We haven't heard the details of Obama's ambitious plan to "fix" the healthcare system, except that it will require another $600 billion to do it.
But we have a pretty good hunch of some of the plan's components. Let us know if this seems off-course:
- A push on electronic healthcare records, complete with obligatory press conference involving executives form Google, IBM and Microsoft.
- A lot of talk about "prevention" and how investing money upfront will save us money down the road. This will be the guise for all kinds of different tiny initiatives.
- More health resource in the school system.
- Greater funding for states, Medicare, Medicaid, etc.
- More means testing.
- Lots of little stuff like sex ed and organic food things that gets blamed on Pelosi.
- Tax credits for employers that provide health insurance to their employees.
- A bigger push on health savings accounts (a nod to Republicans)
We're winging this a little, but does this sound about right to you? Unfortunately, while some of this may be useful, none of it gets at the core issues.
So here's what we'd like to see, in no particular order. Note that he overall emphasis is on returning to the idea of a market for healthcare, where consumers make healthcare decisions like everything else, searching out the best product at the lowest price.
Sever the link between employment and health insurance. We've discussed this one a lot, but basically there's no reason an individual shouldn't be able to buy on the open market the same (or similar) policy that their employer buys for them.
Emphasize catastrophe insurance. There's no reason that insurance should pay for day-to-day or month-to-month basic drugs. There's no reason insurance needs to pay for glasses. And there's no reason insurance should be used for basic check-up stuff. Let's remember what insurance is for: it's to insure against the unexpected: Car crashes, cancer, broken bones, stuff like that. It's rare, unpredictable stuff that's unlikely, but would be bankrupting if it were happen. That's what you need to insure against. Insurance that pays for basic medicines is like the idea of food insurance to protect against hunger around lunchtime.
Change the FDA mandate. The drug approval process is insanely expensive, in part because the demands of the FDA have grown over the years. Rather than having it determine what works or what doesn't, let it just focus on what's safe. As for efficacy, let the trade journals and informal networks of doctors work that out for themselves.
Give out fewer patents. As it is, the legal costs of one drug company suing others for patent infringement is out of hand. Fewer patents should be awarded on molecules that are very close to existing patents. Rather, give companies patents for molecules that are novel, and you'd get drug companies spending their money on innovation, rather than law or marketing.
Bust the medical cartels. This is a big one. We don't need a doctor or even a well-educated nurse to perform basic medical functions. Throat infections, ear infections, urinary tract infections and other basic maladies could be diagnosed by someone with minimal training. Maybe $20 a pop. To get there, we need to neuter the AMA (aka the Doctors Union) and perhaps even the Nurse's union, which don't want lower-paid clinicians doing basic jobs. Sure, there's an issue that arises when an issue is literally above their pay grade, but they could be trained to kick a patient upstairs when they're unsure of what to do, or how to diagnose the patient.
Let pharmacists write prescriptions. This works in Europe. It's a waste of time and money to have to see a doctor every time you need a certain drug. Pharmacists could use their judgment and sell them directly when appropriate. That goes along with busting the AMA cartel.
Make public healthcare spending more performance-based. Government dollars shouldn't simply be based on procedures performed, but on outcomes.
Subsidize private insurance for the poor. We've decided as a matter of policy that some socialization is inevitable, so the best we can do is to make that work better. Rather than have the poor use emergency rooms all the time, costing the system tons, have the government pay for some basic form of private insurance -- ideally catastrophe insurance. Also, if you do the other stuff, like allowing greater use of clinicians, the poor wouldn't need to see expensive doctors for basic stuff.
These are our (incomplete) suggestions. They don't solve all of the problems facing healthcare, but they offer a good start towards improving cost and quality. Let us know yours.
