Sunday, April 2, 2017

Everybody knew health care would be complicated!   It’s not just the health care itself that is complicated.  To some extent that is unavoidable; humans are complex and fussy about their comfort.  The health care delivery system does a pretty good job for most Americans most of the time. 
Unfortunately the health care financial system is like a platypus redesigned by a dysfunctional committee using meth.  Actually you can’t really call it a system, because it’s an uncoordinated conglomeration of semi-autonomous entities.  I can’t name them all, can you?  First, in the news, is the GOPcare replacement for ACA (aka Obamacare) then, Medicare and Medicaid. That’s just the Federal Civilian programs.  Then pubic private partnerships like Queens.  The military has their own, plus CHAMPUS for dependents, and don’t forget the VA.  On the civil – aka, free market - side we have HMO’s like Humana and Kaiser.  We also have insurers like Blue Cross (HMSA), and Aetna.
Health care providers work hard and deserve to be paid, the problem is that each payer has a different schedule of what they will pay and when.  If the payment is too attractive the unnecessary happens.  If the payment is stingy, necessary care may be delayed or forgone; providers have to beg and borrow to get paid.
One reason America spends more than any other country and has mediocre results is that the “system” is configured to insure that at least 20% of health care dollars are siphoned off as insurance profit and operating cost.  Hospitals bill for every penny with a huge markup:  (cotton ball $0.09, Aspirin $0.48) spending more to account for stuff than to buy it.  To get paid they need an extensive detailed cost collection system, like a factory, but unlike a factory every unit is unique and every hour is different.
The ACA was crippled from the start, because it is an assigned risk pool.  It gets the leftovers after the profitable population has been scooped up.  The ACA carriers got all the high risk poorer, older, sicker patients with bad habits.  The low risk young-and-healthy have no motivation to enroll.
What are the options, besides more of same?
One is a single payer system. The providers would not spend time figuring who pays how much for each element of a service. There would be less duplication of effort, but someone would still have to tally up a bill and someone else to negotiate a payment and eventually pay it.  Automatic payment has a frightening potential for abuse.
Another is National Health Service:  Everyone pays a tax like we do for other government service.  Everyone gets treated; providers get standard compensation.  It’s run much like the Fire Department.  Sure some people would overconsume but how many?  It has to include everyone especially Congress.
Third option, take all the money the government and industry spend on health insurance and put it in a pool.  Everyone gets a stipend adjusted for age and demographics.  They can spend it on insurance, HMO, or even a Medical Savings Account (a naive option).   The existing providers can compete for the business.  The idea of a truly free market for health care is almost ludicrous though; nobody can negotiate in an emergency and the products are way too complicated for the buyer to comparison shop. Individuals have no real bargaining power.
GOPcare: Free market solution, chose your own plan, pay with tax credits for those who earn too little to pay taxes, or do without.
I know you’re thinking.  (I would be)  “OK, wise guy what would you do?”  I would have a small select non-partisan committee. Nine members plus staff like the Supreme Court examine the National Health Services of large countries.  Determine which one is most effective, and copy it exactly.  Don’t let Congress try to improve it because when it comes to health, failure is not an option.

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