Here are some other issues
that would come up in a transition from our current health care system to a
Guaranteed Healthcare Entitlement (GHE).
Where does the money come from? Well to begin with the money is already coming from
somewhere so we could start by identifying the current sources and creating a
system around that. For instance, there
could be corporate tax at approximately the rate they pay currently for health
care which, from talking to at least one business owner, they would embrace in
a heart beat knowing that that rate would be fixed for at least a decade. However, it should be structured in a way
that it is not based on the number of employees so as not to discourage
hiring. Medicare contributions from
salaries could still be collected. A small 1 – 3 % tax on non-wage income again
fixed for at least a decade could be created to cover any shortfall.
Where does the money go? Of the $3.3 trillion we spend on health care 80 – 90%
would go directly to ACO’s for patient care.
However, there would be additional cost outside of direct patient care.
These would include . . .
There would be administrative
cost. These would include computing the actuarial tables on which premium
payments would be based. The
distribution of these payments to ACO’s would be an expense but much less than
current Medicare costs because it would be a monthly lump sum payment for lives
covered not a payment for each individual procedure. Establishing what is covered and standards of
care would be required and periodically updated. These would be covered.
The current bill for health
care includes government agencies such as the National Institute of Health, the
Food and Drug Administration, and the Center for Disease Control. These would continue to be fully funded.
What to do about malpractice: If medical groups are to be open and transparent the
malpractice system should be scrapped.
Malpractice is the system we
have to identify medical errors and compensate people who are hurt by those
errors. The problem is that malpractice
is not a system and it does a very poor job of identifying those errors and
providing compensation for the errors.
Malpractice grew organically
out of the fact that there are doctors who make mistakes and there are lawyers
to sue them so on a case-by-case basis we have a huge industry that awards
payments to around 150,000 plaintiffs annually.[1]
It is demonstrably true that there are many more medical errors than this.[2]
It has been suggested that this is a reason for even more litigation[3]
but the problem is that malpractice itself inhibits the investigative process
that would identify individual and systemic problems, formulate corrections,
and provide reasonable compensations to the injured.
Malpractice is litigation and
to paraphrase Clausewitz litigation is dueling by other means. In addition,
when one gets sued, their lawyer immediately advises them that they are only
allowed to talk to their counsel, their spouse, or their clergy. In this
secretive and adversarial atmosphere in which virtually every physician feels
threatened[4]
it is virtually impossible for an open and transparent dialogue to take place.
Furthermore, because
especially those who, in the current system, are labeled plaintiff and defendant
can’t have a dialogue a large part of the healing process is lost.
Finally every discipline has
its own system for establishing truth. The legal and medical epistemologies are
very different. Medicine is
disinterested, rational, and cooperative; litigation is partial[5],
emotional, and adversarial. In my
limited experience legal judgments are hit or miss when they come to accurately
reflecting the medical facts.
This is not to say that
medical errors don’t occur. They, of course, do but these errors would be far
more likely to come to light in a system if malpractice were replaced with a no
fault compensation system for medical errors.
Such a system could be run by the states by strengthening their board of
medical licensure and discipline.
In summary the current
malpractice system does not allow for the open investigation of medical errors,
does not allow for reconciliation between the provider and the patient and
family, and in general does not give justice a good name. Health professionals
and patients need a better system.
There are of course a lot of
other issues that I have not thought of which would effect the implementation
and effectiveness of such a radical change in health care delivery. I would certainly welcome any thoughts from
readers on the matter. If you don’t like
this system you don’t have to worry because . . .
1. I am not emperor.
2. Most people don’t recognize the long-term deleterious
effect the medical industrial complex has on the economy.
3. Those who are concerned put the blame for health care problems on
the insurers or government and not on providers.
4. Currently, the federal government spends $1.2 trillion
dollars on healthcare.[6]
With the GHE that number would be 3 times that. Again We the People are already
spending that on healthcare but there would still be a significant (I would say
knee jerk) reaction to this “socialization” of medicine and corresponding
increase in the federal budget.
5. Since such a system threatens doctors, insurers,
lawyers, and drug manufacturers it may be a good thing but the powers (read
money) that would oppose it would be all but insurmountable.
No comments:
Post a Comment