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Posted on 05/06/2025 6:06:55 AM PDT by Heartlander
The American system of medical-care delivery has no name. It is neither single payer nor based on private enterprise. It is a patchwork of cockamamie carrots and sticks, agencies and incentives, exceptions and accounting tricks, cajoles and punishments, cobbled together over some 50-100 years of legislation that itself was a product of pressure-group pushes, graft, loopholes, mandates, and subsidies.
It’s not even a clean public-private partnership. It’s a public-private-nonprofit-grifter-payola regulatory cacophony of confusion and chaos over which pharmaceutical companies and professional lobbyists exercise the dominant influence.
Still it quasi-functions. It hobbles along year after year with ever more expense and administrators, with ever worse results. Absolutely no one would design such a thing from the ground up. No one is particularly happy with it but neither is there much push to change it fundamentally.
The Covid years devastated trust or, perhaps, just pulled back the veil. Every poll confirms it, e.g. a Harvard/Northwestern poll showed that trust fell from 71.5% in April 2020 to 40.1% by January 2024 across all groups. The reality is likely far worse. Everyone is asking how to restore trust.
The last time centralized reform was attempted was 15 years ago. The debates about Obamacare minted a healthcare expert daily and generated think-tank blueprints reflecting every ideological bias. The final product of a thousand pages, in which no one group got its way, was shoved through with great huzzahs on one side and boos on the other. It resulted in more coverage, yes, but also cost increases anywhere between 50 and 500 percent depending on how one chooses to measure it.
No one can produce evidence that it has made America more healthy. A statistical tour through chronic disease data, or a casual walk through a mall or airport, proves that.
The debate over the Affordable Care Act pretty well exhausted the appetite for far-reaching reform. And maybe that is a good thing because the drive today is not for one system for everyone but a realization that the needs are so diverse and diffuse that it would likely have more success with a series of parallel systems that emerge from the ground up.
Thus has most of the Make America Healthy Again (MAHA) agenda focused on matters that individuals and families can do themselves. They include being more scrupulous about diet, exercise, sleep, sunshine, and caution about prescription medications, whether for mental or physical maladies. The movement against mandates is at the core simply because it now (versus a few years ago) pertains to children and relates directly to the grave concern about ill-health and the rise of autism.
Again, this is a more productive conversation than going back to the drawing board to reform a system that has no name and hardly anyone understands in its totality. It recognizes something crucial, namely that health is not granted by a system of government or a large insurer but rather emerges from individual decisions and habits. In large part and with the exception of unpredictable twists of fate, much of what we call health is mainly within our own control.
Given that insight, we have a better starting point in which to discuss real policy reforms that can give people a greater degree of control than they currently have under the existing bureaucratic patchwork of programs, mandates, agencies, and bureaucratized systems. Here are eight examples that can make a massive difference and should be favored regardless of ideological bias.
None of these eight reforms rub hard on ideological wounds. All are about respecting individual choice, which is the essence of health. They can all be pursued without touching existing entitlement systems and legacy welfare provision. They would amount to the first major steps toward creating parallel systems of experimentation, all within the framework of the existing system. It seems like they should earn bipartisan support.
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US health care is a failing disgrace. The government has ruined it. It is totally focused on getting you put on all kinds of meds produced by Pharma. A person can spend days making appointments and getting run from one place to another getting tests that quite often no one even calls you back with the results. They do manage to get that bill in your mailbox though.
The government quietly got rid of informed consent, so now they can make you the guinea pigs or “beagles” for their poisons.
These measures sound an awful lot like what Reagan proposed forty years ago.
Not a bad list
I will add another four suggestions
1. All doctors must three cash payments.
2. They can’t charge more in cash than an insurance company will actually pay
3. The first, third,and fifth (if there is one) Thursday of each month treatments are considered charity and patients aren’t charged
4. Reform tort law to greatly reduce frivolous malpractice suits.
We don't need CEOs to run health care (nuns did a better job than most of them anyway). Private medicine, fee for service with transparent pricing, malpractice reform, and regional hospitals - not ever growing hospital systems that take over practices and that are overrun by feckless administrators making 7 and 8 figure salaries. How is it that ‘not for profit’ hospitals and hospital systems (the majority) have CEOs making multiple 10s of millions, and multiple levels of ‘administrators’ who are also making large salaries?
