I wrote on someone’s Facebook page recently that it would be amazing what would happen if instead of these “comprehensive” health care reform plans (which are really mostly needless government meddling) Congress should decide what issues have 60-70% support and draft/pass one bill per month for the next several months. We’d have a better system that does repair some undeniable problem areas without utterly destroying a system that isn’t particularly broken for 85% of the population.
This post highlights some of what I think those areas are and invites others to chime in as well. When I say 60 – 70% support, I don’t mean me and the 60-70% of people who are closest to me politically – I expect some ideas would not sit well with me but have good solid support from the center-left “coalition”.
1) Let insurance companies sell health insurance across state lines. Even hometown newspapers agree this is a good idea. (http://www.chicagotribune.com/news/opinion/chi-perspec0823insuranceaug23,0,2946061.story). It’s no surprise the Wall Street Journal supports it. We need to let the marketplace compete in real terms and stop forcing people to buy coverage they don’t want or need just because they have the misfortune of living in a certain state. Different regulatory requirements from state to state impede innovation because a company’s investment to creatively solve a problem can only be used in a fraction of the population. It also drives away hungry start ups who can’t compete with well established incumbents in one state. Granted the incumbents got there because they offered a consumer option that was better than the alternative, but that’s not the point here.
A separate but related point is that providers should be able to offer services across state lines. The Mayo Clinic offers remarkable service via tele-medicine to Qatar, but is not permitted to do it in North Dakota because of silly state regulators.
2) Decouple health insurance from (specific) employment. I understand that health insurance companies underwrite the total number of lives in an employee pool, but seriously if they insured me at $X when I worked somewhere they don’t lose any money to continue that same coverage after I leave. It would be so easy to extend COBRA benefits duration to double what it currently is as an interim step so long as you had all the rights as an employee (e.g. not being treated like a month to month customer). Experts have been saying this is an issue for 30 years for lots of reasons.
3) Pass tort reform that would apply to every state as demonstrated in California (very blue state) and Texas (very red state). Premiums have plummeted in these two places by simply capping non-economic damages to $250k (still a lot of money).
4) Do something to control insurance companies ability to revoke coverage from people once they get sick. Clearly if someone lied on an application they should still be able to bump them, but if the information was available to the company at the time they offered coverage and the company still elected to insure the person, they should be prohibited from dropping coverage. (P.S. Very grateful to a very liberal friend of a friend who pointed out to me that this issue – known as rescission – is a bigger problem than I ever realized.)
5) This isn’t something I’m very much in favor of, but there seems to be good support for creating a government funded high risk pool to let insurers hedge their bets against the kind of people they typically deny coverage for, especially those with pre-existing conditions.
6) Repeal the medicare payroll tax and the accompanying joke called “earned income tax credit” which just aims to repay lower income earners for what the government took from them in the first place. Rich people are already funding poor people’s social security and medicare so let’s just stop kidding ourselves. (okay – this is just something I made up but I will never understand why we tax people like crazy just to give them their money back so they can have a free ride)
7) Prohibit doctors from taking payment from medical device manufacturers so they do not focus on their meal tickets instead of better, cheaper or less invasive technologies/procedures. There are huge conflicts of interest in this area, especially in orthopedics but other practice areas also.
8 ) Find a way to promote total case management over the duration of an illness/condition. This would mean better cooperation between providers, capping the total monies available to all parts of the health care delivery system to help ferret out waste such as rerunning tests and doctors visiting patients on rounds not because of medical necessity but simply because they had free time and a charge code. It would help the problems of fragmented care and medical errors tremendously. (5x as many Americans die every year from medical errors than from being uninsured).
8a) We need to transform the current year by year pricing mechanism to a multi-year model. Paying for per patient per procedure on a yearly basis penalizes innovation, quality, results and entrepreneurship. No other segment of our economy acts so counter-productively. Creating a multi-year system will provide incentive to do something in year one that would reap medical and financial benefits in year 3, driving down overall costs in the process.
9) Promote transparency of provider quality so we can make educated consumer choices like we do everything else. I actually believe this is the #1 problem in the whole system – we live in a free market system but none of those principles exist in health care delivery. Paying doctors on results of their performance not number of procedures would be an attractive way to accelerate this idea.