Monday, May 23, 2011

New(?) Thoughts on simplifying and improving health care.

Just thinkin'....

1. Require insurance providers to treat the entire county as one (1) risk group, with NO divisions like “preferred”, “Non-smoking”, etc… everyone in the same pool.

2. Allow deductions to be applied against the policy premium based on “healthy lifestyles” or other reasonable conditions, at the option of the insuring company, which may/will vary. Implement reasonable penalties for deliberate fraud on the part of the consumer (misrepresentation) to receive unearned benefits.

3. Use the commerce clause to allow companies to sell policies across state lines. Example: As a Georgian, I could buy a policy written under the state requirements of Montana (or California, Texas, etc.) – I’m not restricted to Georgia state requirements. *I*as the end-consumer – get the option to pick-and-choose which set of state-level rules *I* wish to be obligated under (as a payer and recipient of benefits). Some tricky details here, but you get the idea.

4. Set a low minimum coverage requirements (specific conditions) at a national level. Require states to accept national minimum but states may (will) define insurance coverage mandates as they see fit: but which only apply to polices under their state guidelines (see #3). Kick 2% of the premium back to the state whose rules were selected by the consumer for his personal policy (incentive to states to encourage business in their state).

5. Allow consumer to choose to Opt-Out of *any* requirement: federal or state level. If I do not want to pay for pregnancy coverage, I’m not covered. The point: why are MY PARENTS - in their 70’s and 80’s - *required by law* to have a policy that covers pregnancy?

6. Require states to insure citizens (not "residents") of their state at the minimum national level, regardless of income. This could be handled by a “pre-bate” of the monthly premium amount required for national minimum (a health care spin on the Fair Tax pre-bate) – everyone gets the pre-bate regardless of economic status (only fair).

7. With new system in place, drop Medicare/Medicaid and eliminate workers comp. Not needed.

8. Require citizens to insure themselves or prove legitimate reason why not, i.e., taking a pauper’s oath.

9. Establish barrack-style living quarters for those taking pauper’s oath – these become VOLUNTARY “Service Camps”. Minimum living needs (food, shelter) to be provided by state. Unless physically unable, as established by state doctor, pauper to work for state in “community service”. Definition of work required left to states. Sidebar: All illegal immigrants shipped to service camps instead of being deported?

10. Tort reform: Adopt “loser pays” rule for all health care claims. Legal counsel (lawyers) to be personally liable under “loser pays” for lost claims by pauper or any situation where individual loses and has no assets to cover legal costs of winning side.

More details to be sure – a Big one is receiving care for a condition when you chose not to pay for coverage – but that can be handled simply.

BTW - I don’t like it, but I am willing to accept, an individual mandate if imposed on the state level – but I have a constitutional issue with any federal mandate. I can move if I want. *But* under the suggestions above, I don’t *have* to move, I can just take my business elsewhere.


- Steve


  1. Yes - I have several.

    I like just about all your ideas, except for a few technicalities - which aren't really all that crucial.

    I guess the biggest one is concerning #3. The purpose of being able to buy across state lines is assumed to encourage healthy competition among insurance companies. I myself believed that before I looked into it.

    What happens though, is large, multi-state insurance companies can target one or more "sympathetic" state legislatures to create rules which allow for really bad health insurance policies. They can then market these policies across the country and thereby get around a great many sensible regulations imposed by many states.

    Unfortunately, to prevent this from happening, the federal government would have to intervene by mandating that all insurance regulations in every state meet certain minimum standards.

    I really doubt if all the states would go along with this. But even so, theoretically, it could be done - so long as the minimum standards were thoughtfully designed.

    The thought of Steve Green getting pregnant brings up all kinds of disturbing images, but...

    The objection to pregenancy coverage for certain policy holders reminds me a little bit of the objections which taxpayers with no children have to paying taxes for elementary schools. Problem is, this opens up a huge can of worms. For instance, why should young people pay for insurance against conditions common among old people? Why should thin people pay for insurance against conditions common among fat people?

    You can come up with hundreds of questions like this - but the bottom line is that when you start segregating the scope of coverage demographically, all you are really doing is creeping back to the overall problem which the individual mandate was designed to fix. Or, to put it more plainly, sure, people who are unlikely to get pregnant are sharing the cost of pregnancy with those who are - but then again, people who are likely to get pregnant are sharing the cost of hip replacements - which they themselves are unlikely to need. But I think all that could be worked out.

