Lots of negative reasons why the new government health program won't work. Of course if you look closely, many of those against the program and are the most vocal in their biases, are what we know as "special interests" groups or lobbyist for companies, health plans, insurance groups who make lots of money with the current system. Of course, most of these groups will continue to make lots of money, regardless of what happens.
On the other hand, people like Bill, Ian and many of the educated and knowledgeable people who should know what will work, don't get asked by the powers that run our government. So on behalf of all us quiet but concerned citizens. . . What would work???
I remember hearing about a system of points, that one of our states tried, that was simple, fair and worked. Had something to do with people who needed health care being graded according to a system based on the illness, age of the person and a number of other criteria that essentially based the amount of money and other resources that could be used to treat the person on the total points the person earned on the evaluation form.
I don't have time right now to look up which state, but I think Bill and I discussed this a couple years ago and I'm sure he will be able to explain the system better than me.
What is the best health plan?
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gmattson
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What is the best health plan?
GEM
"Do or do not. there is no try!"
"Do or do not. there is no try!"
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Bill Glasheen
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Intelligent people will differ.
Some of what will work MAY be in the new health bill.
One idea that's been around forever (from Enthoven) is the concept of a purchasing cooperative. In other words if I'm not getting insurance from a large company, I can pool my risk in with many others and not have to worry about when/if I get sicker and having my premiums jacked up because of it. This is mentioned in the new health bill, with the individual states putting the purchasing cooperative together. Large groups also have bargaining power against the insurance companies, just as large insurance companies have bargaining power with the doctors and hospitals. We sometimes refer to that as the 800-pound gorilla effect.
Individuals should get the same tax benefit as those working for companies. Period. End of story. I can't tell you how pizzed off I was last year when having to buy individual insurance with after-tax dollars (when I worked as an individual consultant). Good for me that I had great health. Bad for me that I wasn't given the Uncle Sam benefit as others. That's just wrong. And I don't believe that's been fixed.
Something has to be done to increase the numbers and reimbursement of primary care docs. This has not been fixed. In fact... Obamacare will break an already-taxed PCP system. Expect Nurse Practitioners and Physician Assistants to get battlefield promotions once the schit hits the fan. PCPs are the best way to have coordination and continuity of care.
And a PCP empowered with an Electronic Health Record THAT EVERYONE USES has the ability to track your care through the fragmented system and keep bad things from happening to you. Such a PCP also can take advantage of process quality software that gives MDs reminders and ticklers when Mrs. Jones needs a service. That system also prevents duplication of services such as imaging and polypharmacy. Right now I'm trying to do that for my dad who is 88 with metastatic prostate cancer and takes 5 different medications. He could never negotiate the system the way I can.
MDs need to be rewarded for keeping you as healthy as possible, and not by how many services they do for you. "The system" has been working on this for years - with mixed results. HMOs with gatekeepers (IPO or staff model) were supposed to solve the problem, but consumers rebelled when unemployment was low. The latest idea is something called a medical home. I was actually involved in setting up such a demonstration project as a partnership between a Harvard researcher and my previous employer. Funds are available (I THINK...) with Obamacare to help facilitate it. But I don't see these funds being anything to write home about.
The "keeping you as healthy as possible" can be measured using software I've designed with my previous employer. Using diagnoses, age, and sex, you predict how much someone should cost. If they beat the projected cost, then they get some of the savings. If they also score well on myriad process quality measures (> 100), then you give them bonuses.
Some way and some how, individuals need more skin in the game. That means MORE shared cost for the consumer. We consumers need to feel some of the pain. Otherwise we'll want Mercedes when Honda is cheaper and often more reliably good.
Tort reform, tort reform, tort reform. I'm not talking little here; I'm talking major paradigm shift. By throwing 30 million people into funded health care, you've just made it possible for trial lawyers to troll the trailer trash for "get rich" health care litigation. By increasing access to medical information (via EHR and better MD-MD and MD-Hospital communication), you're arming lawyers with ammo when you should be arming the quality assurance people. Something's got to change. But don't expect that from a Congress that's in the pocket of the trial lawyers. So what we have here is a continuation of information fiefdoms because nobody wants to feed the trial lawyer bears. And that's wrong, dumb, and inefficient.
That's my 2 cents and some change.
- Bill
Some of what will work MAY be in the new health bill.
