Tuesday, July 28, 2009

Health Care Alternative?

Health Care Alternative?

I want to start a process (I do NOT have all the answers... yet) where we try to develop an alternative to the current Health Care proposals floating around. I want this to be a new approach with the goal of ADDRESSING THE REAL PROBLEM while maintaining those aspects of the existing system which DO work and respecting the FREEDOM, RESPONSIBILITY and ULTIMATE AUTHORITY of the INDIVIDUAL (as advised by their caregiver; bureaucracy not required or wanted)

A. The primary objective is to provide Health CARE (not “insurance”) to those who legitimately 'need' care, but are unable to pay for it for whatever reason.

B. Private (personally controlled) insurance programs must remain viable and available.

C. Any Government action must be designed to provide actual SERVICES, not simply payment or other types of funding transfers.

D. Reasonable steps taken to recover payment from those able to do so once they are released from medical care.

E. Legal reforms to protect private facilities, physicians and staff from lawsuits (a "loser pays" lawsuit requirement, legitimate caps on fees and awards, etc.)

F. Implement mechanisms to remove the indigent (for lack of a better term) from the private system facilities ASAP. This will reduce crowding and provide cost savings for those who pay for their own care, while limiting 'rationing' at the private level.

G. Implement mechanisms to take appropriate action against usage of the government health care system by non-citizens.

H. TBD...

* * * * *

I propose we start by expanding the existing VA program, which is absorbed into a new, comprehensive service-providing system. (That there are problems with VA care points out that pre-existing government-provided services need fixing before implementing a radical modification to what we have... a topic for a different discussion.)

The basic idea is to allow the Government (VA) system to hire MORE / NEW doctors and nurses to provide (new) services for indigent care (all levels, not just critical care). Anyone needing EMERGENCY care can – as they do today – go to any facility (private or public). If you cannot (or will not) pay for the services received, the goal, at a private facility, is to provide the minimum care to stabilize the patent for transport to the nearest Government (VA) facility - and patient moves into that system until released. Once there, continued care, as defined by government staff is provided. Legal liability of the private facility and its staff is very limited (much tort reform needed here). Costs for transport and other costs assigned to government using standardized rates for billing from private facility with audits. BTW, here's a legitimate 'jobs program' to hire workers to build new infrastructure (buildings, offices, etc.)


1. NON-EMERGENCY care at an ER is immediately subject to severe legal procedures, starting with immediate jail time for not less than 72 hours.

2. Make it legal for PRIVATE medical professionals to refuse providing NON-EMERGENCY and/or NON-CRITICAL care (have to assist with transport to proper facility, but their liability ends there).

3. Non-citizens – when released from care - must assume a non-paid position as hourly government worker (building roads, janitorial, etc.) until some level of funding is recovered. 'Illegals' are incarcerated, and shipped ASAP to country of origin. Repeat offenders become permanent staff at correctional facilities (prisons, etc.). Cost of transportion and maintenance counts as 'foreign aid' and reduces ALL available funding to those countries accordingly.

4. Usage of government health services who are able to remain gainfully employed have wages automatically garnished (no tax 'refunds' either).

5. Mandatory (reversible) sterilization after government pays birthing expenses (or abortion expense) for more than one child. Reversing sterilization procedure must be paid in cash, in full, in advance by individual.

6. Private facilities have option to use same pricing of drugs and other medical supplies as agreed to by government (can work their own deal with suppliers, but start at government cost).

7. All health care insurance programs are paid for by the individual and follow the individual from job to job. Employer may choose to pay for all/ some of package, but all deductions for coverage belong to individual, not business: tax deductions belong to individual.

8. Insurance companies may sell programs across state lines, using any reasonable 'group rates' formula. Private programs are NOT required to provide all services, consumer may pick and choose coverage items (e.g., persons 60+ years old not required to have pregnancy coverage). Consumer choice, again.

9. Medical Student loans (if guaranteed by government) require X years of service at government facility before entering private practice.

10. TBD...

* * * * *

The point is to establish the Government as a CARE provider (not just a mechanism to transfer wealth from taxpayers to a favored group). Consumers have the OPTION to use the system or have their own. Government may use any criteria to provide (ration) care IN THEIR FACILITY ONLY. Staff to be hired by government system in competition with private marketplace.

I submit that overall "COSTS" will come down across the board by shifting the burden to where is costs reside, as opposed to trying to distribute the costs to everyone. Let those who make poor decisions bear the brunt of the risk...

Key point: CHOICE of using the Government Program remains with consumer – not mandated or required - avoid FORCING consumers in any direction, even "for their own good". The consumer assumes the RISK associated with not having adequate coverage.

BTW - My catchy acronym for this is: HEALTH by Government Alternative, Might Be Less Expensive... (the “HEALTH-G.A.M.B.L.E.”)

I know this new project will be tricky and challenging - especially given our diffenent apporaches to the situation by our respective outlooks. That's OK... I have started with a bizarre mixture of philosophical styles; some I don't like, but deem as necessary to achieve the goal.

I welcome your comments and feedback - This is a Real World problem, so let's set ourselves away from the drumbeats of the agenda-driven D.C. crowd and try hammering out details of a True Compromise and build something that will WORK. Propose new requirements or point out problem areas as needed. Enjoy the challenge.

