Dave Winer has written a couple of posts about health care
Debating health care in 2008
Debating health care in 2008, day 2
On day 2 is this nugget:
The basic Republican argument goes like this. Why should I pay for the health needs of people who are so irresponsible as to not have
health insurance.
If I got it wrong, please set me straight.
Now I’d like to answer this, very carefully.
The Democrats aren’t proposing that you should pay for the uninsured. Key point. They either agree with you, or know that they’re not going to get their proposal passed unless they take this into account. The Obama plan says you don’t get care unless you have insurance. His proposal aims to get a lot more people insured. Clinton goes one step further, by requiring everyone to have health insurance. LINK
No Dave, you have summed up the current positions pretty well. There is a but……
Here is my 2 cents.
Health Care Closed Source
Geeze Dave!
You are sucked into the same quagmire as everybody else with the position is that Insurance is the only way to pay for health care. Currently Health Care is the worst Closed Source game around.
Consider that Insurance is a numbers game developed to share the risk of cost. Sounds pretty good, a bunch of folks pool money to pay for illness or injury repair.
Let’s look at what the game really is.
The Insurance Company provides you with a policy to cover health care expenses. With the limitations, exclusions, co-pays, deductibles, networks, and caps, a cell phone contract is a better deal.
Health care premiums are predicated on costs , which are billed by providers, who predicate these on cost plus profit like any other business.(that we are even considering Health Care as a For Profit Business rather than a Service Industry is another rant)You would think that economy of scale and free market forces would bring lower health care costs. You would be wrong.
The Insurance company that is providing you ”coverage”, is the same company providing malpractice and liability insurance to docs, clinics and hospitals, which causes them to raise their rates, which jacks up your premiums, which adds to the administrative burden, which requires more overhead, adding to the cost of care, which at this point we have not addressed actually providing any fucking health care!!
So the Insurance Industry is getting largest amount of money from you, for the least possible level of service, getting the most money from the actual health care providers for liability and malpractice, which they then use as a cost basis to justify either jacking up your premiums, or decreasing your benefits for the same money. And it a lot of cases BOTH!
Notice I still haven’t actually mentioned actual Health Care?
But Wait! There’s More!
There is an entire industry called claims payers, who are between you, your health care provider and your insurance company.
The Medical Information Bureau is another of those semi secret organizations that allow the HCII to deny you coverage.
Don’t forget the Medical Liens Industry
I am really tired of the argument Think of the Poor Health Care Insurance Industry(HCII)!! The dems are just as guilty as repubs, in continuing this lunacy.
What exactly has the HCII really done to control costs which is their selling proposition?
- Have care costs actually come down?
- Are more companies providing Health Care for their workers?
- Are more families able to afford Health Insurance?
- Are doctors and hospitals able to treat patients at a reasonable price?
No they are not. Like the poor woman whose insurance company approved treatment 6 days after she was dead.
Why aren’t insurance companies paying for experimental procedures? One of the best arguments I can put forth against the HCII is their refusal to participate and pay for new and experimental treatments. Yes they are risky. But if the patient, doctor, and hospital are willing to put forth the effort in order to actually try a course of treatment, they should be in the lead in doing this. Currently the rich are being soaked for this, in those cases where there is a confluence of disease and money. Which is not fair to them. The rich are citizens too. All lot of groundbreaking work and procedures are developed as a result of the higher incidence of poorer folks having medical problems. This IS a numbers game. No I am not advocating a gigantic Tuskegee experiment on poor people.
Health Care Open Source
I am going to start with a couple of observations.
Healthy people are more productive. Healthy people are happier. Healthy people are less likely to shoot up malls, classrooms, city councils, steal your car, or kill you for walking down the wrong street. Most people who get into health care, are about helping other people, not about making money. Besides if you want riches beyond avarice, you go into business.
My argument is for Universal Health Care. If you breathe and are a citizen you get health care.
Here me out before you go all private enterprise on me.
There are a few things that need to be done to make Universal Health Care a reality.
1. Standards of Care
Fix the problem. What ever it takes. Record problem, treatment course, and outcome. From a stitch from a bar fight to a liver transplant. Make this information Universally available. This implies a central database to make this information accessible to health care professionals everywhere. This has to be an OPEN SOURCE effort. Microsoft and Google are the last folks on the planet to trust in designing, managing of guarding medical information.
2. Medical Record keeping.
We need a single record keeping system used by everybody. This contains all of the pertinent patient statistics, problem, diagnoses, treatment and outcome information, with treating facility, physician, nursing and ancillary staff including to links to test results. But is not linked to individual patients by name or other identifying information. This can form a useful function in giving doctors access to information to courses of treatments that failed or worked. It also can form a synergystic function if treatments used are parts of either drug trials, (eliminating proprietary or secret drug trials,) or experimental treatment scenarios. In the case of failures, this needs to be used to fix problems and not blame. No the malpractice attorneys will need to find other careers.
Personal patient information, must not be accessible on the public facing side of this. Gaining access to this information needs to be strictly controlled and granted only in limited circumstances, such a Public Health Issues, Epidemics or disease outbreaks. Or by the patient. We can dismantle a bunch of the HIPPA bullshit here.
Since we are talking about Universal Health Care, the Health Care Insurance Industry can be dismantled and those folks can buy a casino and set up a sports book. They probably not make as much money but that is too bad, as my sympathy for the Health Care Insurance Industry is too small to measure by any current technology.
3. Payment
Everybody Pays.
Individuals, a national sales tax which will catch everybody. Welfare to Wealth, everybody buys stuff.
Employers, a premium scheme setup along the same lines as Workmans Compensation is set up now, understanding some industries are more dangerous than others, and do pay higher premiums, with a deduction in premiums for businesses that have better safety records.
Usage Taxes, auto licenses get a surtax as autos are one of the primary populators of health care facilities. Probably consider taxes on other toys like boats and planes.
4. Administration
The only role I see for the Government either federal, state or local is collection. This needs an NGO setup for administration, payment and oversight.
Having this information available is the best way to get the best care at the best price.
Having this information available will also eliminate discriminatory and predatory insurance schemes.
The cost savings in eliminating Private Health Care Insurance, redundant paperwork, claims payer networks, and other third party remoras between the doctor and patient will drive down the cost of health care.
That’s my 2 cents.
