Dr. Obama's Toughest Patient

Washington Post ^ | Monday, August 31, 2009

[nickcarraway]

THE OBAMA administration and other advocates of comprehensive health reform knew that August was going to be a perilous month. It's turned out to be disastrous. As lawmakers return to work and President Obama ends his vacation, the health reform enterprise is in rough shape. So what is the proper course of treatment?

One approach would be to scale back the scope and cost of reform -- spending perhaps $600 billion to $700 billion over the next decade instead of the $1 trillion now under discussion. This would do less harm fiscally. But the interconnectedness of the health-care system makes a piecemeal fix more difficult than a comprehensive one. It would fall short of a cure for two major ailments of the current system: Too many people lack health insurance, and for too many others it is unreliable and, increasingly, unaffordable.

For example, consider cutting the cost of reform by reducing subsidies for purchasing insurance. Many people, unable to comply with a requirement to obtain coverage, could find themselves both without insurance and fined for that failure, while the new insurance exchange purchasing pools would be smaller and therefore less effective in reducing overall costs.

You could extend coverage only to segments of the population, hoping to add more over time. But whom to choose? Extending Medicaid to all those at or near the poverty level -- childless adults and many parents currently aren't eligible -- is expensive (about $400 billion over 10 years) and politically unpopular. Yet if you don't cover that part of the uninsured population, you don't solve hospitals' problems providing uncompensated care, the costs of which are passed on to insured patients.

[jessduntno]

"One approach would be to scale back the scope and cost of reform -- spending perhaps $600 billion to $700 billion over the next decade instead of the $1 trillion now under discussion."

Privatization + Inter-State Sales + Individual Policies + Tort Reform = Healthcare Reform

I can't imagine another way out that will not draw us into the disastrous slippery slope that will be co-ops or "expanded medicaid" or other euthamisms...we need to privatize, make portable and drive down costs by opening a free market.

Performance based outcomes will propel the better providers to the top and the market will sort out the lesser programs. 25% of the "uninsured" are "the invincibles" (the 18-25 year olds) that feel no need to buy insurance...if they do not buy insurance they can contract with private fee for service firms that will compete and possibly make loans or give them credit for procedures.

The higher risk 50-65 uninsured (uneligible for medicare, but struggle with no coverage, low income, job loss or pre-existing conditions) get assigned to a "risk pool" that better performing insurers will ultimately compete for, because they are able compete for them at reduced rates, giving them good coverage and reasonable rates.

The elderly will be covered by medicare and the indigent will be treated pro-bono by participating hospitals. I would like to see THAT pool covered by University Hospitals, many of whom have billion dollar grants behind the universties and should make use of the interns and younger doctors to keep the indigent covered, much as many law firms do.

[VisualizeSmallerGovernment]

spending perhaps $600 billion to $700 billion over the next decade instead of the $1 trillion now under discussion.

But Obama says that it won't cost one thin dime because of all that money we'll be saving on needless foot amputations and buying granny the blue pill instead of a pacemaker.

[Verginius Rufus]

Lowering the life expectancy will also help keep Social Security solvent longer.

[Extremely Extreme Extremist]

Desperation from the ComPost. We all know what the right solutions are, and it sure in Hell ain’t enacting Obamacare piece by piece.

[Jeff Chandler]

And tonsillectomies.

[Jeff Chandler]

The idiots spent the last three decades on a radical anti-smoking campaign and now Social Security is bankrupt!

[ari-freedom]

some other ideas:
1) maybe there should be a tax incentive if you help another person get insurance (such as donate to a charity that insures people). In general, a charity that helps the poor get out of poverty should be valued more than a charity that simply gives $ to them with no conditions or a charity that helps art museums.
2) we need more doctors. We need a better educational system so that kids will have the skills they need so that they can seriously consider becoming a doctor. We need more h1b visas. Also, doctors are extremely affected by high marginal tax rates.

[Candor7]

What ever is done, Doing NOTHING is better than HR 3200.

Why is the IRS involved in deciding how much people will pay for Health Care? Why is the IRS to be involved with collecting unpaid medical bills? ( Say the words "seizure without a court hearing.")

GET THE IRS OUT OF THE HEALTH CARE PLAN.

[ari-freedom]

hmm I just noticed that john mackey also came up with the idea behind idea 1) in his whole foods plan:

“8. Permit individuals to make voluntary tax deductible donations on their IRS tax forms to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid, SCHIP or any other government program.”

[ExTexasRedhead]

Neuter them in 2010
Vote the Rest Out in 2012

[bt_dooftlook]

Hey - here's an idea or two:

1. reduce the cost by implementing tort reform

2. reduce the cost by providing employer tax breaks to self-employed

3. reduce the cost by moving towards catastrophic care coverage