I think it would be fun, and possibly instructive, to imagine what one would do for our health care system if one were king, if there were no political impediments to taking a machete to the whole thing and then building it back up in a logical and proper form. This is what I’d do.
I’d get rid of the HMO’s. I’d give the insurance companies 60 days to revise their policies and procedures. I’d force them to:
• Cover catastrophes more thoroughly and inexpensively.
• Cease covering office calls.
• Cease covering any dental care except for complications.
• Eliminate pregnancy coverage except for complications.
• Forget about pre-conditions.
• Require that they cover everyone, but subsidize the coverage for high risks.
I’d let the doctors become entrepreneurs again. True competition would then begin to influence their pricing and quality.
I’d allow ER’s to refuse service for anything that isn’t a true emergency.
I’d leave the decision of what constitutes adequate preventive health care to the individual. The argument that the government should dictate or at least strongly influence a person’s preventive care, because to not do so would cause us all to have to pay for the consequences of poor care would be largely eliminated by the other provisions herein. I would, however, make government funds available for adequate prenatal care, and I would provide a combination of public funds and insurance funds for MRI’s and other expensive tests.
I wouldn’t legislate against abortion, but I would not enable it in any way, that is, if an individual wants an abortion she would have to pay for it, and I wouldn't let the insurance companies cover it. I would make partial birth abortion a felony, just like murder, which it is. I’d provide extensive education on the consequences of unplanned pregnancy, but I would recognize that education does not necessarily produce responsible behavior. Ted Bundy was very well educated, for example.
I’d make it illegal for the drug manufacturers to advertise on TV, thus eliminating their current rampant scare tactics to try to get us to “talk to your doctor about Avidart”, or whatever.
This is not a complete list of everything that would need to be done to kill the old system and cause the new one to rise up out of the ashes, but it’s a start. I invite anyone to add to it in the spirit of brainstorming.
Here are some of the effects I believe this program would produce.
• The entire system would be a combination of private and public funding.
• People would pay for their routine health care the same way they do for the food they eat.
• Catastrophes would be covered by insurance, which would truly become “insurance” again.
• Doctors and hospitals would have much less paperwork to fill out. They could then reduce their costs somewhat.
• Because prenatal care, so vital to a healthy populace, would be covered by the public, there would be no excuse for mothers-to-be to not get good care.
• Drug manufacturers would save huge sums that they currently pay for advertising.
• Expensive tests, such as MRI’s would be left to the discretion of the doctor.
Here is a summary of our family’s experience with health care over the past 26 years.
• In 1982 we became self employed and couldn’t afford to convert our group policy.
• We lived without insurance, with much fear and trembling, for a couple of years.
• Then we noticed that the sky didn’t fall in, as we had feared.
• Over time we became comfortable, then jubilant over our lack of insurance. It wasn’t that we were “without” insurance; we “chose” not to have it.
• In the 26 years since, we have paid far less, magnitudes less, for health care than we would have paid for insurance premiums.
• We had small children, so we had our share of scrapes, bruises, and broken bones, and we paid as we went.
• I remember on one occasion the ER sent us a bill for what seemed to us an exorbitant amount for a half hour of the doctor’s time, so we wrote them a letter. They cut the bill in half. (Free market forces at work.)
• We recognized, and still do, that we are at risk for a catastrophe, but we also know that the risk, statistically, is minimal. We’re prepared to live with the consequences if the dice rolls deuces, but we honestly believe that somebody up there is looking out for us. We believe with Dr. Norman Cousins that attitude is huge where health is concerned.
• We do not skimp. If a health care provider is needed, we go see him. We strongly disagree with the idea that people will deny themselves proper care because of the cost, unless that cost is huge.
• We also don’t run out to get every test the TV suggests, implying that we’d be fools not to. We take our health seriously. We listen to the inner voice, and occasionally to our son, the physician, and our vitality in the face of advancing years is proof of our philosophy.
• We’re of course not suggesting that anyone else follow our lead, but we believe it can serve as a guide to the crafting of a comprehensive universal health care system.
Summary
Our children’s education is run by the state governments, with some oversight by the feds. This is a good thing, because it falls under the mandate of the Preamble to “promote the general welfare”. It’s not perfect by any means, but it works. If it were left to free market forces, it wouldn’t work, and this is possibly the best example of how some things don’t lend themselves to free market forces.
Health care may be another example. It appears to be so in many other developed countries. Alex, having lived with his family in London for 9 months, has first hand knowledge. To make it work here, however, will require a thorough understanding of the forces that resist it, political, ideological, and emotional, and I don’t think we have that understanding yet.
But I do believe that if we take an idealistic view such as this one, for brainstorming purposes, we might add to the body of knowledge.
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