One idea that's been around forever (from Enthoven) is the concept of a purchasing cooperative. In other words if I'm not getting insurance from a large company, I can pool my risk in with many others and not have to worry about when/if I get sicker and having my premiums jacked up because of it. This is mentioned in the new health bill, with the individual states putting the purchasing cooperative together. Large groups also have bargaining power against the insurance companies, just as large insurance companies have bargaining power with the doctors and hospitals. We sometimes refer to that as the 800-pound gorilla effect.
Individuals should get the same tax benefit as those working for companies. Period. End of story. I can't tell you how pizzed off I was last year when having to buy individual insurance with after-tax dollars (when I worked as an individual consultant). Good for me that I had great health. Bad for me that I wasn't given the Uncle Sam benefit as others. That's just wrong. And I don't believe that's been fixed.
Something has to be done to increase the numbers and reimbursement of primary care docs. This has not been fixed. In fact... Obamacare will break an already-taxed PCP system. Expect Nurse Practitioners and Physician Assistants to get battlefield promotions once the schit hits the fan. PCPs are the best way to have coordination and continuity of care.
And a PCP empowered with an Electronic Health Record THAT EVERYONE USES has the ability to track your care through the fragmented system and keep bad things from happening to you. Such a PCP also can take advantage of process quality software that gives MDs reminders and ticklers when Mrs. Jones needs a service. That system also prevents duplication of services such as imaging and polypharmacy. Right now I'm trying to do that for my dad who is 88 with metastatic prostate cancer and takes 5 different medications. He could never negotiate the system the way I can.
MDs need to be rewarded for keeping you as healthy as possible, and not by how many services they do for you. "The system" has been working on this for years - with mixed results. HMOs with gatekeepers (IPO or staff model) were supposed to solve the problem, but consumers rebelled when unemployment was low. The latest idea is something called a medical home. I was actually involved in setting up such a demonstration project as a partnership between a Harvard researcher and my previous employer. Funds are available (I THINK...) with Obamacare to help facilitate it. But I don't see these funds being anything to write home about.
The "keeping you as healthy as possible" can be measured using software I've designed with my previous employer. Using diagnoses, age, and sex, you predict how much someone should cost. If they beat the projected cost, then they get some of the savings. If they also score well on myriad process quality measures (> 100), then you give them bonuses.
Some way and some how, individuals need more skin in the game. That means MORE shared cost for the consumer. We consumers need to feel some of the pain. Otherwise we'll want Mercedes when Honda is cheaper and often more reliably good.
Tort reform, tort reform, tort reform. I'm not talking little here; I'm talking major paradigm shift. By throwing 30 million people into funded health care, you've just made it possible for trial lawyers to troll the trailer trash for "get rich" health care litigation. By increasing access to medical information (via EHR and better MD-MD and MD-Hospital communication), you're arming lawyers with ammo when you should be arming the quality assurance people. Something's got to change. But don't expect that from a Congress that's in the pocket of the trial lawyers. So what we have here is a continuation of information fiefdoms because nobody wants to feed the trial lawyer bears. And that's wrong, dumb, and inefficient.
That's my 2 cents and some change.
- Bill
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gmattson
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Not a bad start Bill. . .
How about if we level the playing field???
This was forwarded to me by Joe Lewis. At the very least, whatever Washington foists on us would be something they would have to live with as well. . .
This was forwarded to me by Joe Lewis. At the very least, whatever Washington foists on us would be something they would have to live with as well. . .
An idea whose time has come
For too long we have been too complacent about the workings of Congress. Many citizens had no idea that members of Congress could retire with the same pay after only one term, that they didn't pay into Social Security, that they specifically exempted themselves from many of the laws they have passed (such as being exempt from any fear of prosecution for sexual harassment) while ordinary citizens must live under those laws. The latest is to exempt themselves from the Healthcare Reform that is being considered...in all of its forms. Somehow, that doesn't seem logical. We do not have an elite that is above the law. I truly don't care if they are Democrat, Republican, Independent or whatever. The self-serving must stop. This is a good way to do that. It is an idea whose time has come.
Have each person contact a minimum of Twenty people on their Address list, in turn ask each of those to do likewise.
In three days, most people in The United States of America will have the message. This is one proposal that really should be passed around.
Proposed 28th Amendment to the United States Constitution
"Congress shall make no law that applies to the citizens of the United States that does not apply equally to the Senators and/or Representatives; and, Congress shall make no law that applies to the Senators and/or Representatives that does not apply equally to the citizens of the United States; and, the President shall not sign any bill into law that exempts the members of Congress and Senate from the same laws of the citizens of the United States of America."
GEM
"Do or do not. there is no try!"
"Do or do not. there is no try!"
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Bill Glasheen
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