Personally I would love to see us as a nation continue to have the political discussion about how to provide health care to those who cannot afford it.
But I’m afraid that may become a moot point.
That’s where we are headed. We argue about health care benefits, but I fear that the next president, of whichever party, may find himself presiding over riots in the streets, when our debt can no longer be rolled over and austerity measures must be imposed.
Sorry, that’s off topic. But street riots can be an excuse for tyranny. And Obama has already threatened the Catholic Church with that.
The real issues that Obamacare should have addressed are increased access and reduced costs. The Republicans to their credit put forth numerous ideas and proposals for both objectives but were shot down. In fact Howard Dean even admitted that the reason some of these proposals were not considered was “Democrats know better than to fight with the trial lawyers.”
Here are some of the ideas that would/could work if implemented:
Change our system to a patient oriented, market driven system where the patient is involved in his/her healthcare decisions. Most patients don’t have a clue what something costs because of third party payers…both insurance companies and government healthcare. They have no incentive to shop around, look for better prices or shift their families to a particular clinic/doctor/hospital that provides the best quality care for the best price.
Try a different payment model. Our clinic has been involved in two protocols that tried different payment structures than fee for service which tends to encourage maximizing use. We did both a global contract for specific DRGs (diagnoses) for Medicare patients and another capitation contract for a large insurance company where we promised to provide all the care their patients needed for a specific rate per patient (total population). Both methods controlled costs and because the doctors worked in a collaberative basis, patient outcomes were outstanding.
Another area is tort reform and believe me, the trial lawyers are right there with abortion lobby in protecting their turf. Instituting “loser pays” would be a huge benefit to our system as one of the major costs is frivolous lawsuits where the damages are nebulous at best but attorneys hope to get a small settlement as a nuisance that is not worth a trial. No one wants to see someone truly damaged by malpractice not get justice. That is not the problem. The problem is lawsuit roulette. It’s too easy to sue in this country.
Something I thought was rather novel but never proposed was providing malpractice coverage for doctors who volunteer their services. Just an example, one of our clinic’s docs retired and wanted to do part time volunteer work. His malpractice premium would be over $10000 a year for part time office consulting (not surgery or obgyn). Needless to say he volunteers in third world countries where he won’t be sued. He’d be happy to help his neighbors but can’t take the risk.
As to the people who have pre-existing conditions, this would be a good place for the government to help with larger risk pools and underwriting support to allow them to obtain insurance for a reasonable cost. Again were insurance sold across state lines people would be able to find a suitable plan but most of us are captive to one or two payers.
Encouragement and support for the many religious based hospitals and clinics, instead of making their job more difficult by such things as these mandates.
Reducing cost and increasing access is possible. But with the various interest groups in control, it’s become a turf war and the patients are the ones who suffer. Obamacare was the worst of all worlds and we’re just starting to see how bad it is.
Lisa
