Monday, June 26, 2017

Sean's Healthcare Improvement Plan

I was looking back at the G2A Nolan Diagram post for something and saw the following comment from Sean. I am not sure if I ever posted it for discussion, so here goes.
"Sean, If I remember correctly it was something like the German system. Correct?" G2A
 
"No. I think you can make some changes to the ACA to make it work much better. Here are four such changes that could make an impact right away:
  • I would extend the subsidies beyond their current cutoff point to limit some of the impact on those who are being impacted by the rising individual market premiums. The current cutoff point is around $90,000 income for a family of 4, I would extend that up to $250,000 with the subsidies having less value the further you move up the scale.
  • I would increase penalties on those who choose to go uninsured, or alternatively, institute automatic enrollment in Medicaid or a public option (see below).
  • I would institute a public option (allow people to buy into Medicaid or Medicare) at first in areas where there is only one private insurance option and to cover those who don't purchase insurance on their own if automatic enrollment were selected.
  • I would reinstate risk corridor payments in areas where there are low amounts of competition." Sean

21 comments:

Laurie said...

GOP's Obamacare repeal bills threaten huge disruptions across the healthcare system

Anonymous said...

I would put America's health care system out for a bid to insurance companies. The company that makes the best offer would have America's health insurance business.

--Hiram

John said...

From MP CBO Projections

"Per Eric's summary, it does sound simple... Obama etal wanted to lower the number of uninsured and they were happy to charge the wealthy and most of us other tax payers to do so. (ie heroes) And the GOP wants to reverse that. (ie villains)

Now I have always seen benefits and detriments to ACA, however I am fascinated with the idea many here hold that for some reason successful citizens should be forced to pay a LOT more so that it can be given to unsuccessful citizens.

I mean let's reverse Eric's closing paragraph. "The TPC estimates that ACA incurred an average tax increase of $54,000 for households making over $1 million."

Does anyone here think that sounds wrong? I mean are not talking about building bridges, roads, providing national defense, or anything that is of value to all citizens. We are talking about taking money from the "Peters" so it can given directly to the "Pauls".

And this is on top of an already progressive tax code.
How Much Do Americans Pay in Taxes" G2A

Sean said...

I would tend to agree that it would be more optimal to fund the ACA via a more broad-based tax, but Democrats took what they could get passed.

But again, we're back to the point we always come back to. You've got lots of criticisms and no solutions.

John said...

As I said on the other post...

Of course I have articulated solutions... From my view we do not have a healthcare problem, except maybe the American Overweight/Obesity and Drug Addiction problems.

We have a poverty problem that prevents people from paying for their own healthcare insurance. Some ways to improve on this include:

- Promote school accountability
- Promote free LARC
- Promote early ed and parent ed
- Promote accountable parenting
- Promote reducing free handouts
- Promote Buy American and deporting illegal workers.
- Give generously to charities who help these people.
- etc

Unfortunately there are people fighting these ideas for various reasons.

John said...

Now I acknowledge that it will take awhile for them to bear fruit, however the sooner we start the sooner we finish.

John said...

I think I also have recommended many other ideas including:
- TORT Reform
- Legalizing Physician Assisted Suicide
- Insurance / Government end of life expenditure limits based on patients age, prognosis, etc
- Charge people who live a risky lifestyle larger premiums. Of course this does not work well when some folks want to provide free insurance / healthcare... Why make healthy choices?
- Simplify licensing process for Doctors, Nurses, etc. (tied to TORT reform)

Sean said...

"Now I acknowledge that it will take awhile for them to bear fruit, however the sooner we start the sooner we finish."

OK, but what do we do in the meantime?

"- TORT Reform
- Legalizing Physician Assisted Suicide"

Neither of these have major cost savings associated with them. And, besides, the current tort system already undercompensates victims, not overcompensates them.

"Insurance / Government end of life expenditure limits based on patients age, prognosis, etc"

Death panels. Here comes the Appelen authoritarian streak again.

"Charge people who live a risky lifestyle larger premiums."

That's swell, if you can already afford the premiums.

Laurie said...

I was going to make a suggestion that what we need is some form of single payer and then I clicked through the wapo and found P Waldman explaining very much what I had in mind but more specifically and detailed than anything I would have put into my comment. Here is an excerpt from Waldman:

"It’s important to keep in mind that “single payer” isn’t one thing — if you look around the world at highly developed countries, there is a spectrum of health systems with various levels of public and private involvement. But what they have in common is that they achieve universal coverage while working better and costing less than ours. We could well have 15 Democratic presidential candidates proposing 15 different kinds of single payer. Some may be highly socialized systems — what Bernie Sanders would likely advocate if he runs again — but the ones that are most appealing could be hybrid systems of the kind that have been successful in countries such as France. The way it works is that there’s a government plan that covers everyone’s basic needs, but you can also buy supplemental private insurance to get as many more benefits as you want.


Among the advantages of a hybrid system is that one can actually see a path from where we are now to there. That path runs through Medicaid, which now covers nearly 75 million Americans. What if we auto-enrolled everyone under 65 in Medicaid — it’s there if you need it, but if you have different insurance you’d prefer, go ahead and use that instead. No one would be without coverage. Private insurance would evolve into something you buy to fill in the gaps and get perks that Medicaid wouldn’t provide. Instead of covering all your health care, employers could provide the supplemental private insurance."

I think universal medicaid could be basic and have limits- though not super harsh ones as that might be all the insurance some people have. Personally I have no desire for Cadillac insurance if I am choosing what type of a supplemental policy to buy . I don't care if my choice of doctors is limited or I have limits in how much care will be provided near the end of my life. When I am 90 or older I think I would opt out of some forms of life extending care.

