Healthcare: insurance should not be needed

Posted by & filed under Misc, Politics.

It’s Sunday, which probably means that by the end of the day US will have “health care reform”. Political reasons aside, it’s still puzzling to me why politicians do not want to fix the actual cause of the situation.
Scratch that, considering the amount of money involved in politics, I understand that.

I am, like any other guy, fond of the word “comprehensive”. I do think that US has a huge problem with medical industry, being interested in profit and current “status quo” (“quack” for patients, money for doctors). But I don’t think the current form of “solution” proposed in a shape of 2000 pages long bill is the right way.

I wish there were series of smaller, short bills, that deal with specific problems and add clear regulations. Written in plain English, instead of legalize, so you can read them. It’s like with the spring cleaning — the goal of “clean the house” never get anything done. A series of “clean big room, wash floors, dust ceiling fan” etc seem to do the job, and if not the 100%, at least 80% of things get done. Better than none.

So, here are my main rant points:

I don’t think it’s right to force people into relationships with private companies (especially when a few large ones exist in environment of monopoly/duopoly). Yes, I mean the mandate. Insurance should return back to state of helping in a case of a major and unpredictable (more or less) event. Because the regular price of the medicine/procedures should go down.

I wish reform would disallow multiple price points for medical stuff. Nobody can convince me that if hospital allows patients with BCBS pay $12 for blood panel, patient without insurance should pay “regular” price of $320, and if you have another insurance you pay $27. “Contractual concession” should come only in one case – when patient brought her/his own materials to work with. Whatever the lowest price point is, everyone pays.

Please do not allow consumer-facing ads. Psychology aside, marketing should not be making medical decisions. Do not allow bonuses/vacations/free trinkets from pharma companies to be sprinkled onto medical workers or hospitals. If pharma company wants to donate money – let them sponsor a hospital, but make it general sponsorship, like a stadium. Medicine news, along with peer reviews, belong to medical journals.

Do not allow pay-offs of generics manufacturers. If patent is off, paying someone “not to make generic version of medication available right away” is a collusion. Antitrust law, fine up the wazoo, a bit of a mandatory jailtime for involved personnel.

Remove requirement for hospitals/ER to “treat everyone no matter the cost/reason”. Current situation where you have to wait 4 hours for treatment is not sustainable and makes ER a joke. ER should only deal with life-threatening situations. For that, offer people basic low-level emergency insurance. Make that insurance a single non-profit organization, covering emergency services only. I bet this could be done under $5 a month (heck, if it really covers everyone, could be even less).

For hospitals that want to provide social treatment programs, offer tax write-offs. There are poor people out there, and even with prices going down, some probably wouldn’t be able to afford doctors, for those there will be these extra cheap/free clinics. This is where people have to go when they cut a finger or sniffles, not ER. You try to go to ER with that, you get your ass kicked out.

Offer to all doctors/medical personnel centralized non-profit malpractice insurance, with reviews and certifications. Bad doctors get banned. Doctors with good track record and happy patients get lower premiums.

For common maintenance-dependent conditions offer non-profit country-wide coverage for medicine/procedures. Single purchaser is certainly a powerful tool.

For all “basic”/federal programs offer encouragement of early enrollment. While nobody would be turned down for “Federal Diabetes Program” that purchases for you insulin and testing supplies, if you enroll early, before you get diabetes, you get lower premiums

All prices for hospital services should be readily available. Patient should be able to tell that hip replacement in hospital A costs $X and B – $Y, decide which one she/he wants, and go there. Publish ratings of hospitals and comprehensive list of what is included. Disallow little asterisks and fees/taxes.

Do allow private insurance to help people. But make them consumer-facing institutions. They deal with patient only and simply reimburse the client after the fact. They don’t “negotiate” with hospitals and have no say where or which procedure you get (they may not cover some procedures, but there should be no scenario of “Well in this case we won’t cover NNN” – list of procedures and max coverage should be available upfront, no wiggle room). They are a financial service, that kicks in when medical event happened (this is how many European insurances work – they give insurability guarantee, premiums vary only due to age/sex, etc). Allow them to provide patient with a credit card, for those cases where procedure is costly (but will be covered by them at least partially anyways). Tax break for preventative measures, or extra expansion of covered stuff.

I think this should be it. Unfortunately this won’t happen any time soon. Though it would be interesting to watch how public goes from hate to love to hate of the new bill when it passes.

Did I goof off significantly somewhere above? Let me know.

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