Friday, July 17, 2009

Fixing Healthcare


This week, the problem I'm solving is healthcare. I'll post my fix here, it'll get vetted by my very, very diverse fellow bloggers, then put into action. The only missing piece is any authority to enact it, but I can gloss over that...After all, Obama's administration keeps glossing over a bigger obstacle---no way to fund socialized medicine, and our national credit is maxed out already. So, here goes.
Every place in the world that has socialized medicine also has an upper tier level available for those who can afford to pay. We need to accept this now, then decide how best to have a two tiered system.
Every county gets a government run hospital. If you are un or under insured, that's where you go. There are NO televisions. Smoking is banned. The food is nutritious but bland. You are probably going to have to wait a lot, and if you are admitted, you are in a ward with many others; no private rooms. The actual medical care, though, lives up to government standards. It's the teaching hospital too.
The private hospitals are freed from government regulations. They have the right to refuse service, other than stabilization of the most critical patients prior to transfer to the County Hospital. ICD-9 coding is optional. Red tape nonsense like JCAHO is eliminated. If a hospital is good, it will thrive. If it is dirty and people don't do well in general, it will fail.
The government can set whatever standards it wants. If the care is better in the government run hospital, people will go there regardless of income levels.
Under my plan, no one is denied medical care. If you are sick, you will get treated; kind of like now, with ER care being primary care for the uninsured, but they wouldn't have to clog the ER's. If you chose not to be insured, you don't get a choice of hospitals. It's off to the county for you! If you worked hard all your life and made your future medical care a priority, and you sacrificed to get good insurance, THEN you might get a private room after your surgery you scheduled just last week instead of a year ago. Everyone wins---it's far cheaper since the private hospitals are unburdened with regulations. If you are pro-regulation, you have that option at the County Hospital, with all the regulations Health and Human Services can muster.
We already do this with schools. You'll pay for the government schools whether your kids go there or not. If you don't like the government curriculum, you can pay extra for private schools.


Tina said...

Pshaw Steve. They would never go for that! It makes SENSE.

- Rob said...

I generally like the idea. However, there have to be SOME standards at the private hospitals. From the Enrons and such of the world, we have learned that human nature is to cheat wherever possible. Unfortunately, it would take some time to have the free market remove the bad hospitals from the system. If there are some minimal standards that have to be met then it will help get rid of the cheaters faster.

Sure, that leaves some government oversight still. However, it will be a LOT less than now!

You have my vote to be the person to fix the system!

Lee said...

Government audits of quality of service criteria with publicly viewed grading.

If some number of the criteria reaches a certain level, the hospital is redacted.

flyingvan said...

Okay, this is all part of the process. If the Government hospital sets the 'standard of care', and it is understood the private hospitals are liable for damages when deviating from the standard of care, no direct oversight is needed. When doctors can discuss pros and cons and expenses of tests and treatment modalities, the patient has more latitude. If the patient elects to refuse a treatment that is under the standard of care (in either system) an AMA will be signed and liablity rests with the patient. Mcuh of the cleanliness issues would come under OSHA anyway.
Audits should not be done by government but by insurance providers. If you make insurance competitive, (best product for lowest price) everyone comes out ahead.
I want all the government oversight at the government hospital, and all the private policing done at the private hospitals. Then people can see which works best.

Lee said...

That reminded me of an old idea I had. Have the insurance companies be the ones to license drivers.