- Steve


  1. First off, I hope you know this is going to take precious time away from my work on a response to the spurious JoNova article you sent me. Oh well.

    You say in your initial post some things I would expect, but also some things I didn't. This is impressive.

    I'll put together a post ASAP, and this time try not to be so anal retentive about it. The one thing I've always admired about you is the way you are able to get your thoughts on paper so quickly. Being a typical liberal, I suppose I am always second guessing myself - and this leads to constant revisions. Moral: libs should never challenge cons to a game of slap jack.

    On the positive side, dealing with you has forced me towards unlikely avenues of thought. For just one instance, I wonder what government's obligation (if we consider it a mandate) is to individuals who consciously pursue extremely unhealthy lifestyles. Should government be required to mend the bones (for nothing) of some knot head who crashes into a parked car while illegally base jumping from a building down town? Hmmm.

    Oddly, some of your main points have a lot in common with what conservative pundits have been deriding as "ObamaCare". I admit it is breathtaking to witness a conservative in the early stages of metamorphosis into a liberal.

    On the other hand, the penalties prescribe you are draconian. They have the dual nature of both offending my sensibilities and being conspicuously effective. My my...

    You mispelled "approaches" in your next to the last paragraph.


  2. Sorry for the typos - stuff happens and gets by when you move this quickly... (grin).

    Please understand I'm trying to collect aspects, ideas and concepts from all sides ('left, right, across and hold' is our blog's title, after all). There *are* good ideas all around - removing them from the ideological fluff allows one to appropriately consider their (a) reasonableness to a rational thinker, (b) relevance to addressing the Real Problem, and (c) likely outcome if implemented. Shifting through the chaff should be separate things into multiple piles, as it were. We just have to choose the right pile, no matter how bad it smells to some.

    And I'm hardly transforming into a liberal.. I merely recognize that my opinion - no matter how correct it may be - has little chance of being accepted by the great unwashed. ;-)

    That said, you won't be surprised that I think "penalties" are critically necessary to any comprehensive system. They are critical for two simple and obvious reasons:

    1. (really obvious) The demand for a Free Good is infinite. NO completely 'free' Health Care system can survive in that environment. Period.

    2. (a bit more subtle) Health Care is a SERVICE provided by one or more individuals, using their acquired skill, efforts and equipment. For anyone to receive health care, SOMEONE ELSE has to either expend their abilities, time, property or all of the above. Therefore, claiming a "right" to health care is to claim a "right" to someone else's Life (in the form of their time, skill and effort) for them to render the service or produce the medical implement or drug that is being used. How can any truly rational being ignore the inherent injustice of SLAVERY by allowing (a) any individual to make that (legal) claim upon the life of another, or even (b) justify the authority of some 3rd party to determine exactly what is 'just compensation' for those efforts? HINT: This way lies madness.

    Thus, the RISK (and therefore the COST) of using the system should fall upon those who DIRECTLY benefit from it: the recipients; not the PROVIDERS, and certainly not any other 3rd party, e.g., 'taxpayers'.

    Are parts of the proposal Offensive to some? Absolutely, Highly likely, and inserted into the proposal with that deliberate intention. I want people to THINK about the CONSEQUENCES of *any* action, BEFORE we go down a dangerous road.

    Personally, I don't like being forced (as a taxpayer) to provide ANY service to whoever asks (demands it) at no/little/reduced cost without SOME kind of assurance that the very real DEBT will be repaid. So, insisting on payback via mandatory Public Service is a (hopefully) effective compromise. And such a system should help prevent abuses of the system (and reduce governmental bureaucracy costs in other areas, too).

    Or, as our friend Bernardo might put it, T.A.N.S.T.A.A.F.L. ("There ain't no such thing as a free lunch"). A truism to be ignored at our peril.

    BTW - I fully recognize that the implementation point which is most likely to raise the loudest howls of outrage is the Force Sterilization requirement. (Followed closely by the deportation of non-citizens after treatment.) If you KNOW the Risks, you are obligated to make an informed personal (individual) CHOICE - and *you* bear the consequences. What could be more 'fair'?

    Seriously, I'm sincerely hoping you can help hammer out the details, especially those aspects of the Real Problem my primitive, knuckle-dragging (i.e., 'conservative') mind set inherently overlooks. ;-)

    - Steve

  3. Re-stating the obvious... This propsed mechanism effectively puts ANY government-run system in DIRECT COMPETITION with private systems/providers.

    As such, extreme care *must* be taken to insure the bureaucracy does not impose 'requirements' or 'mandates' that gives EITHER SIDE (public / private) an operational advantage over the other.

    Competition is a good thing: it tends to make ALL players better at the services they provide.

    By example, if government could properly handle providing services the marketplace needs and requires, the USPS would efficiently and effectively manage *ALL* mail/package handling and delivery services... and FedEx, UPS, et.al., would not exist or have a marketplace demanding their services.

    A viable (and profitable) PRIVATE alternative *must* exist and be properly protected. Relying SOLELY on the government to provide a solution for all aspects of Health Care is, by definition, unacceptable.