Reducing Health Care Costs

SEARCH BLOG: MEDICINE

President Obama: don't spend $1 - 2 trillion of our tax dollars supposedly fixing health care by replacing what we already have... with what we already have. Here is my plan to expand health care and lower overall costs... by doing four things for less than $50 billion annually or less than the cost of the war in Iraq or annual Congressional pork projects:

• Eliminate lawsuits for medical mistakes
• Pay for medical school educations [$15 billion - 100,000 x $150,000 annually]
• Fund free clinics for those unable to pay for medical insurance [$25 billion - 5,000 x $5 million annually]
• Provide catastrophic insurance coverage for those unable to pay for it. [$5 billion annually]
  

That's all that needs to be done... along with the implementing the corresponding requirements for those actions.

First, remove entirely medical malpractice from the court system.

Analysis of trends in medical malpractice claims and payments reveals
that the total dollars in paid physician medical malpractice claims have
approximately doubled in the past decade. Average defense costs per claim
have increased substantially, also doubling. As expected, there is substantial
variation across states in these measures.

Further analysis shows the growth in dollars paid on malpractice claims is
mainly due to increases in the average size of claims. The total number of paid
claims has been relatively stable, despite a sizeable increase in the number of
physicians. The overall increase in total medical malpractice payments was only
slightly above the rate of medical care inflation, but somewhat greater than the
general rate of inflation.

The impact of medical malpractice law reform on the appropriateness of
malpractice awards, rising malpractice premiums, and the availability of
coverage is often unclear. And while medical malpractice continues to be a
focus of state legislatures, the U.S. Congress, and the Bush Administration, little
agreement exists on what approach best addresses the problems of medical
malpractice. Whether reform of tort law or changes in the malpractice
insurance system provides better solutions is debated. But better
understanding of these complex systems and their interaction could lead to the
most appropriate proposals for change. [p. 28 of Summary and Conclusion]

Replace that with boards of review composed of medical experts, legal experts, and patient advocates [eliminate adversarial environment] that determine if there was medical malpractice or fraud.

• If a doctor has made a medical decision that inadvertently harmed a patient while taking a reasonable course of action that has an uncertain outcome due to circumstances, the doctor is held harmless and catastrophic insurance will cover all of the patient's medical expenses and extended care... including both at-home care and nursing home care and, possibly, loss of income as a provision of patient-purchased or government-provided coverage.

  For example, the patient suffers a stoke due to the doctor taking proper action to treat a life-threatening breathing problem or heart condition.

• If a doctor has made a medical decision that was based on incompetence or applying unreasonable approaches, suspend/revoke the doctor's license and catastrophic insurance will cover all of the patient's medical expenses and extended care ... including both at-home care and nursing home care and, possibly, loss of income as a provision of patient-purchased or government-provided coverage.

  A pattern of harmed patients is considered evidence of incompetence, but not absolute proof in a specific instance, except for known high-risk situations where treatment cannot be reasonably guaranteed to succeed. For example, the doctor fails to take appropriate action for a situation where the problem is obvious and the treatment is standard. If the review finds that the harm was done maliciously... intentionally withholding necessary treatment, the finding should be grounds for criminal prosecution.
  

• If a patient was not harmed, but knowingly attempts to receive financial gain from the system, the patient may be subjected to fines or jail sentences as de facto fraud.
  

Secondly, remove the cost of medical training and education from the patient care equation to bring more doctors into the system so that care can be given before the problems of so many patients becomes too serious and care extremely expensive.

Doctors can elect to earn, but are not required to do so, their free medical training and education through a contractual term of service at free clinics, after which they may compete for jobs or establish their own practices. Foreign doctors wishing to practice in the U.S. would also be required to be certified within the U.S. system and provide a lesser term of service at free clinics.

Individuals remain free to pay for their own medical training and education and avoid any contractual obligation to the government. This is similar to the military program of providing an education in return for service. Universities still would be able to offer scholarships for particularly deserving students... academically deserving.

• The cost of medical training and education will be borne by the taxpayers as a necessary cost of maintaining a highly functioning medical system under a mandate to provide expanded health care to those unable to pay for it [shared costs].
  
• Doctors still will earn, through a merit system and judgment by the medical establishment, the privilege of entering medical training and further specialize into more advance areas [maintaining quality].
  
• Doctors retain the right to higher compensation based on their qualifications and services rendered [increasing incentives].
  
• Fees will be lowered by not limiting the number of doctors who are general practitioners or within an advanced specialty [increasing supply] and by removing the liability coverage costs associated with higher risk specialties [reducing disincentives and costs].

In return, the government will provide minimal catastrophic insurance coverage for those unable, not unwilling, to pay for their own health care insurance.

• Those who are able to pay for catastrophic insurance coverage [based on a percentage of their income] are free to elect to not do so, but they will cover such costs personally until their estates are exhausted. The income standard for coverage will make adjustments for the number of dependents similar to the way income taxes adjust gross income.
  
• The government will fund free clinics for those who qualify for government assistance that must be used instead of hospital emergency rooms to treat common illnesses or injuries unless no free clinic is within a reasonable distance... say 10 miles. [$25 billion]
  
• Free clinics may transfer patients to hospitals as medically required after initial evaluation; however, those clinics that routinely transfer patients for non-emergency care will be subject to penalty and staffs will be subject to disciplinary actions. Patients who simply bypass the system could be subject to refusal of service or may simply receive assistance to get to the local free clinic... a taxi to be paid for by the local free clinic. The government can figure out what to do after that.
  
• No persons illegally in the U.S. will qualify for any such assistance at either free clinics or hospitals... period. They may receive medical assistance through funds established by non-profit groups dedicated to that purpose or from funds provided by the Department of Homeland Security that has the responsibility keep out illegal aliens in the first place.
  

Taxpayers are given the most for their money and not forced to pay for:

• Unnecessary legal actions,
  
• Medical actions that are "cover-your-ass" only because of fear of lawsuits,
• Those who abuse the system, and
• Those who do not belong within the system.

Insurance costs must reflect the significantly reduced liability risks and the government's intervention in catastrophic medical costs for those unable to pay... who would otherwise still receive payment from private health care facilities, regardless.

Individuals will always retain the right to seek and pay for their own medical services without resorting to the government contributing toward the payment of those services... or limiting access to those services.

Treat the causes, not the symptoms, of high medical costs. Everyone will win except those who seek to gain from fraudulent lawsuits and those who raise the cost of medical care by promoting excessive compensation demands for medical mistakes... including incompetent doctors.

Of course, simply by eliminating huge lawsuits, the cost of medical services can be reduced significantly... without other government subsidies.

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