Tuesday, July 21, 2009


Rather then just bashing Obama’a approach to healthcare, I would like to offer up a few suggestions that could make the system better, and not cost the government or taxpayers any extra money.

Health Care Fee Reform

I think there is a fundamental problem with the way fees for services are determined. The way the system works now different patients are charged wildly different amounts for the exact same services. This is completely unfair and a huge problem with the current system. If you are a Medicare/Medicaid patient a small amount is charged. If you have health insurance, you will be charged different larger amounts based on what brand/type of insurance. Lastly, if you are uninsured you will be charged way more (sometimes 5x) what the same insured person would pay. This last part artificially inflates the “cost” of the uninsured on the system, and makes it prohibitively expensive to not have health insurance. Fees should be mandated to be identical for all patients, and should be set by the provider at a competitive rate of their choice. Medicare, Medicaid, and Private Insurance can say what the maximum fee they will cover per procedure is, and the patient can pay the difference if any. This allows for higher levels of service for patients willing to pay for it, and can allow for low levels of service for Medicare/Medicaid patients. It also allows for people to forgo health insurance altogether, and just pay as they go without getting completely ripped off by the provider on the same exact services. If people had a reasonable option of not getting insurance, it would help to keep a lid on insurance prices. Also insurance prices could be held in check on some policies by not increasing the payout amounts, and forcing the patient to pay a larger difference amount over time.

Tort Reform

Part of the increasing cost of health insurance is due to the many expensive lawsuits that are lost and defended every year. I would fix this, by having a two-tier fee schedule. The low base fee would come with an agreement to settle all claims in arbitration with a 2 million dollar cap. For an extra fee of $10 to $20 per procedure, you could waive the arbitration requirement, and waive the max. settlement cap. The extra fees would pay for the insurance to cover the extra liability. This way all patients do not have to pay for the costs associated with massive lawsuits.

Emergency Room Reform

Nobody should be turned away from an emergency room with an immediate life threatening condition or after a serious accident. However, if you show up at an emergency room for a regular doctor visit of some sort, and not with a life threatening condition, hospitals should be required to deny emergency room care. They simply should be refer the patient to the nearest walk-in clinic, and face no penalty from the government for doing so.

Health Insurance Reform

Government regulations on health insurance need to be greatly reduced. If we simplify the fees as stated above and go with a transparent/identical fee structure for everyone, insurance plans should be able to just state what they pay per procedure, and offer whatever coverage they want to. There should not be any minimum level of coverage mandated by the government. Where government regulation should exist, is in denial of claims. Once you are accepted for insurance, and have paid your bills you should never be denied coverage for any reason. Pre-existing conditions may get an exception here, but that is it. You apply for health insurance and unless you are outright lying about a major pre-existing condition, you can’t be denied coverage once accepted. This would eliminate tons of headaches and lawsuits from the system. Insurance providers may need to beef up their prequalification process, but that’s the correct way to do it.

Pre-existing Condition Reform

I am totally against allowing someone to go without insurance until some major problem happens and then apply for insurance to cover it. That is simply not fair, but seems to be what the liberals are after. I think that as long as you have had “continuous coverage” of health insurance, pre-existing condition requirements should be waived. If you are laid off at work, and are going to lose your existing policy you should be able to roll your insurance over to a new carrier with no penalties or pre-existing condition checks. If you have not had “continuous coverage” you should have to pay a much higher premium or simply be denied for health insurance coverage. Currently, many people are trapped in their jobs due to a medical condition that would be pre-existing if they switched insurance, but that is really not fair. Denial for pre-existing conditions should only be used against those who do not have current coverage.

Health Care Record Reform

I actually think there is some cost savings to be had here. If privacy concerns, can be addressed electronic health records could be a real cost saver, and help to reduce medical errors. How many times have you filled out the same medical form when visiting different doctors? They should standardize on electronic medical forms, and they should be filled out once, and updated on an ongoing basis. This eliminates the cost of obtaining and entering the same information over and over again in different computer systems. This can be entirely paid for by fees charged to doctors. Charge a $5 fee per medical record pulled for a while to cover the costs. The doctor’s office saves the time and money to print out paper records, and enter them into the computer offsetting the $5 cost.

Dealing with the Uninsured

Well I have not said a thing about what I would do here, or if it is even an issue. I think this is a small issue that is overblown, but I have a solution. The fee reform ideas will allow many to safely go without insurance, and not sacrifice on care. There should be some type of supplemental insurance that only covers major issues (say 10k or higher in bills), that pay as you go types could get. What’s left are illegal immigrants that should not get insurance, and those who simply can’t afford it. For those that can’t afford it, we need to come up with a bare bones policy that has high deductibles, co-pays, and low levels of coverage. No optical or dental should be included and only generic drugs where possible. The monthly cost of such a plan could be kept small, but it would be pretty shitty coverage. When the uninsured show up for treatment, they should be required to apply for the low cost plan, and pay all co-pays, deductibles, and fee differences when seeking treatment. They can ask for assistance there as well. The government then determines if they have the ability to pay all or part of the premiums, and deducts from a paycheck as required for the barebones coverage, and supplements the rest. This way the uninsured get some low level, bare bones coverage at some government expense, but would still need to shell out cash when receiving services. The poor coverage is a great incentive to go out and get a job and get better employer health insurance, or to afford a better private insurance policy.

I think all of the above are good logical steps to take to contain health care costs and get more people covered. The best thing is that none of them include a competing government plan, or require large amounts of government outlays to put the reforms in place. It’s more about writing some new regulations to address the issues rather than creating a costly government run mess to do the same. We simply can’t afford to raise taxes in anyway in the current economic situation. An approach like the one above is all that is currently possible with today’s budget deficit, yet it will still go much farther in reducing cost growth long-term than an expensive government run option.

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At 7:39 PM, Blogger Kevin said...

Regarding your suggestion on standardizing medical forms..in theory, I think it is a good idea. Unfortunately, all of the large EMR vendors have their own forms and the systems don't communicate with each other.

At 9:02 PM, Blogger John said...

Obamacare will cost this nation thousands of jobs. We are discussing the 40,000 medical device sales representatives who will lose their careers under this plan. You can follow this discussion at http://www.gorillamedicalcare.com/blog

At 8:40 AM, Blogger jjok said...

good post blinders.....solid


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