Many have argued for healthcare reform. Many of those same people have subsequently failed to identify which aspects of healtcare need reforming, speaking only in generalites, and never providing specific solutions. Right now, the "solution" that recieves the most press is Socialized Medicine. An obvious problem with that idea is that it's socialized. We don't have the money to supply a population of over 300,000,000 with adequate and effective healthcare. Since this is not a piece denouncing socialized medicine, I shall leave my criticizms at that. Unfortunately, we are still left with a broken healthcare system that truely does need reformation
As is the case with many things, the answer is not found solely to the extreme right or the extreme left, but rather, is found somwhere inbetween--incorporating the better ideas from each solution. It is clear that what is our more-or-less capitalist system does not work as effectively as is needed. At the same time, all one has to do is look at what was the purely socialist Soviet Union to understand that the socialist solution doesn't work either. That is why I propose a solution that addresses the problems individually rather than collectively.

SECTION 1: The uninsured/defining poverty level
As has been made clear on this forum in the past, some people prefer not to have insurance for one reason or another. However, many people do want insurance, and although they do not qualify for Midicaid, they do not make enough money to afford health insurance. Currently, those who are given medicaid are those who make under $18,000 a year. The proplem is the poverty level is relevent to the local economy. For example, where I live (northern VA), the poverty level is $45,000 a year, yet in other states, it is significantly lower, and $45,000 would be plenty enough to live off of. Therefore, I propose that individual states take over the areas of healtcare that are already socialized. They are better equipped to adjust the baseline for qualification within certain regions of their states than the National Government is. A baseline that fluctuates with the poverty level is better suited to address the problem of people who cannot afford insurance, but cannot qualify for Medicaid. This solution is also a much less bitter pill to swallow, and a much more practical solution than an entirely socialist system.

SECTION 2: PEDIACTRICS
This is a seperate area of healthcare than general healthcare, and therefore, should be regarded differently. Currently, pediatrics are run similar to general healthcare. It is up to the parents to decide whether-or-not to provide thier children with the necessary healthcare for them to thrive. It is not difficult to see the implications that come with this. For one reason or another, an adult may decide not to go to the doctor or maintain their regular check-ups. The problem is, children are not yet old enough to make this decision for themselves, so they are at the mercy of their parents. When a parent decides not to provide their child with adequate medical care, they make a decision that affects the life of another human being. And because children are regarded as the future of the country, they vicariously make a decision that affects the future of this country. That is why, up until a child is 16, they too must have manditory healthcare that if the parents cannot provide it for thier children, the state of their residence must provide it for them. Once the child reaches the age of 16, the choice can be made by the child or their parents to continue in the program.

Section 3: Excessive Malpractice Suits
Currently, doctors can be sued for anything from innocent mistakes, to giving a patient a prognosis they disagree with, to deliberate negligence. For my purposes, I will focus on the minor and questionable instances of malpractice. While most of these cases are thrown out, it is still left to the individual parties to pay court costs and legal fees. This has had a negative effect on the medical practice overall. Many good doctors have left the practice because of the unfair pressure, and many prospective doctors have been discouraged from joining the practice. To curb these excessive rates of malpractice suits, some of the rulebooks must be rewritten. When a case is thrown out of a court, the financial burden should fall on the prosecutor to pay any legal and court fees. this would dissuade many from making eronious claims without sufficient proof.

Section 4: Maintain a Capitalist System
Capitalism MUST be maintained, therefore, it is up to the individual people to decide if they wish to apply for the healthcare provided by their State of Residency. Other than in pediatrics, this may not be imposed on them. The people are free to stay with their current insurersand continue seeing their preferred doctor.
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If anyone has thier own ideas that can be incorporated into this, please share them. I am anxious to hear your evaluations and my goal is to eventually present this to congressmen and senators for approval. Some other issues I have not addressed but want to are:

• Putting a moratorium on all advertisements for perscription medicines in order to cut down perscription pill addictions
• Putting a cap on the cost/profit ratio of perscription medicines
• I had one more but I lost it

Anyway, if anyone can write up their ideas for addressing those and anyother problems related to healthcare, please do so.

__________________
~John Locke

Discuss the Issue, Not the Poster

"Everyone is entitled to their own opinion, but not everyone is entitled to their own facts"
-Sen. Daniel Patrick Moynihan

"Great thoughts speak only to the thoughtful mind, but great actions speak to all mankind."
-Teddy Roosevelt

Well i'm not sure what the situation in America is in regards to children, but here in Oz, anyone under the age of 18 is privy to free vaccinations every year, for Influenza and all other viruses.

