Friday, August 14, 2009

What's Your Plan?

Tis the season for multistep plans for fixing healthcare. Everybody's got one: There's the usual pundits on the right and on the left naturally. It seems we're always just a few steps away from a healthcare utopia, if only we'd kill all the lawyers, eat our veggies, and either get the government completely out of healthcare and let the private market work its magic, or get those greedy, evil insurance companies out and let the benevolent government take care of us. Heck, even I've been touting a plan, although I make no claim to inventing it.

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So here's my question: In three steps or less -- extra credit for doing it in three -- how would you fix healthcare? What are the three things you'd do, if we made you healthcare dictator for a week, to remake the system.



  1. I like "your" plan. I like the mandate but there needs to be a rule that those who choose not to buy have to pay cash or charge or can be turned away at the door of the hospital. Why buy insurance when you can get "free" care in any ER at any time just by showing up? So what if they bill you? Don't pay!

  2. Any plan must address the medical liability issue. It is estimated that $210 billion is spent on defensive medicine, every year. Substantive tort reform would free enough resources to insure every American, pay for ehr and have change left over. The current house bill makes no reference of the liability issue. Zero!

  3. 1) Simplify and even the playing field between purchasers and sellers of insurance (govt can do this part). A fair and open exchange with objective comparisons of "apples to apples" will allow consumers to buy their own plans. Change IRS rules that allow 100 % tax deduction for anyone buying health coverage (at least catastrophic coverage)-individuals or business. Remove the concept of "networks" and "participation" and"CPT/ICD", which means that any patient can get care from any physician/lab/hospital. Reimbursement criteria must be regional, not national, and should go back to the conventional model. Consumers should be aware what a new office visit of follow up visit would cost and what % insurance would pay. This way physicians could have open contracting with patients, who would then be able to select which doctors makes financial and medical sense for them rather than being forced by insurers to select "in-network" doctros, even when these docs do not provide any value of service to them. Consequently, physician offices can post their charges, whereby each patient could decide how much they would like to pay over and above what insurance would cover. If they felt that they would pay $40 more for a valuable visit, then they could decide that. There will be true competition in the medical marketplace as compared to now. Since large labs and hospitals have a more "corporate" stucture, they could work out deals amongst equals. These options could also be laid out as part of an exchange. Finally, govt could mandate that at least 90% of insurance premium dollars must be utilized towards payment for health care. This will be a major step.

    2) Creat special "health care courts", where judges with specific knowledge of health care or local medical experts can be hired on a consultative basis to opine on whether standard of care was met and/or whether negligence was invovled in a particular incident or adverse outcome. This would eliminate a lot of excesses going on now as well as provide a quick redress to legitimate plaintiffs.

    3) Finally, doctors, hospitals, labs, etc. should be provided direct tax deduction for serving the poor/needy/uninsured as part of community free clinics. These professionals should be allowed to take tax deductions based the actual value of services they provide. This almost completely eliminate the uninsured care problem.

    These are the 3 major changes needed.

    A Cavale, MD