People are familiar with it, and most people getting Medicare like it. It has political viability as an idea because it sounds like such a simple, clear solution.
Just do it.
But there are questions and problems. How to pay for it? How to transition to it? What about current institutions, including insurance carriers? What about people who like what they have now, and consider Medicare a downgrade? And what about people who want less government, not more government?
I asked people who work in health care for their best suggestion on how to structure a reformed health care system. The first person to respond in writing is Mark Knudsen, a near-classmate in college, graduating a year after me. Knudsen went to business school and then had a long career in administration of health care for providers and insurers. He administered hospital and clinical services at the Shriners Hospital for Children and Cascade Health Solutions. He also negotiated health care contracts with employers. He is retired and lives in the Portland, Oregon area.
He doesn't describe a simple solution, nor a government-run one. He says to get employers out of the system. His idea is hard to describe and it would be a much harder one to build a political movement around. (Hillary Clinton's 1994 solution was mocked and dismissed as too complicated -- its fatal flaw.) I don't dismiss this idea as wrong; only as politically impossible. But I pay attention to it because Knudsen had a career dealing with the issues and problems of providing and paying for health care, and I don't dismiss the thoughts of people with knowledge and experience in complicated matters.
Guest Post by Mark Knudsen
Proposal for Health Care Reform
Advocates of health care reform face two problems. First, it is too easy to opt out of paying for services and secondly, there are too many unaligned interests in the health care market unlike other commercial markets. The proposal below defines the health care market as medical, dental, mental and drug services and providers.
The first step is to require all people in the United States to enroll in a healthcare payment program or demonstrate that one has sufficient liquid assets to pay for services that can be attachable by a healthcare provider.
Employers, state and federal governments, providers, patients, drug companies, and insurance companies are currently involved in the marketplace. Each has different and conflicting interests. Of those involved, the employer has the no legitimate interest in health care. Eliminating the deductibility of health care expenses and rewarding companies who increase employee pay for the loss of this benefit would be the next step.
The third step would be to create independent consumer consortiums which would negotiate directly with insurance companies for benefit packages and premiums. Costs would become more apparent to potential patients, and patient needs more apparent to insurance companies.
Insurance companies would retain their care delivery contracts with providers. By being in direct conversation with subscribers, the insurance companies can more effectively pressure hospitals, physicians, drug companies, and other providers to meet changing consumer demands and to minimize expenses. Insurance companies who fail will become less competitive and lose subscribers. Providers would be more effective in negotiating their reimbursement levels given their knowledge of their patients and their needs.
State and federal governments would be the primary payer for indigent and special needs populations. They could enter into agreements with insurance companies to administer these programs or contract directly with delivery systems or specialty clinics. State and Federal government certification and licensure programs would be the only quality assurance standards for delivery providers. The federal government would be the reinsurer for extraordinarily expensive cases and for experimental efforts that show promise for a wide swath the American public. For example, the Federal Government would have reimbursed providers for Tommy John’s surgery in 1974, not the Los Angeles Dodgers.
Medical expenses incurred by a taxpayer are now an itemized deduction on Schedule A. Under this proposal, medical expenses would be an adjustment to adjusted gross income on a personal 1040.
Like any proposal, the devil is in the details. The transition period would be complicated and involved but removing the employer from direct involvement in the health care marketplace should make reform easier.
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5 comments:
If heaalth care providers handle payments and negotiate fees with medical providers there should be a defined profit for that service since it would be effectively a monoply.
Complicated makes it harder, but we have to keep trying.
The words "independent consumer consortiums" jumped out at me. How exactly would such bodies be staffed and maintained so as to retain independence alongside proper qualifications? If the comparison makes sense, I'm thinking of the historical (and yet necessary?) revolving door between top U..S. Treasury officials and e.g. Goldman Sachs.
Most of the Western world has it. We can’t figure it out? Or is healthcare now more political? Anytime you mix politics with anything, it gets worse.
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Peter C wrote:
"Most of the Western world has it. We can’t figure it out?"
Free healthcare is never free.
During my international travels, I learned a lot from my coworkers in Europe. None of them had issues with healthcare in Western Europe, but they told me stories about those who did.
Some had additional health insurance to get faster access to needed services. In other words an additional health benefit from their employer. They told me stories about the wait times for ordinary appointments and care.
I met people traveling from Europe who were traveling to the states or other countries like Canada to get more timely care as they did not want to wait for their free healthcare.
In general, though, many of those Europeans were a bit more healthy than the typical American.
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