Health care proposals: Let's start over

OK, let’s start over. Forget plan A. Let’s just start without a plan but just asking for your ideas. Here’s a list of what I want to do. How would you go about making that happen?

1. Everybody is covered by health insurance. Strike “uninsurableâ€, “benefit deniedâ€, and “pre-existing condition†from the health-care lexicon.

2. Everybody has affordable access to health care. And everybody is required to access health care through annual screening. Those who are unable to pay are subsidized.

3. Health care decisions are made between the patient and the doctor, without interference by any third-party entity.

4. Get the patient involved in spending decisions as a health-care consumer in order to foster competition in health care. The patient must share some portion of the cost, either as copayments, insurance, taxes, or some combination so that wise spending decisions are made.

5. Excess costs are removed; e.g. costs due to:
\t- multiple layers of middlemen between provider and payor
\t- cost shifting due to health care for uninsured (see #1 and #2)
\t- legal protection: malpractice, product liability
\t- patent protection
\t- duplication of services
\t- lack of competition
\t- defensive medicine
\t- patient demand for uneeded health care
\t- patient neglect of health care
\t- patient ignorance of the cost of health care

6. The Medicare/Medicaid/VA systems are dissolved and their functions absorbed.

7. Discourage or do away with the employer-provided health insurance model.

Enuja - good observation about #4.

About #3 -- what would be your solution to the problems of the payor denying benefits or telling the doctor that this and that has to be tried before that can be done? I've run into that multiple times where my Doctor and I both know that options #1 and #2 aren't going to work, but the insurance company won't pay for option #3 until I waste my time and THEIR money on #1 and #2.

Are there other reasons why #3 isn't feasible other than the pragmatic reasons you noted?

2dogmom gave me a whole bunch more stuff in a post on another forum, thanks for that input!!

sharky - should all alternative therapies be included do you think? I can see accupuncture and chiropractic because of the training and credentialing and licensing required. What about other therapies that people claim help them? Reflexology? Cranial-sacral? Massage? Chinese herbs? Where should a line be drawn, or is a line necessary?

Enuja -

How about this: an independent medical advisor/counselor/advocate would represent the interests of the payor in doctor/patient health-care decision-making. I want to preserve the separation between payor and provider such that we can still strike "benefits denied" but I can see your points about #3. Keeping the payor out of the doctor's office is an essential point with me, but there's got to be some way your concerns can be accounted for as well. The idea above was suggested on another forum. It adds another layer of complexity and expense, but there's merit in it if it can address the issues with #3.

I agree that covering something requiring a prescription is a good way to define what's covered and what's not. However, the dietary and health supplements industry has been fighting FDA efforts to regulate them tooth and nail for years. I'm sure they'd really pop over requiring prescriptions (and that includes me, since I use dietary supplements.)

Your question sounds cynical, especially in light of your previous comments on the topic, but instead of dismissing it with the snide remark that first came to mind I'll treat it as a genuine question; someone else reading this might have a genuine curiosity: I hope to get something worthy of sending to my legislators; perhaps put up a website. If you've been tracking my postings here, you know this is one of my hot button issues. Right up near the top of the list. In this country we have the attitude that anybody can accomplish anything if they set their mind to it, and that it's up to the people to solve the problems of the country. We have a system whereby not just the power flows from the people but the ideas as well. Good ideas do get listened to, especially when enough people are saying the same thing.

All right, Linda, thank you for the kind words and I apologize for the presumption of guilt until proven guilty. And the answer is no, I don't plan on doing it myself. If you lived here, I'd ask for your help.

And this process is being productive. I'm finding where my original ideas are weak and I'm getting some really good input, too.

Thanks for the links. Learning from others' mistakes is key. Learning from their successes is also.

I had a lengthy and interesting conversation with a knowledgeable person inside the insurance industry yesterday, giving me some insight on how the insurance industry would view a two-tier hybrid risk-sharing system as I proposed. Mainly I wanted to get a sense of whether it would be easier to underwrite the bottom tier or the top tier. I didn't get any firm answer because that depends on the actual numbers. What I did get is that insurance companies don't want to underwrite risk when the maximum possible loss is unknown. So that gives me the sense that insurance companies would do a better job insuring the bottom tier, with the government insuring the top. Unless a three-tier system is used, with private insurance companies insuring the middle, and the government the top and the bottom. This adds another level of complexity, though. This would make the government the payor for the high claims frequency of routine care and minor ailments and also for the super-catastrophic but low-frequency claims of major illnesses. It's worth considering, I think, despite the extra level of complexity.

Actually this idea of insuring up to a cap is already used extensively in the insurance industry through re-insurance. Essentially an insurance company buys insurance from another insurance company (the re-insurer) to cover claims over a certain amount. So if we think of the government as the re-insurer, then this tiered system of risk is something they're already quite used to working with. And with the already extensive claims history, they should be able to competitively price insurance policies.