Reforming Health Care in the USA

Note this is a rough draft. The statistics are not sourced but are just plucked out of thin air. Later i hope to correct them and provide references.

If a person has a serious ailment, health care costs far more than the average American can afford out of their own pocket. Typically a major surgery procedure and the attendant stay in the hospital could cost as much as $200,000. But people need this health care - so how can we solve that problem?

Now it may be that the nation as a whole can afford appropriate health care for its citizens. We have many examples of other countries doing this quite successfully: for example Sweden, Canada, France and many others. But even when we can manage to implement such a national health care system, we will still end up with a staggering national bill for that care. Many will say that bill will be too high and since, with the current recession, it would need to be financed through deficit spending. That will end up plunging us further into a debt spiral which will bankrupt future generations. But we still need health care for all of our citizens, so how can we afford it without resorting to deficit spending?

The cartoon above points a way; but seriously the air fair will kill us. Let us look at where all the dollars go that go into health care and see if there is somewhere we can cut without sacrificial the quality of care. Here is a pie chart of where our health care dollars actually go:

What part of the pie can we cut without sacrificing the quality of care?

This is a work in progress. Contributions welcome, but any comments that are hyperpartisan, off topic, or miss the point will be summarily deleted.

Comments

Mark de LA says

I wouldn't put Canada on the list of the successful crowd. It is well known that they slip across the border to avoid long lines at home. When health care is considered as a commodity then it violates it's nature which is a service to humanity. It doesn't belong to the economic sphere. How to divorce it from that sphere is the question. Get rid of lawsuits related to providing health service. That is an encroachment of the legal sphere upon the domain of service to humanity. (spirit for those of you who grok the word). Add a new slice called spending on fitness & preventive medicine (prophylaxis), chiropractic, etc & mental health care & health care information systems. Emphasis on preventative medicine & such to intercept problems before they become a disease. Turn the problem of lawsuits into a high-strength, self-policing association or guild of medical service providers. The reputation of the entire guild is placed at stake. Transform the profit motive into a community status & recognition process. Provide the housing & family support for the health care providers free, but uniform. If hospitals & clinics are to make use of the guild members then they will have to transform their operation & behavior processes to conform to the highest ethical standards & virtues. Health care is beyond a right - it is a service to humanity; reward it as such. Education is also such a service but that is one for another topic.

Mark de LA says

A possible transformation model of an economically encumbered domain such as healthcare affects 2 groups - the direct providers such as doctors & the holders of the capital assets needed to provide the doctors with their tools; hospitals, MRI. The people in the equation are given homes & such as a level better than what they currently have but with the additional feature that they are almost resort level, but community facilities. The Apollo astronauts lived in such communities. The current NASA programs for the astronauts are a good example to follow. More perks are provided for the highest performers. All of this must conform to ethical standards of behavior. The real capital entities such as hospitals & clinics is a matter of competition. The support of the service to humanity sector is born by everyone- details to be worked out later. That is obvious when you figure out that everyone gets healthcare. Provide competition to current ones or convert them. There is a need of a transformation model for capital as well; a spectrum from market driven system to service providing system of capital. When a domain becomes free of the sphere of economics it also has to be free of governmental control & capital manipulation. ... more later

Seth says

source: M above
Get rid of lawsuits related to providing health service. That is an encroachment of the legal sphere upon the domain of service to humanity. [.....] Turn the problem of lawsuits into a high-strength, self-policing association or guild of medical service providers. The reputation of the entire guild is placed at stake.

This is the point of this item which you will see as i flesh it out. The collective benefit of malpractice suits should be to improve the overall quality of care. But in practice patients are compensated and their greed is stoked. No effective measures are taken to reduce malpractice; rather the results of settlements are by the most part hidden from the public. My solution is to not only ameliorate medical mistakes for patients in a no-fault non liturgical, non punitive procedure, but also to publish information about those making the mistakes so that the public can make better choices of medical practitioners. I don't think self-policing will work. Rather i see standardized web information service where you can view the risk associated for each prospective practitioner - kind of like ebay reputation.

Mark de LA says

Well, the lawyer lobby is extremely strong in Congress - this will probably never happen! OTOH, if you really want to fix things the way out of lawyer hell is to have a strong guild of doctors, better than the AMA & other current ones, who have such a pride & reputation that they can essentially blackball those who fuck up. The AMA is a lobbyest organization. Right now, it's mostly a joke like unions and associations whose main function is salaries & protection of their own. Public openness is a requirement. Also is pride & reputation. Astronauts have a certain pride & reputation. I expect that some new doctors & providers will have that too when the profit motive is removed. The key is self-organizing in balance with all the other factors. There will be a lot of dirty laundry to look at after the lawsuits are prevented from happening. Right now it is a RWG with doctors protecting their own because of lawsuits. Once that possibility is removed then doctors should not want to be associated with incompetent & the criminal.

Mark de LA says

10819: ... Sounds a bit like letting the fox guard the hen house. I would favor something like ..

... simply big dippering (fox guards hen-house) the self-policing distinction applied to medical personnel does not serve the larger purpose. I threw enough adjectives into the mix to remove your fears in that regard:

source: ... strong guild of highly professional medical caregivers having their own extra-judicial process of policing their members including expulsion & loss of licenses; no lawyers, insurance people or politicians allowed.

... i.e.

a strong guild - as opposed to a self-serving association of doctors with MD's etc
highly professional - people who care about the QA & QC of their practices
extra-judicial process - perhaps mediation, perhaps some other process which is as formal but more skilled in the details of medicine, psychiatry etc.
things at risk are loss of license & loss of membership both of which should be made valuble
absence of participants from the process which gummed the industry up in the first place like lawyers, insurance adjusters, hospital administrators & politicians .

Seth says

Good source: MALPRACTICE LIABILITY REFORM, MARK MCCLELLAN, MD, PH.D. ADMINISTRATOR

Seth says

Reforming Health Care in the USA

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