Saturday, November 6, 2010

FreedomCare: How I'd Do Health Care Reform

I believe that the following simple plan would be infinitely more helpful to patients than ObamaCare and challenge you to make a legitimate case why I'm wrong:

1. Per the post I just wrote, make health care provider training shorter and more practical. That would improve quality while reducing cost and increasing supply of providers.

2. Except for the truly indigent and for catastrophic health care, health care would be paid directly by the consumer. If consumers had most of the money at stake, 300 million Americans would be exerting the power of the invisible free hand of the market to drive down costs and improve quality. The good quality, cost-effective providers would succeed, the bad ones driven out of business.

3. To ensure that those consumers had the information needed to make smart choices of health care providers and procedures, there would be outstanding, easily accessible consumer information on all licensed doctors, nurses, hospitals, etc: for example, patient satisfaction (disaggregated by condition,) the provider's risk-adjusted success rates for different procedures, etc.

So what do you think of this plan?


Anonymous said...

Good start to a plan. Strengths of the plan:
Public coverage of truly catastrophic illness like mental illness, cancer, MS, ALS, etc.

Routine care should be made affordable to the masses through urgent care centers staffed by nurse practitioners and physician assistants that follow a career-oriented program that is shorter and affordable. Aim should be to get away from people using the emergency room and hospitals as centers for primary care.

Weaknesses: the free market cannot magically solve the problem of cost of care. How many world-class doctors, NPs, and PAs would be willing to work in the indigent care sector even if they were getting paid a fair wage (which is another discussion in it of itself)? I hardly can believe that the best of the best would want to work in the health care ghetto of poverty. AS you’ve seen in your practice, many doctors go into it for the money not the vocation of healing the sick regardless of ability to pay. And it would be an interesting experiment to compare scholarship-paid MDs to self-pay MDs (who take out loans) and see what careers they choose. Most will choose the comfortable high-wage lifestyle, even when not in debt up to their eyeballs. Maybe as a part of this, medical education needs to change to be like Medicins San Frontiere where you have to do residency in the health care ghettos before you can call yourself a real doctor. We all have to remember that the free market is not morally driven; proof of it is in Bernie Madoff, Enron etc. They were driven by the motivation to make money. Health care cannot be solely based on money; it has to be ethically and morally driven.

I think the solution lies in having publicly-funded scholarship programs that pay for medical education (any flavor, MD, NP, PA, etc.) in exchange for working at these urgent care centers in disease hot spots that are frequent in poor localities. Create the infrastructure to then facilitate the free market to take over.

Plus, I believe that if you want to be on the public assistance, than you must go through mandatory birth control/family planning counseling and proof of use of it, plus mandatory nutritional counseling, and psychological counseling in order to get your check. Any of these providers would be able to cut off your benefits if you're faking illness, etc. to get a check. We have to create a healthy stigma of consciously not bringing in children into the world that you're not prepared to raise and provide for materially.

The other point: many diseases such as diabetes and high-blood pressure are lifestyle-related diseases. No matter how great a medical practitioner you are, if the patient is non-compliant, they will be sick and there’s nothing you can do short of holding a gun to their head or having a professional chef prepare their foods to get them to eat right.

How would your health care plan deal with the non-compliant?

Marty Nemko said...

Thank you Anonymous. Payers and non-payers into the system should NOT be entitled to the same level of care. That's why I'm not concerned that the very best docs will choose to charge more. As long as the non-payers get a humane level of care (as you say, nurse practitioner-staffed urgent care, doctors NOT of their choice when needed, etc, I'm fine with the plan.

And yes, birth control counseling is key.

And we beyond decent health ed. in the schools, esp. in low-income areas, we cannot guarantee or should we waste the money to ensure compliance. If a person chooses to continue to smoke, do drugs, overeat, etc--it is his responsiblity. Yes, he'll get that basic level of humane care when he gets diabetes etc, but that's it.

ST said...

I wonder if 100% consumer funded (beyond catastrophic) health care would work. I would still think there'd have to be some sort of risk pool instrument (like insurance), to even out the costs for the average Joe. Health, like auto, home ownership and life expectancy, is a probabilistic phenomenon, but maybe there's a way, but I just can't think of how it would work.

Also, we have to be careful of the compliance issue and I agree with Marty not to deal with it. I have (slightly) high blood pressure and high cholesterol, and I run marathons and if you ask my coworkers who witness my salad bar lunches, and pretty healthy diet of fruits, vegetables, high fiber cereals, whole wheat bread, chicken and fish. Hardly any red meat, but I will splurge, and my weakness is some sweets. But, my parents both have high blood pressure and cholesterol also, so I've inherited their strong propensity genes for both. If I lost weight (about 15 pounds over what my Dr. says I should be) and ate like in an old folks home, maybe, those would go down. They have crept up as I've gotten older (in my 50's). So, my point it's a blurry line as to what following compliance is.

Anonymous said...

With the sweaping change in House and nearly the Senate. It appears from analysis that employers nationwide wide that GRANDFATHERED their health plan stand a better chance to weather whatever the Republicans can repeal in employer burden with health care reform. It is still likely that employers will still incure a penalty for every full time employee that refuses coverage. The penalty being $2,000. If you can GRANDFATHER your renewals this January you should do so to protect your backside.

Lightning Bug's Butt said...

I think you have a wonderful idea, Marty.

But so many people are cynical of market forces -- particularly when it comes to health care, which they feel should rise above it.

And that's why our healthcare system is in big trouble!


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