
14.Evidence Based Practice - This provides a "Safe harbor" for physicians who run the necessary tests with out blowing the budget. This is an attempt to prevent MDs from using tests as a money making vehicle
15.End of Life care - Keep in mind that a majority of our health care expenses are spent on a minority of patients who are terminal. Doctors expend an inordinate amount of resources not so much to keep the patient alive, but to protect themselves from law suits. Tort reform has to address this.
16.Establish a "Health Care Court" - Medical cases are heard by Judges and arbitrators with medical backgrounds. The intent is that jury awards are commensurate with the actual damages done and the impact to someones life. Keep in mind that if a patient is harmed for life (I.e. the doc screws up so bad that someone is left a quad for the rest of their life), then the courts would not be restrained from allowing an award that recognizes this.
17.Digitize patient data - Gee no shit, you can save money by going paperless? Well no shit Sherlock. A few obstacles to this. One, doctors are primmadonas and will fight it. Next, there needs to be draconian consequences for anyone who willfully breeches patient confidentiality. Of course the government is forbidden to access this data. I'm serious when I say this should be a federal death penalty offense. Finally the government sets the data standards and protocols. Medical providers (Hospitals, offices) provide the equipment on their end, insurers provide the equipment on their end and maintain the data.
18.Pro Bono - If ambulance chasers can be required to do it, so can the ambulances. Require medical workers to donate X numbers of hours per year perhaps. Yeah this is one of the prices of tort reform.
19. Post operative care - There was a recent news item on Littleton, CO and how by having home health worker care follow up on patients at their homes after surgery they were able cut down the incidents of re-hospitalization and lost productivity, thus saving everyone time and money.
Anyways those are our ideas. Sure some of it goes against our libertarian philosophies, but we're also realists. So pick this apart. Why cant the government think of this stuff?