Friday, January 15, 2010

Lefty's Last Health Care Reform Bill?

Much of our attention is rightly focused on the disaster in Haiti at the moment, but lest we forget, there IS still a health care reform effort working its way through Congress and there IS still a chance to modify it.

So, here are a few ideas for modifying the HCR bill such that a) it still has a chance of passing, b) it actually does something useful and c) it does MORE useful things than the existing bill.
Looking for comments, questions, and additions.

First, keep most of what's in there, modulo the following things:

  • Add tort reform. Seriously, why the hell not? Why do the Democrats refuse to budge on this? What the hell do we care? Reform away! If there exists a system for ensuring that people always have care, do we really need to be extracting millions upon millions of dollars in punitive damages from doctors who tried their best? Do we really believe that most doctors DON'T try their best? I feel like this is a small concession to make on the Democratic side and a massive sop to throw to the Republicans who are mostly concerned with making sure med mal insurance companies that donate to their campaigns stay rich. Fine. Screw it.
  • Allow interstate insurance competition, WITH THE FOLLOWING CAVEAT: any insurance company wishing to do business in a state must follow the regulations of that state. This will prevent the race-to-the-bottom in standards the Republicans are so eager for that would result from unrestricted interstate competition -- that is, if they got their way, all insurance companies would immediately move to California, which has the worst medical insurance regulations in the country. There is, however, no reason not to allow interstate competition with that modification to it.
  • Listen to Dennis Kucinich and modify ERISA such that it permits states to enact their own single-payer health care systems, and furthermore pool their risk and funding together should they so choose.

What would this result in? You would get a network of blue states that would link together to create a single-payer system, and the remaining states would get to be the free market health care fairground they apparently want to be. Then over the course of the years, we would get to see which model worked better.

There would certainly be no liberal objection to this; liberals want to see single-payer enacted to remove the perverse incentives the health insurance companies have -- as we administer health care today, it is essentially a bet between the insured and the insurer. The insured bets with their premiums that they will get sick, and the insurer bets with the potential to outlay for health care that the insured will not get sick. The problem is that right now, the insurer holds all the cards and can simply fold if the insured demands a payout. Besides the ethical and moral outrage of administering healthcare as a bet, this ensures that the actual GOAL -- which is providing healthcare when it's needed -- is reached, because the perverse incentive to NOT provide healthcare in order to make a profit is removed.

There SHOULDN'T be a conservative objection to this measure either, because really, what business does the federal government have telling the states what they can't do with respect to health care? If a state decides it wants to do this, the conservative thing to do is let it.

Now, you then have the corporate Democrats and corporate Republicans to contend with, but at least from a PR point of view -- which, in the 24-hour news cycle we live in is what's ACTUALLY important -- I strongly feel these measures would actually have a decent chance of passing.


Michael Kirsch, M.D. said...

Lefty, no tort reform for this decade. As a physician, I have enduree the unfairness of the system repeatedly. Is doesn't improve medical quality and it misses most patients who have been harmed. See under Legal Quality.

ShamRockNRoll said...
This comment has been removed by the author.
ShamRockNRoll said...

I'm not ready to jump onto tort reform. Why should people who have been harmed or killed by gross negligence on the part of a doctor or a shoddily-run hospital have the right to go to court essentially taken from them. We don't do this to protect any other type of businesses do we?

My dad has done a lot of medical malpractice and has seen a lot of fucked up stuff in his days--people's lives forever ruined not because doctors/hospital admins "tried their best," but because they seriously fucked up, made stupid mistakes or otherwise just didn't do their jobs.