Opinion : More on Healthcare reform

Notes to 2008 presidential candidates: How to achieve universal healthcare.

No one is more for universal healthcare than I am, but we need to provide it in a way that makes economic sense. Laying off 1000's of American workers for the benefits of cost cutting does not make economic sense. There are many ideas out there that can save money, but throwing them all on at once will cause a disaster. Healthcare reform needs to be a gradual process that helps everyone and also contains costs. Here is my plan (most of which I stole from Ed Rendell's advisors)

Immediately:

The key here is to save just the amount of money that it will cost to cover the people who don't currently have insurance. First determine exactly how many people are under or uninsured, and how much it will cost to provide them with the minimum acceptable level of coverage. Then determine how much we are currently spending on care minus charity care and services to the uninsured. Take the cost to provide expanded coverage as a percent of total current costs and this is the amount that we will need to cut/find/raise in taxes.

The cuts at this point should be able to come with simple efficiency improvements to the system. This can include: going to centralized electronic records, requiring generic drug use, mandated error control and reporting procedures, outlawing competitive advertising, and limiting the amount of profit that private insurance companies can make based on payouts.

It is also important to establish long term health trends at this point that will stabilize costs. This can include smoking and trans fat bans (or any other public health measures), starting exercise programs, and beginning to negotiate pharmaceutical drug prices. If extra financing will be necessary (Pennsylvania claims it will, Massachusetts says it won't, who knows) then now is the time to pass the necessary measures, such as lotteries, sin taxes (alcohol, firearms, pollution, casinos and tobacco) or private insurance taxes.

In the near future:

The key in future years, once everyone is covered, will be to contain costs, improve quality, and expand services. The ideal cost increase per year should be roughly the rate of inflation (about 3%) plus the rate of population growth (around 1% depending on immigration laws). measures should be phased in slowly to decrease system wide costs each year. These include: geographic redistribution of resources, training more general practitioners, opening more nursing and urgent care clinics, implementing chronic disease management plans, expanding hospice, malpractice reform, negotiating cheaper drug and equipment prices, etc.

There should also be an effort to improve quality and access, mainly by education and out reach and by cracking down on under-performing operations.


In the long term

We need to move towards a more unified and non-profit, centrally planned health care system. As laws are passed and reforms are implemented, Growth and profit should be reduced industry wide and private companies will have motive to sell out. Eventually the goal should be to consolidate systems into non-profit or government run, vertically integrated units. The eventual goal should be Community based pricing by a single payer or a few non-profit payers, in a system organized and overseen by individuals who do not stand to profit from it. This will ensure that care delivery is fair and patient centered. I hope that this is not only a dream.