Tuesday, July 21, 2009

Health Insurance

Costs and Revenues
For whatever reason, US ideology makes it impossible to have a single payer system. In addition, the major players in the for-profit health system are too powerful to attack directly. That is why we have this repellent spectacle of the Democrats dancing around trying to make fundamental improvements in outcome by snipping and tugging at the system's edges.

Everybody knows that a number of measures, if seriously pursued, would sharply reduce costs. I would start by beefing up enforcement to prevent the endemic fraud in Medicare, Medicaid, and other gov't programs. There are plenty of other good ideas around.

Dealing with malpractice would also have a major impact. The basic problem is that medical communities don't police themselves, government won't, so the lottery-like litigation system is all we have. I suggest that states create boards consisting of retired professionals (doctors, lawyers, accountants, actuaries, etc.) to review every malpractice claim in what would be essentially an arbitration hearing. The board's opinion would be appealable, and if reversed a board with different members would hear the case all over again. A worker's comp system of valuing such intangibles as pain and suffering could be created as well.

One of the striking things about the debate on revenues is how much everyone seems to ignore Obama's clear and simple point: that of all the possibilities, doing nothing is the most expensive. So if the CBO says this plan will "cost" x billion, that's without subtracting the cost of the present system; it's comparing the new cost, not with the higher one currently in place, but with no cost at all. Idiotic!

There are also various ways of generating revenue that don't seem to be on the table at all. For example, increase the Medicare copay. Or, since so much of the cost falls in the last 6 months of life, require a copay by the estates of the deceased.

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