I think that there needs to be a balance between public and private hospitals, and where even private hospitals must maintain a emergency clinic that provides free care for emergency patients.

In regards to medicine, i agree with you Locke that, for people to be eligible for Medicaid, they must be near the poverty line within their own state to qualify, however, i think there also has to be restrictions to how much any company can charge for their medicines, especially prescription medicines.

I'll add more, but i gtg to work right about now.

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"Socialized" is only an obvious problem to Americans and the very rich. Socialized medicine certainly could cost less than it would via the private sector, as the goal there is profit, not health. You forget that the countries that do have universal coverage spend far less per capita than America.

For-profit enterprises normally work out because of the push and pull between supply and demand. Medicine is different because the suppliers set the demand, and because people have an absolute but unknown need for medicine (i.e. if we get very sick, we choose between medicine and death, but we don't know if or when we'll get very sick). This situation makes it very easy for profit-driven healthcare to continuously jack up prices, give unecessary care to the well-insured, or deny care to those underinsured, uninsured, or under managed care.


I don't think healthcare in the U.S.S.R. had much to do with its downfall, but I admit I don't know much about what they did have. Do you? What I do know is that socialized medicine is working better for the rest of the industrialized world than the more-private system of America.

Well insurance is expensive and it's hard to know when you'll need it, especially if you feel healthy or are young. It's an understandable but not a reliable way for such people to go. A single-payer system would eliminate this problem.

In my state, medicaid is where the federal government gives matching funds to what the state puts into Oregon Health Plan. The state puts nothing into Oregon Health Plan from its general fund (there is a small source of revenue from special taxes dedicated to it), and only about 1/40 people who are eligible for OHP get it.

Yeah, using the poverty level on a federal level is difficult. Again, a single-payer system would be simpler and we wouldn't need to worry about how much or little somebody made except in getting income taxes to begin with, so in order for us to worry about this we'd have to assume that socialized medicine wouldn't work. You said it wouldn't, but you didn't really say why.

Yeah, if only states like mine weren't incompetent. The federal government has at least done a good job recently with the VHA.

Basic health insurance simply doesn't work well privitized. Ideally, the federal government would replace it. The private health insurance companies stay in business because they take more from people than they give. They also cost a huge amount of administrative overhead because there are so many of them and they all have different policies. For this and other reasons, a federals system would actually be more efficient and much simpler.

Again, this would be covered more simply and more effectively with government insurance for everybody.

That would help. I also think we need caps on pain and suffering damages.

Pure capitalism does not exist, and is a poor model for healthcare. What we have now is a government that caters to corporations and ignores the needs of everybody else. This is symptomatic of a wider problem with our system of government: presidential system, and single-district plurality in general.

Ban DTC ads for Rx? Yes. The cap on profits makes sense because they often develop drugs at the expense of taxpayers.

I can't recall if I posted it elsewhere, but my ideas go by an acronym: SIMPLER.

S = Salary group physicians with bonuses for outcomes. This could be required of hospitals, but only encouraged for those in private practice. This would allow doctors to focus on what would benefit their patients, and not profit which creates a dangerous conflict of interest when you consider that the doctor is the one who tells you what you need. Overtreatment is as much a problem as undertreatment in America.

I = National health insurance with an emphasis on preventive care. Preventive care should be free, but intervention-based care should have income-adjusted copays to encourage the use of preventive care.

M = More general practicioners. This would allow us to give more preventive care, and make healthcare more efficient overall - limiting both undertx and overtx. We could allow tuition forgiveness for outstanding doctors who go into general practice. Right now, the worst doctors go into GP, but it is actually the hardest type of doctor to be effective at as one must know and understand the whole patient, and not just one system.

P = Pharma regulation. Require new drugs to be tested against existing Tx/Rx, not just a placebo. Ban DTC. Fewer tax breaks for Pharma. More 3rd party testing of drugs without oversight from the drug company itself (they now pay others to research their drugs, but they bias the research).

L = Malpractice law reform, including but not limited to caps on pain and suffering.

E = Evidence-based medicine. There is little scientific backing behind much of what's done in medicine. Under a single payer system, this could be ameliorated by lowering reimbursement to suppliers, and lowering coverage% to patients, for treatment that has no scientific backing in its clinical effectiveness.

