Monday, July 10, 2006

Back on June 22nd, I posted on the subject of the crisis in medical care in this country, listing a few of the many issues that bear on the problem of inadequate and unaffordable medical care and suggesting that I had some ideas for reforming the system. Here they are:

* First - and probably most difficult - remember that death is part of life. In a society that values the enjoyment of life and worships the technology that enables us to extend it, we view death as something to be feared, avoided, and postponed as long as possible...often at the cost of a life sustained only at great expense in a shell kept alive by drugs and machines and the heroic efforts of armies of doctors. We need to learn what our ancestors knew - life ends, and we need to re-learn when to let it go.

* Second - and equally difficult, but for different reasons - put a lid on enormous jury awards in malpractice cases. While some may be justified in the very rare case of true professional malfeasance, these are very few, and the end result cascades throughout the health care system as huge malpractice insurance costs for doctors and hospitals, which end up being passed on to patients as higher fees, higher insurance premiums, and skyrocketing costs for expensive tests and scans necessary only to protect the doctor and the hospital from lawsuits. Oh, yes - and it's the lawyers who see most of those jury awards, anyhow.

* Third - make the cost of medical care (including medical insurance premiums) 100% deductible on federal and state income taxes, rather than the current practice of deducting only that portion which exceeds a certain percentage of income. A healthy taxpayer is a productive taxpayer - why not let the tax system recognize and reward the government's interest in keeping taxpayers healthy?

* Finally (for now) - take the decisions on medical treatment away from insurance companies and put them back in the hands of the doctors. When courses of treatment are dictated more by what the insurance will pay than by what the patient needs, it's the patient who suffers the consequences.

These are just four ideas, each of which has merit and each of which is certain to offend and upset some part of the reading audience; nevertheless, each of them will undoubtedly help to bring some much-needed repair to a health-care system that has much to offer and which is, at the bottom, the best in the world. We need to work together to save it.

Have a good day. More thoughts tomorrow.


1 comment:

Anonymous said...

Bilbo: Glad to see you've come back up on the net:

Great Post, especially the first issue. Of course people of faith find it easier to let go--although that can be carried way to far, as the existence of slamofascist suicide bombers proves!

Second point: no argument here. It would be really nifty to try out the following system: Patients and doctors could sign a statement requiring both sides to accept binding arbitration in case of unexpected consequences. The reward for the patient would be that he/she would pay a reduced rate, based omitting the fraction of the doctor's fee caused by his malpractice insurance. The doctor would gain the peace of mind knowing he couldn't be sued into the poorhouse. The arbiters would be medical professionals (say teaching M.D.s, social workers, economic experts (to measure the value of the loss to the patient--say much less to an old guy, compared to paralysis of a youngster., etc. Also, nothing would be paid for losses during pure cosmetic surgery! Obviously punitive awards would disappear, as would lots of lawyers.

Third point: Your plan switches the tax deduction to individuals as opposed to businesses. Along with that switch, I would expect the recognition of the system that worked 50 years ago. Those who did have health insurance normally only bought a "Major Medical" policy. This policy only kicked in when the costs of a single illness exceeded a threshold (about a year's salary). People would before malpractice, pay about one hour's labor for a doctor appointment. While we can't expect it to be that cheap, we could help by establishing pre-tax medical savings accounts, so people would have an incentive to save some untaxed money, any dividends on which would be also untaxed. Should drive down the costs of medical care--make make totally unemployable millions of people who just shuffle insurance paperwork around! Remember, they don't produce anything, just like lawyers!

Proposition III should logically soon result in your proposition IV.