Monday, April 18, 2011

A Modest Proposal - Health Care Spending

Please read Parts 1 and 2 of this discussion first.

OK, now that I've touched on military spending and Social Security, we'll give the pitchfork and torch crowd the final excuse to test my new moat: Health Care.

This one is going to probably be one of the tougher ones to cut. Health care spending that prevents disease and stops epidemics in their early stages is a force multiplier to the country and the economy.  Also, the emotionally wrenching thought of a sick child or grandmother being cut off from necessary care because the government refused to pay for it and they can't afford to do so themselves makes me ill.  I'm tempted to either leave this one alone for the most part, or fall back on the old saw of finding efficiencies and reducing fraud.  But I think we will be able to make at least a few cost saving measures here without violating our senses of decency.

Health Care Spending

General Thoughts:
  •  Federal employees stationed within 50 miles of the District of Columbia, to include members of Congress and their staffs, employees of the Executive Branch, and members of the Judiciary and their staffs, will get their day to day medical care from military doctors at facilities equal in sophistication, staffing, conduct, and decor to the Troop Medical Clinics at the U.S. Army Infantry School.  This will not only cut down on the amount of money spent on these individuals' medical care, but will give them a taste of what they put our soldiers through to get decent medical care.  Use of Bethesda Naval Hospital will be on a referral basis only, and military patients get priority in non-emergency care over civilians.
  • Health care plans for federal employees and their families will provide no more coverage than the best plan that the VA offers military retirees through Tricare or its replacement programs.This is an upper limit, not a gold standard.  If we have to have public employee unions, then I expect management negotiators to get the cheapest healthcare coverage for them as they can.
  • Anyone who signs up for a government health care program of any kind, including health care insurance for federal employees, voluntarily agrees to not sue the doctors and other medical professionals that treat them under the plan, unless that professional is charged and convicted of a crime in relation to the incident in question. For example, if your cardiologist makes a mistake in reading your test results, or makes the wrong choice in a diagnosis that could go in multiple ways, you can't sue unless she committed a crime such as criminal negligence or malicious mischief.  That alone should bring down the cost of healthcare.
  • The existing legislation, good or bad, will be repealed.  I'm not going to get into whether or not it's a good idea, we just flat can't afford it without raising taxes to the point where I might as well be living in Helsinki.*
  • If you want to provide universal health coverage for everyone, change the Constitution to say that the government a) has that responsibility and b) has that power.   Then raise taxes enough to pay for it. 
  • Good Luck

For those outside the U.S., Medicare is the government program that provides a minimum level of health insurance to our senior citizens.  
  • Just as I said when I discussed reforming Social Security, current recipients and citizens born before January 1, 1950 will still be covered.
  • Citizens born between January 1, 1950 and January 1, 1965 will become eligible for Medicare on their 75th birthday.  In addition, the means testing I discussed for  Social Security will apply to Medicare as well.  
  • Citizens born on or after 1 January, 1965, warm up the lube some more.  You're not going to get Medicare benefits either.  We get to keep paying into the system, but the amount will decrease over time as the number of Medicare recipients dwindles.  
  • To compensate for the fact that the second two groups will have increased out of pocket costs for healthcare in their later years, the cap on the amount of pre-tax income that can be put into Healthcare Spending Accounts will be lifted.
Now that we've established who will be covered by Medicare, let's talk about how the program itself will change.
  • Elective procedures and therapies are not covered. Elective means "It is going to be very difficult for me to be a productive member of society without it", not "If I don't get this, I won't be happy or pretty".  I'm not saying that our seniors get a lot of Botox or Viagra, because I'm sure they don't.  But a lot of the questionable coverage is going to have to go.
  • Only drugs that have gone generic, and are therefore less expensive, are covered. Drug companies can make their money on the non-government funded market.
Federal Medicaid Funding:

For those outside the U.S., Medicaid is the generic name for the program that provides minimal medical insurance to low income people.  It is partially financed and managed by the federal government, with the rest of the money and implementation provided by the individual states.

  • Again, the list of what services are covered by federal funding to Medicaid needs to be rigorously evaluated and thinned.  
  • Just as I recommended with Social Security, a condition of accepting Medicaid benefits will be to submit to regular, random testing for intoxicants.  If you want other people to pay for your health care, then don't spend money on smokes, drugs, or alcohol. 
  • Again, only drugs that have gone generic, and are therefore less expensive, are covered. Drug companies can make their money on the non-government funded market.

Unfortunately, any effort to control spending on these programs will cause medications or procedures to become unavailable to the old or indigent.  While cancer treatment may cover chemotherapy or a mastectomy for a woman, due to budget cuts, it may not cover reconstructive surgery for her breast.  An orthopedist may make sure your broken back is fixed mechanically, but the length of physical therapy for the injury may not be optimal.  The dentist will make sure you have teeth in your head, but government programs won't pay for braces.  In order to help make sure that these and other procedures that may not be absolutely necessary to staying alive, but are still important, I would encourage charitable giving by removing the cap on writing off charitable giving from individual and corporate income taxes.  Yes, I'm forcing some members of our society to go to charities for what is easily available from the government now, but I believe that charity should be voluntary, not withheld from paychecks under force of law.  Prior to 1965, the poor and old weren't keeling over in the streets any more than they are now, and I don't believe that asking them to go to charitable organizations for health care that isn't absolutely essential will make it happen now.

That's the last of the major spending areas I'll talk about.  Next we'll discuss the little, when compared to what that I believe could be done with military spending and entitlement programs, things that I think can be either reformed or eliminated to save just a bit more.

*Not that there's anything wrong with Helsinki. It's one of those places I'd run to if I ever had to leave the U.S.  It's just not the most tax-friendly places on earth.


Spikessib said...

Sorry, I'm a little behind on this, but as a healthcare provider I am in agreement with you.

I would add that healthcare is the most highly regulated field in the country and yet has the highest rate of failure of any, simply due to the fat that the majority of patients won't help themselves. Many simply won't do as recommended. They don't fill prescriptions, or take their meds as prescribed or follow basic rules such as diabetics monitoring blood sugars and CHFers monitoring their fluid intake.

I think that everyone should have at least a small co-pay so that they respect the system, that abusing the Emergency Dept. or EMS should be a fine-or-arrest worthy offense, and anytime anyone being treated on the public's dime is listed by a physician as non-compliant with treatment recommendations their continuing assistance should be reviewed, with progressive discipline even to saying we're are not going to pay for your treatment anymore so the next time you go to the doctor or ED you'd better have cash.

Too many people abuse the system we have currently and a great cost savings would be achieved if they would just do what the doctor says.

perlhaqr said...

A federal law mandating that insurance companies be allowed to cross state lines wouldn't be out of place, either.

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