R = Electronic medical records programs like VistA (used by the VHA). This would aid in continuity of care, and help reduce medical mistakes.

LiveUninhibited-Very good analysis and recommendations. Is there an organization or candidate with similar recommendations?

LiveUninhibited, I liked some of the Ideas you had for your SIMPLER thing, but I think you severely misinterpreted the purpose.

I was not offering my evaluation on Socialized healthcare, I was offering solutions of my own.

As for your comments on maintaining a capitalist system, I wholeheartedly disagree with your premis that capitalism in healthcare is a bad thing. People must make money, or they have no incentive to do a good job. Same goes for doctors, the drug companies, or the insurance companies.

Are people not entitled to make a living and support families of their own?

I do not want this to turn into a debate on socialized medicine, so whatever anyone's sentiments, for or against, socialized medicine, that's not what it's about. It's about offering your solutions, not arguing for or against socialized medicine

__________________
~John Locke

Discuss the Issue, Not the Poster

"Everyone is entitled to their own opinion, but not everyone is entitled to their own facts"
-Sen. Daniel Patrick Moynihan

"Great thoughts speak only to the thoughtful mind, but great actions speak to all mankind."
-Teddy Roosevelt

Thanks. I don't know of any organization that advocates all of those ideas for sure, but there may be some out there. I made up the acronym but the ideas within it aren't entirely original. In Oregon there is the Archimedes Movement and the Center for Evidence-Based Medicine, which if I recall correctly advocate parts of what I mentioned. Both have been run at some time by former governor Kitzhaber. He probably would approve of most of the SIMPLER plan, but he obviously failed to make a lasting difference for Oregon's healthcare while he was governor. So he thinks this movement has to start at a grass-roots level to succeed, as his efforts at the state level did not. I think it has to happen on the federal level.

Well my problems with your plan were based upon this difference, but since you say that is not the purpose of this thread I will not debate that further.

Note that I advocate private delivery, albeit well-regulated, combined with public funding. So the only part of the private healthcare sector that would be eliminated would be much of private health insurance, though other portions would be downsized due to increased efficiency.

For a totally different take and one more in line with competition and freedom of access (you chose who you go to). I think a more capitalist way is superior but certain things need to be understood for this market.

First, this is an industry which has exhibited annual double digit inflation for over a decade. There is a reason for it and it has to do with demand. Demand for medial care is basically infinite. Supply never actually matches demand in this field. It almost guild like in its nature, the ADA is particular guilty of guild tactics.
Anyways there has been and still is restriction of supply. I have a 3way attack on the problem that should leave everyone rather unhappy ( a good sign considering th parties involved).

First we increase supply, we can do this now and immediately with a very simple action. We let all RNs and Nurse Practitioners give basic health services without doctor supervision. I admit the RN thing is a stretch and some things would have to change in their education, but nurse practitioners are basically ready to be able to prescribe and drug for treatment right now. This will immediately drive down prices with sure competition.

Second we go after the lawyers. Mal-practice caps. Take "critical mass" number and adjust fr inflation and viola you have a fair cap. You could up to triple it for punishment reasons, but the amount must be capped.

Third insurance companies, this needs regulation like a hawk it begs for it in away that seems very distressing to me. Instead of going all out socialized medicine and dragging down everyone to second rate healthcare we can regulate prices for a short time. Socialized medicine means regulated pricing anyways, but this would only be temporary. By getting monthly rates down to about 80$ a person then viola, afforable healthcare. If you really wanna push it for everyone, write a law that takes money from paychecks of the poor and pays for it that way. I would leave it alone.

So yea I'm sure people clan blow wholes through this and in such a long rant I'm sure I've left out stuff but the basic idea is flood the market with supply regulate insurance rates and mal practice caps temporarily. If you can get rates under what 85? 75?$/month for basic medical care then you should be golden.

Single payer systems drag everyone down. Always a bad principle. Anyways fire away.

People don't want an open-heart surgery unless it will save their life. Not everybody will need one to save their lives. You are correct that supply and demand work differently in medical care, though. Demand for medical care should be very finite, but I think I know what you meant. The difference is caused by an unusually high asymmetry of knowledge between suppliers and consumers, as well as an absolute (but not infinite) need for healthcare where applicable.

