06-11-09 On Healthcare

We need a public option
where doctors
1. do not get paid by fee for service
2. get rewarded for wellness not illness
(but with safeguards to prevent scams)
And where
1. Where non-profit really means NO
profit – and no padding of the budget.

If a Coop is really to do the job it would have to be
1. national (not state by state)
2. subject to govt control over costs and service and proceedures –
3. proceedures would have to be simple and clear – so the patient can walk in get initial diagnosis and treatment and walk out –
without having to think about money.
(How do Sweden and Switzerland handle the problem of hypochondriacs with no illness overusing the system?)

If these criteria are met – then it would be the same as a good public option
– SO a COOP would merely complicate the process and put another layer of administration and bureaucracy in the way.

We need a real and functional PUBLIC option – financed by a 2% tax – and if the private companies cannot compete with that then they should not be in the business.
They need to offer something that somebody really wants and this would force them to do so.

Govt money more than the 2% tax should be limited to the first five years of the program or for major emergencies by Congressional action (with other checks and balances).

Power to interfere to insure competitive drug prices – and to insure that drug prices are related to the income of the consumer need to be included in any bill.
Incentives for research should be funded separately – to insure that research is for the purpose of improving health, not for cosmetic improvements to existing drugs. Or for advertising etc.
And the permission for generic competition should happen faster and/or earlier.
Mass drugs such as Lipitor essential to health should be moved to have generic competition
almost immediately – with the companies rewarded as if it was a normally popular rather than an essential drug.

Hospital billing and charges need to be made rational, efficient, subject to real scrutiny, simple and clear, not arbitrary, and related to ability to pay.

We need the real thing.
If every other modern country can do it, why not the United States?
I know doctors in England and Scandinavia –
and they are quite happy with their lot.
They may not be paid as much – but they are very comfortable indeed.
And much happier with their working conditions.

SIMPLICITY and CLARITY and relation to income is of the ESSENCE.
But done via a tax – NOT at the time of illness.

And of course all people are to be included in such a plan.
If there is to be a higher tax for people with incomes well over the comfort level in respect to charges and inflation that would be reasonable – but should not be set at a fixed amount of income but with the level somehow indexed.


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