Now as with any plan condensed into the space of a blog post, if i miss a specific or am a little lean on detail, I'll catch it in the comments (unless I really hose it). Plus, some of the details, by the nature of my plan, have to take care of themselves.
First of all, my assumptions:
1. No matter what, there will be people that will not get the proper medical care, and will die. This happens now, and it will happen under any reform, as people are dum.
2. The debate is not whether we need a public option, or more private ones, or more or less regulations, or any small change bullshit. The debate is whether the government or the private sector is best equipped to handle health care in America. Right now we have the worst aspects of both.
3. The problem is not accessibility of services, but the exorbitant cost of said services.
4. My goal in this is to create the fairest, most flexible, and best health care system in the world. And my approach is to keep it free from the control of as many people as possible (except doctor and patient, of course).
1. Tort reform - As with most highly paid and therefore litigiously lucrative professions, much of a doctor's overhead is in malpractice insurance and CYA medicine. And since most of the procedures are covered by insurance, why not just order them all? Taking away much of the liability for educated guesses, and for the inherent risks that come with cutting and pouring chemicals into the human body is the first step in shrinking the costs. And capping most malpractice awards (except in cases of gross negligence, where a little cya procedure would have saved their ass) also affects the cost of malpractice insurance (lower the payouts, and you lower the cost).
2. Insurance Competition - Our insurance market is so burdened by so many regulations, limitations, and piles of bullshit that it's no wonder they do everything in their power to pinch every penny (as they're trying to rake in their last dime before the government pinches them). This has led to them pulling some vile practices (rescission) in the pursuit of the last dollar. So there are three things that we can do to fix the current insurance mess:
- Reduce all barriers to selling insurance, keeping only regulations that ensure transparency and protect the rights of all parties. This would include access to the medical records of the patients they insure, so that everything is clearly on the table. It would also create the opportunities for insurers that
- Make insurance something paid with pre-tax dollars for the individual. And make it 100% portable, attached to the individual.
- Create a streamlined method to legislate disputes when insurance companies deny coverage (except in cases of fraud).
- Start treating insurance as insurance, not a payment plan for health care. When a routine medical check is paid for by someone else, it ain't insurance.
3. Non-Naughty Nurses - Doctors, for all their expertise in treating illnesses and diagnosing symptoms, are often complete fucking idiots when healing people. This is not to belittle what they do, but often, most of a patient's contact with medical staff is through nurses, from the lowly shit wiper to the haughty head nurse (complete with kneepads (kidding)). And they can tell very quickly what the hell is going on in most cases. So why are we waiting for an hour for some moron with the right alphabet soup to get our routine shit looked at?
In some cases, we have the Certified Nurse Practitioner (like the one my kids see for their wellchecks). Or the Certified Nurse Midwife (she caught my first when he fell out, was there for most of the second). These are nurses with a little more training and experts in their fields, often taking the place of the doctor for the most part (the doctor is the consulting expert). For most things, people don't need the burden (and price) of a real doctor. So why do we see them?
Expanding caregiving responsibilities to the people most competent to do so (and having the doctors just do the cool shit they went to medical school for) would be the fastest way to both cut wait times (a reason I ditched my son's first doctor) and the cost of getting your shit looked at.
4. End-of-Life Care -In this area, I'm going to get a little grief because I'm a believer in dying with dignity rather than being kept alive as a human vegetable. In fact, since I lost one grandfather to Alzheimer's, I know how I want to be treated if I get the disease. When I reach the point I no longer recognize people and places and can no longer function effectively, I want to be taken on a road trip. Anything tho accelerate my decline so I die quickly.
Now this is not to say we should start snuffing the old (despite it working for one planet in Star Trek: TNG). However, when a person reaches the point they can no longer function, we need to find a point at which we can let go, and help them to let go. I don't have any specific legislative ideas, because this is a matter of personal faith and relationships. But the need to prolong the aged for years after they become miserable is futile.