    I'm just a teensy uncomfortable with "tort reform". As a practical matter, I've mentioned before that Texas already has tort reform in place, yet health care costs in Texas are among the highest in the country.

    Generally speaking, health care providers have access to legal resources far beyond that which any ordinary citizen can pay for. As a counter-balance, lawyers in most states are allowed to pursue litigation on a contingency basis - and, the higher the potential judgement, the greater the odds are that single citizens can retain adequate counsel. To asssume - a priori - that instituting "loser pays" restrictions and damage award limitations would automatically improve the system is not necessarily justified.

    Frankly, we are constantly bombarded with the meme that a huge part of the high cost of health care is accounted for by malpractice insurance which health care providers must pay for. But, wouldn't it be wise to first consider how much successful litigation against malpractitioners has had to actually REDUCE costs? I think its fair to study the problem in depth before we go instituting radical changes based on what is essentially anecdotal evidence.

    Finally, I salute you for an uncommonly open minded approach towards disadvantaged citizens. Knowing you as I do, I completely understand you don't envision some kind of Dickensonian nightmare in which poor people are transformed into an underclass of serfs.

    Steve Green's "Service Camps" would consist of free people performing useful and necessary work, with the added incentive of gaining the pride and dignity which only comes from living up to one's responsibilities and obligations.

    More - later, I've run out of gas...

  2. The operative concept here is "Who Decides?" - the one paying the bill.

    As to your point on "creating really bad policies"... I prefer leaving the ultimate control and choice to the consumer, as opposed to assigning the task to a well-intentioned bureaucrat, who seeks to limit MY choices based on HIS determination of what is MY best interests. That some people are unlikely or even incompetent to make such decisions is a given, but we MUST have a system which does not restrict the freedom (and control) of choice from those willing to do so and live with the consequences.

    The whole idea of minimum federal standards is to leave the door open for the STATES to expand upon those minimums (not replace them) as they desire for their state. This allows the marketplace to inform such august bodies how well they have done their jobs (e.g., if your state has what YOU, as the end-consumer, consider 'needless' requirements, you are free to pursue options in other states according to your desires, and those state are compensated accordingly. This is to provide the incentive to legislate regulatory requirements with consideration of the free-market, instead of purely limiting the input to those with a vested interest. The idea of far-ranging 'deductibles' (or discounts), as determined by the provider (insurance company), for life-style choices provides a similar incentive for consideration in the marketplace.

    My tort reform suggestion is to take a direct stab at the ambulance chasers... IMHO, it is they, who by wielding an unrestricted ability to SUE, SUE, SUE who generate the sky-high malpractice premiums, which, in turn, drive up the cost of insurance by 'encouraging' doctors and facilities to perform test after test after test - not because they are truly needed for diagnosis, but because they are needed to avoid lawsuits. I believe asking the lawyer to PERSONALLY have some skin in the game will reduce 'questionable' lawsuits and reduce costs across the board. I don't think the evidence is anecdotal; I think it is very real, and no one wants to annoy the Trail Lawyers about how they make their living for fear of upsetting the political donation money tree. Sure, we can study it: but do we really expect "what everyone already knows" to be disproved?

    I don't really *like* the Service Camp idea. Yeah, it's that Dickens thing, not to mention where many of the original settlers for Georgia came from... Notice I didn't say folks are stuck there "forever", but I think the number of people that would honestly and joyfully accept such conditions INDEFINITELY would be surprisingly high... and it's also a decent landing spot for Welfare recipients (another rabid, spittle-generating hot topic, I'm sure).

    But if I am forced to deal with the Reality of providing care for those who simply WILL NOT or CAN NOT PAY FOR IT, there *must* be consequences for that decision. TANSTAAFL.

    Yes... more to come, I'm sure.

    - Steve

  3. I wasn't being sarcastic about your "Service Camps" idea. Not in the least. Maybe it needs a little work, but all in all - I meant what I said to be taken literally.

    On the subject of tort reform, gosh, Steve - stop and think for a minute. I mean seriously. In our debates over climate change, you're the guy who has been CONSISTANTLY arguing against action because you are not satisfied all the facts are in.

    Yet, you argue for radical change in our courts on the basis of something "everybody knows"? Come on man. Where are your facts? Where is the empirical proof?

    I think what you're doing here is reading sensationalized stories about "ambulance chasers" and outrageous settlements and simply ASSUMING this characterizes the whole system.

    Steve, really, this is a breathtaking departure from the aproach you take towards the science behind climate change.