Archive for the ‘Single payer’ Category

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Open Mike – Departments – Johns Hopkins Public Health Magazine

December 8, 2009
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Reform 2.0

by Michael J. Klag

I have to find a new doctor.

Last month, my primary care physician wrote me a letter. He said he was leaving private practice. He’s an outstanding physician—a doctor’s doctor whom I’ve known since he was a medical student. His reason for closing up shop? The sheer frustration of getting paid by private insurance companies.

When a physician of his stature and skills departs private practice for a reason like that, it is an indictment of our health care system—that is, if we had a health care system. We all know the U.S. has great physicians and the world’s best medical technology. But the best health care system? Not in the least. Our crazy patchwork quilt is an accident of history and one that we need to fix. It fails us in so many ways, from its gross inefficiencies to the fact that it has left 47 million Americans without health insurance.

Open Mike – Departments – Johns Hopkins Public Health Magazine

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Logic, facts, socialism, fascism, guns and health care

November 28, 2009
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When a 2,000 page piece of legislation traverses the legislative sausage making process, it is a large target for those who want to take pot shots.

When you are trying to fix a system that is broken in lots of places, it is not an easy process.animal,bazooka.m

Let’s remember what we are trying to fix.

The system does not cover everybody.  Estimates on the number of uninsured range from 30 million to 70 million depending on whom and how you are counting.

It’s expensive.  Our economy already sets aside more resources per person than any other country on the planet.  We pay more in taxes for health care than any other country on the planet.

We are not a healthy country.  Relative to other industrial countries, we don’t live long.  Our babies die before they reach their first birthday.  Our pregnant mothers die in child birth.

That’s a lot of fixes. Continue reading ‘Logic, facts, socialism, fascism, guns and health care’

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Health Care Reform and Ability to Pay

October 31, 2009
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There is nothing simple about our health care maze.  Fixing it is not easy.

I prefer to look for the simple.  The complexity will evolve naturally.

Congress prefers to start with the complex and make it more so.image010 duck family

Spreading the medical risk

There  are two major challenges to fixing the customer side of the health care mess – spreading the medical risk and spreading the financial costs.

Spreading medical risk requires that everyone be in the system.  That spreads medical risk evenly between the sick and the healthy.  That can be accomplished by a system of automatic eligibility or a system of required enrollment.

Automatic eligibility describes a single payer system.  All citizens are enrolled by virtue of their citizenship.  To draw from known models, automatic enrollment describes Part A Medicare, Department of Defense medicine, and to a lesser extent, the Veterans Administration.

Funding for those programs is separate from enrollment and may or may not rely on direct participant financing.

A system of mandatory enrollment implies a system of mandatory participant financing.  That is where we bump into the second challenge.

Spreading the financial costs

How do we transfer money from those who have it to those who need it? Continue reading ‘Health Care Reform and Ability to Pay’

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American Values in the Healthcare Debate

August 1, 2009
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11_47_8---US-Flag_webAllan Brett, M.D. published a thoughtful piece in the New England Journal of Medicine on “American values” and health care in the United States.

Of course, thoughtful has not proved to be very useful in advancing any political cause.

Emotional, yes.  Thoughtful, nice try.

Nevertheless, the coupling of the terms ”unique” and “American values” to derail a policy that Americans clearly want deserves at least some thoughtful reflection.

What are American values and are they unique? Continue reading ‘American Values in the Healthcare Debate’

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Open Enrollment and Health Care Reform

July 4, 2009
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Our plan just completed its annual open enrollment.  Members are permitted to change medical or dental plans; to add or remove dependents, and change life insurance options.

Open enrollments highlights certain flaws in our current system.

The logic of an open enrollment is compelling.  The object of any insurance is to spread the cost of any risk over time and over as many people as possible.  Open enrollment helps to spread the risk over time.

MazeThe risk of health care is different than other risks that we insure against.

We buy life insurance to insure against death; auto insurance to protect against an automobile accident; homeowners insurance to shield against damage to our home.

Those hazards (the technical term) generally occur without warning.  No one is likely to approach their insurance agent to buy auto insurance because they anticipate an auto accident in the near future.

Illness, on the other hand, can offer some warning.  Someone may experience symptoms and has not seen a doctor.  The doctor may have recommended expensive surgery.  Or maybe it’s just a young couple planning to start a family.

Open enrollment is the only opportunity that insurers have to spread risk over time.  By insisting that people enroll only during a specific time period, the insurer reduces the risk that someone is only enrolling because they know they have an approaching medical expense.

It may seem unfair to the person with an immediate and pressing need.  But to the others in the group who ultimately foot the bill, it makes perfect sense.  It is one reason why a mandate – an employer mandate or an individual mandate – makes sense.

Medicare has its open enrollment rules.  Their annual open enrollment for Medicare Part B is from January through March each year and is not effective until July 1 of that year. Continue reading ‘Open Enrollment and Health Care Reform’

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