Consumers usually have little idea what they need in terms of healthcare. They only know that they will pay any amount they can possibly come up with to save their lives. Different people make different incomes. Some people will be able to pay and some people won't, without government health insurance. Therefore, under a private system the poor die preventable deaths and the rich live, or alternatively, the poor are saved when they need catastrophic care and everybody else pays for it. The second scenario roughly reflects the status quo, and is problematic in that it is inefficient for everybody. The shortfall in profit caused by the non-rich/underinsured is made up for elsewhere with overtreatment. Either way, you lose with private funding.

Remember the suppliers set the demand, and hospitals have this saying: No margin, no mission. Your mission may be to help everybody, but unless you have a positive profit margin your hospital will die. Thus if you help those who cannot pay, you must charge everybody else more. If you're a hospital administrator, and your doctors set the demand, your job is basically to encourage doctors to do anything that will increase income but not get you in trouble. Since doctors and hospitals are paid by the quantity of healthcare they give, not the quality of it, they generally maximize quantity to the extent that their consciences will allow. If the government had control of the funding of healthcare, standards could be set to protect everybody from this.

General practitioners (GPs) often work with nurses as a team to help with costs. GPs are not a significant source of the rising costs of healthcare. For-profit managed care, which was one of those government attempts at trying to solve the problem with a market solution, actually led to a major decline in the income and prevalence of GPs, and in turn a decline in the use and availability of preventive care. This in turn led to a greater need for intervention-based care, which is much more expensive.

We have an overabundance of specialists, but this increase in supply has increased the demand because they set the demand. Now some policies allow people to bypass their gatekeeper GPs, which is a very dangerous thing to allow. These specialists often only do a few different procedures that they're very good at. They sometimes act like a hammer seeing every problem as a nail. For example, cardiac surgeons often do bypass surgeries on patients who have never had a heart attack. As of when I read a book on overtreatment, there was no evidence to suggest this is beneficial, but bypass surgeries can have complications such as pump head, where the person loses some cognitive function as a result of being on a heart-lung machine. People, including some physicians, often assume that more medicine is always better, but most procedures come with risks and potential complications. When the potential benefits outweigh the risks, then the procedure should be done, but often the evidence is not available so doctors must rely on their "intuition." When a physician completes his/her residency at a hospital that overtreats patients, he/she will likely do the same in the future. Thus, we need federal regulation and evidence-based standards.

I agree with malpractice caps, but for it to be fair we should cap mostly pain and suffering damages, or eliminate them altogether. If somebody incurred a million dollars in medical bills due to a medical mistake, then they should get a million in a settlement. Obviously that would not be typical, but caps should allow for that. However, I don't think that same person should get 2 million, 1 million of it being pain and suffering. There should be no profit involved in suing a doctor, only getting reimbursed for the expenses you incurred as a result of a mistake.

I know the OP didn't want this to be about socialized medicine, but it's an impossible issue to avoid when talking about healthcare reform, IMO... unless we're supposed to avoid criticizing each others' plans.

Many Americans assume that socialized medicine would drag us down, but the other industrialized nations that use it have lower costs and higher quality than ours by almost any measure. The only measure America does really well on is "consumer satisfaction," and like I said, the consumers don't know what's going on, but their health outcomes compared to other nations would suggest that they are wrong.

Well what I'm advocating is flooding the market with people who can treat common issues such as bronchitis and the flu. Most big issues would still need a doctor, and yes while I'd agree that the industry is not in a healthy place right now, I think some regulation is in order but not socialized medicine.

I did forget a couple of things in my plan. . .

Free med school for those that qualify. . .This would help alleviate common reasons for high prices. It would also encourage many to go into the field that are scared away from it due to cost.

I know that so far other countries have enjoyed decent over all increase in health and thats fine. Me? I say no to sin taxes on principle. Socialized medicine will always seek to pay for itself through such measures, its already started in some states that offer more universal care.

Again instead of closing the market altogether and falling into second rate care I think we should focus on fixing this market. Move forward not backward, socialized medicine is regressive thinking imo.

So if socialized medicine is regressive, should we eliminate medicare, medicaid, VA and military health care and let the market place and charities be the providers? What % of our medical health care is socialized now? I read that we spend more government money per capita on health care than any other nation. Getting to be a smaller number of folks paying the taxes and higher insurance and not getting in on socialized benefits. I'm happy to be on medicare, but am beginning to worry about the high cost of drugs.