Ideal Healthcare – Part 2
Practical implementation…think
schooling.
In my last article, I offered
the solution to healthcare as dependent upon three key elements to be successful:
1) Healthcare must be
provided for all U.S. citizens.
2) Medical professionals must
be able to work in a profitable environment.
3) Insurance companies should
be excluded from healthcare
Unless the Affordable Care Act is dismantled, the law forces us to continue with government controlled healthcare. I would like to continue to outline how we can modify the ACA to have a successful healthcare system.
As expected, a more liberal view would doubt that my proposed system could work
without government control overseeing abuse in healthcare institutions. While
the conservative view believes that government should not be involved in
healthcare operations due to inefficiencies. To achieve this, I believe it necessary to detail items 2 and 3 to resolve these concerns.
I have said before that we
should not do what other countries have done, but learn from their mistakes. I will begin with two countries who I believe have the most promising of healthcare plans and expand upon them.
First, the Netherlands changed their
government controlled “single-payer” (single-funded) system in 2006 to a privately run single-payer system
by the insurance companies. The key point is that they realized a few things
that occurred when government was completely in control. Health inequality between rich and
poor, long waiting lines, and cost increases were a few of the reasons to let
the private sector run the program. (See link below)
After 2006, the healthcare
system did improve, but negatives also crept in. 80% of the insurance now
operates through only a few companies. This is an example of an
oligopoly and not true competition (something the state wanted to avoid)…the results were costs increases. Besides
increases in health spending, there are also many instances of less competition
and consumer choice.
Second, In 1995, Taiwan’s “single-payer” system
was implemented and modeled after the U.S. Medicare concept. The working population
pays premiums split with employers. Waiting lists are short and most preventative
services are free. They use a smart card with their health info on it, which
keeps fraud down and efficiency up. They have the lowest administration costs in
the world...in a way.
After closer scrutiny, Taiwan is spending more than taking in, and borrowing to finance the rest. The government is afraid to raise premiums because they fear a voter reprisal. Their solution is to ration care to keep spending in line with revenues. (see link below). Unfortunately, there is a low doctor-to-population ratio resulting in too many patients depending on too few doctors. Patients visit the doctor more frequently causing doctors to keep visits short to about 2 to 5 minutes per patient. There is no system to regulate systematic reporting of clinical performance, patient outcomes and adverse events. Taiwan is also slow at adopting technology except for drugs, and borrowing is needed to cover for these needed costs.
After closer scrutiny, Taiwan is spending more than taking in, and borrowing to finance the rest. The government is afraid to raise premiums because they fear a voter reprisal. Their solution is to ration care to keep spending in line with revenues. (see link below). Unfortunately, there is a low doctor-to-population ratio resulting in too many patients depending on too few doctors. Patients visit the doctor more frequently causing doctors to keep visits short to about 2 to 5 minutes per patient. There is no system to regulate systematic reporting of clinical performance, patient outcomes and adverse events. Taiwan is also slow at adopting technology except for drugs, and borrowing is needed to cover for these needed costs.
Both the Netherlands and
Taiwan have good healthcare at a good price. Both countries initiated their
programs after looking around the world and gleaning the good from others. As they examined other countries learn the good and bad, so too should we in the U.S.
I'm suggesting that a common negative with these two
countries is the lack of incentives and the greater reliance on punitive measures
to control healthcare. Doctors and medical
institutions need efficiency at a
reasonable cost if they are to remain profitable and successful. Competition can resolve this issue (see link below).
In the Netherlands, with only
a few insurance companies in the system, lack of competition restricts
efficiency in operations and choice, ultimately leading to cost increases.
In Taiwan, with insurance
companies removed and smart cards in use, millions
have been saved. Again however, there are no incentives for doctors;
this reduces a reason for doctors to enter the workforce, ultimately resulting
in a burden of a high patient ratio and reduction of effective health care (i.e. those visits of only 2-5 minutes). Additionally, with no competition between health
institutions, advancement in new medical technology has been suffering.
I would like to veer off topic a moment to examine the U.S. school system...the reason will soon become clear. Our government requires every child to attend school. Not every child is required to attend a public school, but every parent
must pay into the public school fund (taxes). My proposal for healthcare
would mimic the U.S. education system - with one exception.
The exception is that the
school system, albeit quite functional, could be much more efficient and
successful…by implementing private sector techniques. Charter schools have been
experimenting with better techniques in the last several years. The jury is out on the total effectiveness of charter schools in
general, but some areas are proven (see link below). Examples would be to give
teachers rewards for high performance, or maybe a bonus to school principles effective in high
standards and efficient use of funds. The ideas are endless, but the basic concept is sound.
Healthcare can run in a
similar fashion.
Every person should pay their taxes for their healthcare, like we do for the school system.
Every person should be able to go to the doctor, like we do for the school system.
Every person should have a local healthcare administration center to monitor effectiveness of the program in the community, like we do with the local school board (creative incentives would best work closest to the source).
Every person should pay their taxes for their healthcare, like we do for the school system.
Every person should be able to go to the doctor, like we do for the school system.
Every person should have a local healthcare administration center to monitor effectiveness of the program in the community, like we do with the local school board (creative incentives would best work closest to the source).
In the end, the United States school system has a ways to go to achieve excellence in education, but the private sector has already proven some techniques that can help make improvements. And so too can we implement the current school system as a model to redesign our healthcare system, then make additional improvements that have proven successful.
I contend that if we exclude the insurance companies from the process and allow doctors and institutions to be profitable, our healthcare system could once again be truly rated the best in the world.
I contend that if we exclude the insurance companies from the process and allow doctors and institutions to be profitable, our healthcare system could once again be truly rated the best in the world.
Netherland healthcare
Taiwans healthcare
Teacher performance incentives
Sample of competition gains
Sample private sector
incentive plan
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