[FoRK] Accidental theorist lost, wanted back

Stephen Williams sdw at lig.net
Thu Jul 16 13:50:10 PDT 2009

geege schuman wrote:
> http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/AR2009071602242.html
> On Thu, Jul 16, 2009 at 1:02 PM, Stephen Williams <sdw at lig.net> wrote:
>> I agree that health insurance company reform is what is needed.  I think
>> that the public plan is supposed to be competition that causes that.  Better
>> would be some creative incentives that encourage everyone involved to be
>> ever more efficient.
>> It is being said that the public plan idea will be killed, and instead
>> non-profit coops will be created.  This works pretty well for credit unions,
>> despite long-term and constant constraint and attacks by commercial banks.
>>  Being an entity separate from the government allows a lot of flexibility in
>> how it is set up, incentivized, etc.  It can vary from nearly commercial to
>> pseudo- or semi- governmental (Freddie Mac et al, postal service).
>> sdw
The benefits tax is a stupid idea.  They have latched onto it as a way 
to put downward pressure on costs, however it mainly hurts the employer 
and employees, with little that I can see affecting those charging those 
costs.  I could endorse taxing costs above a baseline, $400/mo. or 
something, however I still think this is the wrong mechanism.
> Elmendorf also suggested changing the way Medicare reimburses 
> providers to create incentives for reducing costs.
> "Certain reforms of that sort are included in some of the packages," 
> Elmendorf said. "But the changes that we have looked at so far do not 
> represent the sort of fundamental change, the order of magnitude that 
> would be necessary to offset the direct increase in federal health 
> costs that would result from the insurance coverage proposals."

Hopefully there will be enough insistence on reform and savings that 
nothing will get through until a real mechanism is created.

Off the top of my head, how about this:

Health insurance, and perhaps health providers too, have to operate as 
cost plus.  Their profit fee is inversely proportional to their A) 
effectiveness / success rate and B) efficiency of treating most or 
perhaps all medical issues.  This includes a big bonus for preventative 
care.  I want caretakers hounding diabetics, the obese, and maybe even 
smokers to head off serious consequences.

In return, we reform malpractice and malpractice insurance: Those 
screwing up still get penalized and have to pay restitution, and those 
wronged or simply unfortunate get some compensation, free care, and 
other support.  However, the fear mongering and other insurance company 
and law strategies are eliminated to create high efficiency.

As just one clear example of the kind of artificially enforced 
Many people have severe snoring and sleep apnea, which is now known to 
cause several issues.  You can buy a CPAP device and mask for as little 
as $300 that cures the problem with essentially no risks to a reasonably 
healthy person.  Except it is RX only, so the minimum costs of the 
process and equipment amount to $2000-4000.

Or people who go for appointments ($100-180 for a specialist) to have 
measurements taken that could have been done at home.  Temp and blood 
pressure devices are available at the pharmacy, however pulse/Ox and ECG 
machines are supposed to be RX only.  You can get a pocket pulse/ox for 
<$100 and a pocket, recording ECG with display for $400.  An office ECG 
probably costs $200 each.  (They are better, but the pocket device is 
good enough for many checks.)


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