Laurie said...

I try to read conservative writers (and usually fail to either find them or read them) but I did read this column by Hugh Hewitt:

If GOP senators blow this, say hello to single-payer health care


I sort of think we're headed toward single payer either way the vote goes.(don't know the time frame.) I am not sure I understood all of Hewitt's reasoning so I will probably reread my own link.

Laurie said...

If GOP senators blow this, say hello to single-payer health care

John said...

This does get complicated...

Laurie is okay with benefit limits on "free healthcare" whereas Sean accuses me of supporting "Death Panels"...

Sean,
If you have better ways to:
- Reduce end of life costs.
- Reduce unhealthy / risky living
- Reduce law suit costs / payouts
- Reduce unnecessary testing

I am all ears... Unfortunately all of your ideas above seem to be about who is going to pay for the high cost of healthcare, not how are we as a country going to fix reduce it.

John said...

And of course legalizing Physician Assisted suicide could reduce healthcare and long term care costs significantly. Rational humans who are looking at a painful, vegetable like or miserable death that will decimate the finances of their family could simply opt out... Thus saving a ton of money, caring for their family and freeing up medical resources for other patients.

Of course this will not work if they are not paying the cost out of their wallet.

Sean said...

"And of course legalizing Physician Assisted suicide could reduce healthcare and long term care costs significantly. Rational humans who are looking at a painful, vegetable like or miserable death that will decimate the finances of their family could simply opt out... Thus saving a ton of money, caring for their family and freeing up medical resources for other patients."

The reality is that most people are not interested in physician-assisted suicide. In the first 17 years of Oregon's law allowing it, an average of 47 persons per year utilized it. The experience in other states and countries that allow it is similar. I'm not necessarily opposed to allowing it, but it's not going to have a major cost impact.

Sean said...

"Sean accuses me of supporting "Death Panels"..."

The concepts you are discussing here are what Republicans claimed "Death Panels" were during the ACA debate.

"Reduce unhealthy / risky living"

This is a useful goal, but it's not necessary to get to universal coverage. Practically every other nation on the planet manages to do this in some form or fashion. Why can't we?

"Reduce law suit costs / payouts"

This is the incorrect policy goal. The goal should be twofold -- first, to reduce the number of preventable medical errors, and second, to rationalize how people are compensated when they occur. Regarding the first goal, we have far too many people who die every year as a result of preventable medical errors (up to 100,000 by some counts). There are a lot of steps we can take to prevent them (working to make sure every health system is using accepted best practices, getting tough on doctors who commit errors because most of the errors come from a subset of repeat offenders, etc.) As for the second goal, the current system makes it difficult for most victims of medical errors from getting compensated for them. Some victims get too much, while many victims get nothing at all.

John said...

Oregon's Law is still pretty limiting...

"The law states that, in order to participate, a patient must be: 1) 18 years of age or older, 2) a resident of Oregon, 3) capable of making and communicating health care decisions for him/herself, and 4) diagnosed with a terminal illness that will lead to death within six (6) months. It is up to the attending physician to determine whether these criteria have been met."

Kind of leaves out all the long term chronic sufferers.

John said...

You should know by now that I often disagree with the Republicans.

People will only have the motivation to change their lifestyles if enough carrots and sticks are in place. I think free healthcare weakens these.

With most things the challenge is to balance QUALITY, COST and AVAILABILITY / TIMELINESS.

If you want to eliminate errors in high risk, highly variable, highly human activities like healthcare it will be expensive.
NPR Errors 3rd Cause of Death?

NASA and other very HIGH COST entities do this with redundancy after redundancy... And they are working in pretty controlled circumstances.

Sean said...

"You should know by now that I often disagree with the Republicans."

Oh, so you don't like the label I assigned to you? Funny how that works...

"I think free healthcare weakens these."

Who is getting "free healthcare", exactly? Medicaid and Medicare have cost-sharing. I guess low-income veterans would fall into that category (although even they have copays on prescriptions), but I don't think you're really asking them to pay more.

"If you want to eliminate errors in high risk, highly variable, highly human activities like healthcare it will be expensive."

Obviously, you're never going to get to zero. But there are wide variations in how various health systems and hospitals fare at preventing errors. Those errors inject great amounts of actual cost not to mention pain and suffering into our system. Moving poor-performing facilities to use the processes and procedures in more successful facilities is a reasonable step.

John said...

I do vote Republican pretty consistently. Just pointing out that I disagree with them quite often also. Please feel free to think of me as a Conservative and/or Republican if it helps. I'll correct you when I disagree, no problem.

I'm sorry but if the tax payers are picking up vast majority of the costs, I think the Medicaid recipient is get something almost for free.

The big question is what is the benefit/cost of taking on the "successful" facilities processes, personnel, head count, etc. Again you forgot to even mention that.

Sean said...

You may disagree with Republicans, but the policies you are espousing are what they described as "death panels".

"The big question is what is the benefit/cost of taking on the "successful" facilities processes, personnel, head count, etc. Again you forgot to even mention that."

Your link says 250,000 people die each year as a result of medical errors. How much cost should we be willing to take on to cut that in half?

John said...

Sean,
That is a very good question...

"How much cost should we be willing to take on to cut that in half? "

And who should pay this additional cost?

There are literally hundreds of millions of opportunities for failure in the healthcare field and unfortunately many of them end in death. It is quite the challenge...