01 December 2009
Three Keys to Health Care Reform
The health care reform debate has become an ideological battle defined by those who wish to avoid facing the fact that some things are indeed better done by us collectively through our government. It is those contrarians who have tried to make the matter of providing equal access to the benefits of medical science an issue of equalizing the cost for everyone of a minimum level of health care. The American ideal to assure equal opportunity for becoming and staying wealthy is not incompatible with the ideal of assuring equal care for physical and mental illnesses. Our capitalist system has generated enough wealth to allow all our citizens to eliminate the handicaps on the fulfillment of their dreams caused arbitrarily by poor health. Three systemic changes will be required:
The U.S. health care system needs to cut the tie between the supply of medical service and payment for it. For that to happen, insurers must collect premiums according to subscribers’ ability to pay, regardless of their previous medical condition. The premiums will range from zero to as much as the 16% level that our overall health care industry represents of GDP. Part of this tax will be paid by employers and may alter the compensation plans they offer their workforces. Presumably, the graduated income tax and payroll taxes will be adjusted to reflect a reduction in the government’s responsibility for sharing the health care burden.
Insurers, including the public plan, if there is one, will pay primary care physicians on retainer, at a standard rate for each patient, and pay any specialists designated by the Primary on the basis of “fee for service.” The Primary will also receive an annual bonus based on the medical outcome of each patient, which he may share with associated specialists.
Co-payments will be required; but any patient will have the option to withdraw from the system by forfeiting his insurance premium and purchasing care privately. Insurers will essentially be administrators, for the risk of arbitrary medical afflictions is assumed by the entire system. The insurers compete with each other and with the public plan, if there is one, on the basis of efficiency and ability of their affiliated providers to optimize medical outcomes.
The two goals of health care reform are to improve medical outcomes overall and to control overall costs. As pointed out by Professor Paul Starr in his OpEd article in the November 29, 2009, New York Times, “Public Option,” we have no time to lose if we are to avoid the cost disaster; but he fails to direct his prescription for regulatory reform to the appropriate part of our health care system. It is the providers--doctors, clinics, and hospitals—who need to be relieved from their reliance on the “fee for service” model. Health care reform will only happen when providers are compensated for results rather than for procedures.
The health care reform debate has become an ideological battle defined by those who wish to avoid facing the fact that some things are indeed better done by us collectively through our government. It is those contrarians who have tried to make the matter of providing equal access to the benefits of medical science an issue of equalizing the cost for everyone of a minimum level of health care. The American ideal to assure equal opportunity for becoming and staying wealthy is not incompatible with the ideal of assuring equal care for physical and mental illnesses. Our capitalist system has generated enough wealth to allow all our citizens to eliminate the handicaps on the fulfillment of their dreams caused arbitrarily by poor health. Three systemic changes will be required:
The U.S. health care system needs to cut the tie between the supply of medical service and payment for it. For that to happen, insurers must collect premiums according to subscribers’ ability to pay, regardless of their previous medical condition. The premiums will range from zero to as much as the 16% level that our overall health care industry represents of GDP. Part of this tax will be paid by employers and may alter the compensation plans they offer their workforces. Presumably, the graduated income tax and payroll taxes will be adjusted to reflect a reduction in the government’s responsibility for sharing the health care burden.
Insurers, including the public plan, if there is one, will pay primary care physicians on retainer, at a standard rate for each patient, and pay any specialists designated by the Primary on the basis of “fee for service.” The Primary will also receive an annual bonus based on the medical outcome of each patient, which he may share with associated specialists.
Co-payments will be required; but any patient will have the option to withdraw from the system by forfeiting his insurance premium and purchasing care privately. Insurers will essentially be administrators, for the risk of arbitrary medical afflictions is assumed by the entire system. The insurers compete with each other and with the public plan, if there is one, on the basis of efficiency and ability of their affiliated providers to optimize medical outcomes.
The two goals of health care reform are to improve medical outcomes overall and to control overall costs. As pointed out by Professor Paul Starr in his OpEd article in the November 29, 2009, New York Times, “Public Option,” we have no time to lose if we are to avoid the cost disaster; but he fails to direct his prescription for regulatory reform to the appropriate part of our health care system. It is the providers--doctors, clinics, and hospitals—who need to be relieved from their reliance on the “fee for service” model. Health care reform will only happen when providers are compensated for results rather than for procedures.
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