Health Care -- Do No Harm

Let’s take a brief look at the situation the organizer and his team and the leadership in congress have created for themselves and then spend most of our time on how real reform can, hopefully, be attained. (H. R. 3200 can be viewed via the link at the upper left side of this page.)

There are two objectives being promoted by the above groups: Coverage for the uninsured and health care cost reduction for the insured. These are contradictory objectives. The former will cost big money and the latter is supposed to save money but contemporary government has no track record of being able to accomplish a cost reduction mission. Further, there is great uncertainty about the service reductions that will occur as a result of the cost savings. So, best thing is to lead slowly where the uncertainty exists and try to accomplish some stated objectives. What are these?

The cost savings are reported to be in “the hundreds of billions of dollars.” Who knows? The source of these savings is reported to be threefold: Elimination of fraud and waste, technology applications to recordkeeping and procedures and reduction of payments for doctors, insurance companies, hospitals and pharmaceuticals. The latter component of savings causes the most angst among the older folk. In any objective environment – business, home budgeting and other for profit activities the boss(es) would insist that the implementers establish budget objectives with defined plans for specific activities and report periodically on a progress. If the organizer and his team had any real life experience they would do so also. Here’s how they can do it.

Lead with a cost savings plan. State the intent. “We know we can spend more money but we need to prove that we can implement cost savings changes without major deterioration to the services most people are quite satisfied with.” Layout the specific areas of fraud and waste, technology improvement and reduced provider payments. Set dollar budget objectives and time periods for attainment and hire an independent auditor to track, analyze and report to the public every six months in simple, understandable terms. Not government speak. No save and create jobs vagueness. Specific plans with specific time periods and independent review and reporting.

Step two. Insured bill of rights. Clearly people who have paid premiums for insurance over the years have a contractual right to benefits when needed. This is the concern of both Medicare and private insured’s. The major areas of concern are: doctor choice, treatment option alternatives and continuation of private insurance alternatives. These concerns must be met with legislation that guarantees these options, choices and alternatives. The real problem is who will write the legislation? Neither congress with its corruption nor the lobbyists with their bias can be trusted. Who will speak for the insured is a tough question to answer. TheFundamentals is open to suggestions.

Step three. There are two major areas of tort reform that can bring reasonable change to health care and produce costs savings if managed properly. These are: loser pays and caps on non economic damages. These changes will be opposed by the lawyer groups. The opposition will be emotionally based. But some degree of change can be insisted upon as others are also making sacrifice. There will be no change to the economic damage claim law. But there will be the positive results from added cost/benefit analysis consideration given to marginal litigation and real savings in eliminating the large emotionally based judgments for non economic damages.

The above plan can be implemented, measured and observed over two, probably three, years. Then pass the public option for uninsured citizens and do it with the same degree of goal setting and measurement/reporting by an independent auditor to the public. Make it mandatory if you want and provide a large deductible option for the risk takers. You may even want a trial period during which the public option is made available to federal government employees. The legislation must be budget neutral (i.e. pay for itself and not tied into any of the above savings, if attained.) Pay for it with new taxes on the higher earners.

This is not a perfect solution but it is light years ahead of the mess created by Obama, his advisers and the leadership of congress. It will take very little time to determine if this government can accomplish visible stated objectives and sustain them under the microscope of reporting and the real life experience of those affected by the change. Your comments are most welcome. This is important stuff!