March 8, 2006

Single Payer Hackery

In the comment thread for one of Drum's typical single payer blurbs is this about how the US health care system sucks compared to the Canadian system:

She is also able to get to see her G.P. typically on the same day, an experience I have yet to enjoy here in the US. Instead, I'm told to go to an urgent care clinic where I pay more out of pocket.
Perhaps this guy should get a different GP! My family is routinely able to get in to see our GP on the same day. The rest of his comparisons are pretty much anecdotal apples and oranges.

As to Drum:

1) Well, yes the government incented and dominated US system has big issues. As usual Kevin wants more of the same.

2) He has the solution for both Canada and Britain's systems: Decent funding levels would make both of them a lot better. Yep, if it ain't working throw more money at it.

Kevin, some day the money is going to run out....oh yea, as the bushies demonstrate on a daily basis it already has.

Posted by Steve on March 8, 2006

We live in a wonderful nation nearly three hundred million strong. Among us are some of the brightest minds in every field of study. When we have had great leadership, we have dedicated ourselves to great and noble causes before and accomplished near miracles in short periods of time. The time has come for us to rally around a cause so glaringly obvious that it is clear both to those on the far left, the far right and everyone in between. We need a health care revolution in this country.

Many who see the problem look to solutions provided elsewhere in the world and see a government run, single-payer, universal health plan as the solution. I believe this solution to be so, well, been there, done that, 1965 thinking. It has never worked brilliantly anywhere it has been implemented. Some countries have better systems than others, but all the countries provide marginal service which is neither cost-effective, nor patient friendly.

There is no doubt that our complex patchwork of pseudo-systems is the most expensive in the world and provides service that while the best in the world for many, is only average in spreading that greatness across “universal” coverage. It is important to note that even in countries which provide “universal coverage”, the populations on a whole are not universally covered. For example, small pockets of rare minorities always get the worst service.

I think that we should be ashamed of ourselves if we accept a single payer system that has really failed to produce anything but mediocrity in every country it has been tried in. Additionally, our country is exponentially larger than these others and so the systemic faults would be proportionally larger in our application. The cost would be astronomical in both dollars and human suffering.

The good news in that we can draw on the brilliant, talented and caring members of our large community and come up with a system so wonderful it becomes the model for the rest of the world to emulate. Any new system should include three main components:

1. It must be universal in nature where everyone is covered through a combination of free market plans, federal re-insurance funds, and a redesigned Medicare safety net.

2. It must provide individual portability so consumers can change plans regardless of pre-existing conditions.

3. It must provide a plethora of free market plans which allow individual consumers the range of options to pick a plan that fits their balance of need and budget. Even low wage earners should be able to buy simple plans to at least cover some of their health care needs.

Additionally the plan should include three core economic elements:

1. Pre-Tax Medical Savings Accounts: Consumers can buy a variety of their health care needs in cash transactions which uses market forces to increase competition and drive down prices. Routine medical exams, some prescriptions, immunization, simple blood work, dental cleanings, and other small or routine expenses all could be paid for from these cash accounts.

2. Consumer purchased insurance plans. - These plans would cover consumers for expenses greater than those paid for from health savings accounts, and for things which require ongoing treatments. All plans would, or at least could, have ceiling limits where responsibility of liability is transferred to larger, or perhaps national, re-insurance fund. Consumer would no longer get health insurance through their employers. Transitional regulations would force business to give raises to all employees based on the cost of their health care.

3. National Re-Insurance Fund – This fund, separate from the general funds of the government, is used to cover catastrophic health needs allowing insurance companies to cap their liability which will allow companies to provide much more reasonably price plans. This re-insurance fund would also be set-up to cover the “policy portability” issue. If consumers need to switch insurance companies and pre-existing conditions make it difficult for free-market forces to work unabated, consumers would get help paying premiums with a re-insurance fund co-payment. This re-insurance treasury would be funded by a surcharge on health insurance premiums of about five percent paid equally by consumers and insurance companies.

Regardless of the specifics, I am sure that if we pool our minds, our hearts, and our resources together we can create an amazing system that really delivers world-class, top-notch, health care to each and every member of our society without breaking the back of anyone. I know that if we dream together, debate together, and work together, we can create a true masterpiece of public policy remembered hundreds of years from now for it’s brilliance. Or, we can use a tired old system more reminiscent of the 19th century than of the 21st. It is up to you. Do you want the best the world has to offer? Or, do you just want to settle for the same dysfunctional system much of the rest of the world wishes they didn’t have either?

Let’s start a true health care revolution! – (Peaceful please, no need for violence.)

Posted by Chad Currin at March 9, 2006 10:49 AM
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