5. P-p-p-p-p-pilllllssss -One thing I saw early on sitting at the doctor's office with my newborn son was the result of the doctors I mentioned just trying to solve problems rather than treating people. There were old people in there with BAGS OF MEDICATION. Now I've always been the type of person who tries not to pop a pill unless it's absolutely necessary. The occasional antibiotic when fighting an infection. Maybe a vitamin (well, for the kids, I haven't touched my horse pills in months). A few pills to stave off the bitch-headaches that sometimes blast me (or that time when I had the abscessed tooth and was smashing aspirin on my gums).
But we may not have had a "crisis" that required a prescription drug program if we weren't addicted to the idea of solving shit with pills. I had one grandmother who fought this tendency (mainly because the doctors kept diagnosing more shit (when she was 87 and due to die 2 years later)) and another who appears to be as almost messed up by the medication designed to "fix" shit as by the problems that got her to the doctor in the first place.
And this trend of doctors popping prescriptions so we can pop pills is also very much the thing that helps exacerbate the abuse of the prescription drugs, affecting people from Rush Limbaugh to on-the-street junkies, to the now-late Michael Jackson (who likely was killed (directly or indirectly) by his prescriptions).
Again, it comes back to healing people and not just trying to fix problems. And fixing problems caused by pills by using pills IS a problem.
6. Grandfather Clauses - One of the sources of our current debt is the expanding costs of Medicare and Medicaid. So these are going away. However, there are two problems with that. First people are paying in for this shit. Second, there are lots of people currently receiving the programs (full disclosure, my kids are both receiving medical through Medicaid).
So it's grandfather time. Anyone currently in a program may stay within that program until they drop out or die. We create a 1-year window for Medicaid and a 5-year Window for Medicare. Then we start shutting the programs down. That leaves us with....
7. Insuring the Uninsurable and Irresponsible, AKA The Safety Net -That leaves us with the people who can't get insurance or fail to do so and need help. In any system, as I said, there will be people that aren't served by the system. They fall into four categories.
- Senior citizens - Those who didn't do what they needed to prepare for their retirement, who missed the deadline for Medicare above, and will need care. I'm inclined to say we should create a program similar to Medicare in the sense that it covers our seniors, but structured much differently than our current mess. Also, the eligible age will be based on current life expectancy, not some arbitrary age set by Congress that means the average person gets 15-20 years on the program. And preferably, this will be something administered at the state level.
- The poor - There will be people who, even with the inequities of the current system eliminated by market forces, simply cannot afford basic care. And we as a society have a moral obligation (not a legal one) to help our fellow man. This requires that we find ways to help. The establishment and enhancement of free clinics is the key here. They can be supported by donations, by the free time of doctors who would otherwise be writing off non-payments. I don't have the particulars, but from someone who's seen the power of philanthropy, I know we can do this.
- The chronically ill - There are people who have diseases that will plague them until they are dead. There are people who have diseases that take their time to kill. And there are people who cost a lot of money to keep alive. I'll be honest when I say there's no easy answer here. Part of it will be though the generosity of people (speaking of which, someone like Jakari could use some of that). Part of it may come from the government (I may oppose this on principle, but I'm willing to compromise. Because like any moral society, there are times where we have to do the right thing. This may be one of those times.
- Addicts and the self-destructive - Okay, here's where I draw the line for helping people. Now I do believe in trying to find ways to help people beat addiction (and there's a public role in this). And sometimes, when someone comes into the emergency room, doctors are going to fix first and ask questions later. But there comes a time when someone who is intent on doing things that will kill them should be told, simply, no more. We're not going to give you help to survive your latest binge. We're not going to patch up your latest hole from a shooting. And you knew your behavior was killing you and you kept doing the stupidest things imaginable. Now if you've got the cash to pay for it, or insurance that will still cover your dumb ass (and since you're in this category, you don't), then we'll keep going. but you chose your poison, and we're not going to eat more money just to continue your useless existence. Die. Is that harsh? Yes. But we're denying coverage to people who chose to mess themselves up.