December 14th, 2009 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
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Over at The Corner, Ramesh Ponnuru theorizes that people want more control over how they spend their health care dollars:
[Ezra] Klein’s argument is that if employees understood that the employer’s alleged share of their health-care costs are really part of their wages — and if they saw it on their paychecks — they would be more supportive of cost control. I agree with that. But I assume he means (based on his examples in this op-ed) that they would be more supportive of cost controls imposed by HMOs or Congress. I think they would be more inclined to favor turning over control of health insurance from their employers to themselves, and making the cost-quality trade-offs for themselves with their own money. Under the status quo, those trade-offs are made by other people and the fact that it’s the employees’ money is obscured.
It sounds nice in theory. But in practice it seems to be exactly wrong.
Here’s why. Read more »
*This blog post was originally published at See First Blog*
September 16th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
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by Charles W. Patterson, MD
Health care reform has long been one of my main interests and currently, it seems to be everyone else’s. The President said he thought a single-payer system would be best, but submitted a proposal he thought could be passed. The outcome is in doubt.
Actually, the single-payer system is the second best possible solution. The government would hold the money but would remain vulnerable to political manipulation, bureaucratic inefficiency.
The best system would be a well regulated “Everybody Hold Your Own Money and Pay Your Own Way System.” It would empower patients to deal directly with their caregivers without third-party interference or regulation and lead them to become sensitive to the potential benefit and the cost of their care.
This could be accomplished without taxes and without insurance premiums by a properly designed system of health care savings accounts (HCSAs). These should be funded with pre-tax money from regular automatic savings, like payroll deductions, and everyone should have one from birth. Children’s accounts should be funded by their parents. In only a couple of years, normally healthy people would save enough to stay ahead of their health care expenses. They would save the same money they now pay in insurance premiums, so once in place, the new system would cost less because no money would go to insurance company administration and profit, and unnecessary procedures and tests would decrease because people would keep the money they didn’t spend.
When any account becomes large enough to cover anticipated needs (with, say, 90 percent probability) the extra money could be rolled over into a retirement account, or children’s HCSAs. At death, a person’s HCSA could be rolled over to heir’s HCSAs, after an inheritance tax which would be used to fund HCSAs for the poor and unhealthy. Everyone would keep the money they didn’t spend, so they would not spend it unnecessarily.
Government’s role would become only regulatory. A commission might be needed to determine a fair market value for services and patented drugs, but it is likely that market forces would control these and make the mix of available services more appropriate to people’s needs.
To insure that account money was spent on effective care, and not wasted or stolen by fraud, standards of medical practice should be established with a Wikipedia-style online system to allow each licensed practitioner and researcher to propose, amend and vote on standards of practice in his or her’s field. A true consensus statement would then be available on every relevant standard of practice, which would be more up to date and represent truly effective practice, better than the opinions of a panel of “experts.”
The quality of evidence on any issue varies from one study to the next, and leaves room for differences in opinion about what is good treatment. HCSAs should be allowed to pay for all procedures which received an overwhelming vote of approval, and not for those with overwhelming disapproval. The more money in an account, the lower a procedure’s vote would need to be to have it included. The list of approved procedures would change, and its quality would improve as fast as new evidence and experience accumulated.
Regulations should also end patents for new drug which do the same thing as established drugs, as well as new preparations of established drugs. Advertising of prescription drugs should end, because it leads to unrealistic expectations and misdiagnosis. And these regulations should require saved money to be invested conservatively.
Charles W. Patterson is a psychiatrist.
*This blog post was originally published at KevinMD.com*
August 17th, 2009 by GruntDoc in Better Health Network, Health Policy, Opinion
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John Mackey is the CEO of Whole Foods.
John Mackey: The Whole Foods Alternative to ObamaCare – WSJ.com
While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:
Make sure you read toward the end to see what the Whole Foods Canada employees ask for…
Update: the reality based community took this very well…
*This blog post was originally published at GruntDoc*
February 17th, 2009 by Dr. Val Jones in Health Policy
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Republicans do not support Barack Obama’s economic stimulus bill, nor are they too keen on the democratic approach to healthcare reform. Congressman Paul Ryan outlined an alternative approach to healthcare reform at the recent Medicare Policy Summit conference. His key points:
1. All Americans should have access to the same health benefits that federal employees have. They receive a medical savings account, with subsidies offered when they are sick, according to their need. Full support is available for low-income beneficiaries, while partial support is offered to high income beneficiaries. Ryan argues that targeting Medicare according to need will keep the program solvent (rather than offering full coverage to the very wealthy, etc.)
2. Tax credits should provide the basis for healthcare coverage so that individuals are not dependent on their employers for health insurance. Individuals would purchase their own health insurance either via their employer or on an open market that would promote competition between the plans to drive prices down. Individuals would be able to keep the remainder of their tax credit if they select a health plan that costs less than their yearly credit.
3. Americans will be allowed to purchase health insurance across state lines, allowing them further coverage options and increasing competition among the plans to decrease costs.
4. Small businesses may join a national group (Associations Health Plans) to pool risks and drive down the cost of providing health insurance to their employees.
5. States would create “high risk pools” for people with pre-existing conditions who could not afford insurance premiums. Federal funding would help to offset the cost of insuring these individuals.
Ryan explained that the Ways and Means Committee that oversees Medicare is basically “a bunch of politicians sitting in a room playing Caesar – giving either a thumb’s up or thumb’s down to healthcare reform and finance issues.” He warns that they will be doing a lot more of that if America continues on its current course of “more regulation, with the federal government dictating the practice of medicine, and rationing our healthcare.”
Ryan’s predictions are grim:
1. Within 2 years 17% of our economy will move from the private sector column to the public sector column.
2. Pete Stark will lead the charge for an Institute of Comparative Effectiveness to direct care choices in medicine. Physicians will have fewer treatment options to offer their patients.
3. Small health plans will go out of business, leaving only a few large plans, with decreased competition and fewer choices for consumers.
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For more information about Ryan’s views, please check out The Roadmap For America’s Future.
