What can we get for giving up the public option?
I really don't want to see universal care with regulation on insurance companies lost to a battle over the public option. Once universal health care is in place the public option can be fought over by itself. It's much smaller as an issue and not as easy to defeat by itself. Once true universal care is in place the real issue shifts to paying for it and controlling health care costs. We are very close to that right now. Is it reasonable to think that the public option could be traded off (for now) to get the rest?
The key is to get universal health coverage and community health pools. Add to that provisions that do not permit insurance companies to reject any applicant, or to increase the premiums for health condition or anything else. Add some effective form of regulation and monitoring that keeps close track of these things.
Once those things are in place they will begin to eliminate a lot of hospital cost-shifting that currently is needed because they provide care to the uninsured. Medically caused bankruptcies should also drop greatly.
A universal standard process for getting reimbursed would lower administrative costs to an amazing degree, both for health care providers and for the insurance companies, and it would aid in monitoring the effectiveness of the system. It would highlight the problems.
I'd also like to see a unified standard procedure and system for appealing denial of coverage. As it is, the insurance companies decide not to cover a procedure, then deal with the appeal themselves. The system for the appeal is different for every company and no one really knows what the decision is based on. That appeal process should be taken away from the insurance companies and standardized. It would fit in with the medical effectiveness studies.
Most of the advantages of size that allows one plan to currently dominate a region would also disappear, especially with a single standard system for getting reimbursed. So competitors could more easily take on the big regional monopolist health care companies.
The Medical effectiveness studies would put pressures on the pharmaceutical companies to sell medications that were more useful, not just me-too drugs that were patented and high priced. The practice recommendations would also quickly become a legal defense for physicians in malpractice claims. How does a lawyer justify a malpractice claim when the medical effectiveness studies suggest the treatment used? And if the physician deviated from the recommended treatment, careful documentation of the reasons for the deviation along with consultation would be a similar defense. Frankly more consultation would improve our health care a lot. Lawyers wouldn't take those cases on contingency, since they would be quite expensive and not likely to pay back anything. Right there the biggest cause of truly frivolous malpractice claims would be eliminated.
I'd like to see the government option as it would lower costs even more and more quickly. But with the above items included in a health care plan we could quickly get to a level of care similar to what the Swiss have.
After getting universal coverage we can focus on lowering cost. Politically that is less important than universal coverage, and probably easier to deal with.
Such a trade off is clearly dissatisfying considering how rotten the Republicans acted when in control of the federal government, but that's what governance is all about. Do the right thing, not the satisfying one. But do something. The Republicans failed when trying to govern because their first choice is always to do nothing, then try to force their agenda on the population, and finally to milk the government for as much money as they can. Health care is a massive and long-term problem both for the population and for the budget. Good governance demands that something be done, and not much has happened for over six decades.
Something has to be done, and I think the core of that something is universal coverage and consolidated risk pools the insurance companies can't manipulate to skim the health individuals and abandon the rest. along with those community risk pools goes a single standard premium for everyone and a government agency to enforce those things and report to the people what is happening.
The key is to get universal health coverage and community health pools. Add to that provisions that do not permit insurance companies to reject any applicant, or to increase the premiums for health condition or anything else. Add some effective form of regulation and monitoring that keeps close track of these things.
Once those things are in place they will begin to eliminate a lot of hospital cost-shifting that currently is needed because they provide care to the uninsured. Medically caused bankruptcies should also drop greatly.
A universal standard process for getting reimbursed would lower administrative costs to an amazing degree, both for health care providers and for the insurance companies, and it would aid in monitoring the effectiveness of the system. It would highlight the problems.
I'd also like to see a unified standard procedure and system for appealing denial of coverage. As it is, the insurance companies decide not to cover a procedure, then deal with the appeal themselves. The system for the appeal is different for every company and no one really knows what the decision is based on. That appeal process should be taken away from the insurance companies and standardized. It would fit in with the medical effectiveness studies.
Most of the advantages of size that allows one plan to currently dominate a region would also disappear, especially with a single standard system for getting reimbursed. So competitors could more easily take on the big regional monopolist health care companies.
The Medical effectiveness studies would put pressures on the pharmaceutical companies to sell medications that were more useful, not just me-too drugs that were patented and high priced. The practice recommendations would also quickly become a legal defense for physicians in malpractice claims. How does a lawyer justify a malpractice claim when the medical effectiveness studies suggest the treatment used? And if the physician deviated from the recommended treatment, careful documentation of the reasons for the deviation along with consultation would be a similar defense. Frankly more consultation would improve our health care a lot. Lawyers wouldn't take those cases on contingency, since they would be quite expensive and not likely to pay back anything. Right there the biggest cause of truly frivolous malpractice claims would be eliminated.
I'd like to see the government option as it would lower costs even more and more quickly. But with the above items included in a health care plan we could quickly get to a level of care similar to what the Swiss have.
After getting universal coverage we can focus on lowering cost. Politically that is less important than universal coverage, and probably easier to deal with.
Such a trade off is clearly dissatisfying considering how rotten the Republicans acted when in control of the federal government, but that's what governance is all about. Do the right thing, not the satisfying one. But do something. The Republicans failed when trying to govern because their first choice is always to do nothing, then try to force their agenda on the population, and finally to milk the government for as much money as they can. Health care is a massive and long-term problem both for the population and for the budget. Good governance demands that something be done, and not much has happened for over six decades.
Something has to be done, and I think the core of that something is universal coverage and consolidated risk pools the insurance companies can't manipulate to skim the health individuals and abandon the rest. along with those community risk pools goes a single standard premium for everyone and a government agency to enforce those things and report to the people what is happening.