Hospitals should be collaborative, with the health of patients being the number one concern (not acquisitions and politics and non-physician administrators). You can't run hospitals like corporations. It doesn't work, and it will never work. It just ramps up costs, with ever decreasing quality of care.
Marked. Thank you.
Free markets? Let’s not get CRAZY here. There’s GOTTA be more top-down ‘solutions’ here
- Left/State/Global-ists any/every time/where
Hospital costs can be reduced by splitting most hospitals 50/50 between two companies.
Medicaid costs can be reduced by gently nudging people away from the program, discouraging ER use and making nursing home care cheaper. Start with $2/month Medicaid premiums and raise them by $2 for each month and each ER use. The time-based Medicaid premium amount to not exceed the monthly Medicare premium.
Premiums to be lowered by $1 for each week you subsequently have private PPACA-scope coverage.
Nursing homes could be two side-by-side eight-bed units primarily staffed by four people, with one night staffer for each unit.
Medicaid reform could be tied to State and Local Tax (SALT) relief. Republican members of Congress too afraid to vote for Medicaid reform would have to do so to get SALT reform.
Government drug costs could be reduced by multi-government buying.
For the private sector, I’m in favor of all-the-doctors prescribe pharmaceutical plans with patients having to pay a plan set amount for the manufacturing cost. Pharmaceutical plans would normally buy into entire product lines. These pharmaceutical plans would be sold on a national basis and not be subject to state law.
For drugs not in a plan, there would be payment voucher issue to patients based on drug class: biologic large volume, biologic small volume, etc. The Secretary of HHS would compute recommended amounts annually. There would be a ten-day plan purchase cooling off period for plans not offering to pay the recommended amounts or more. Let the patients wave the voucher at Walgreen’s and CVS. The drug companies will gladly take $500 for a monthly prescription that might cost them $100.
As for pharmaceutical product liability, insurance coverage might be purchased at the pharmacy. Would you like pharmaceutical product liability coverage for that Covid vaccine jab? Yeah!
Medical and drug plans would not have fixed premiums; the monthly premium would change based on claim payouts. In that way, the insureds would bear the financial risks collectively and plan providers won’t have a strong financial incentive to deny claims.
We need merit-based doctors, not ones chosen b/c of DEI policies.
Great article here by Heather MacDonald that explains it well:
The Corruption of Medicine
"Guardians of the profession discard merit in order to alter the demographics of their field."
https://www.city-journal.org/article/the-corruption-of-medicine-2
...discouraging ER use...
Nearly every time I call to may an appointment with my primary care doc, they refer my to the ER. I never go. I'm not going to sit in the ER for hours for essentially routine care.
The PROBLEM in health care is “third party” pay. Get rid of insurance and you remove the pile of money currently being targeted by our legal system along with countless other in-betweens who profit from the current system without providing a drop of health care. Reduce healthcare to what it once was and should be, you and your doctor.
I liked it when you could call (and a person would answer) your doctor’s office and make appointments. They would call you with test results and mail you a copy of the results.
Now each and every friggin’ specialist, hospital, pharmacy has their own “convenient” (to THEM) website that is full of idiotic stuff you don’t care about but is confusing to navigate and find what you need.
Meanwhile you get 10-20 spam-ish emails and text messages for crap you don’t care about.
Translation: Abe Simpson: Old man yells at cloud.
Reform we need to make is to help American citizens become doctors. Most doctors my wife or I have seen speak with a foreign accent, some you can’t understand. There has to be a reason why foreigners are encouraged and Americans are not.
“Liberalize generic therapeutics from prescription control and make them over the counter.”
Senator Hubert Humphrey, once a pharmacist, made prescriptions a legal norm in 1948.
Dr. Humphrey,....
There are 14 people behind you, lady.
********
Drugs might be ordered by you via computer based on your medical record.
“Allow employers to offer employees an opt-out of mandated health insurance. The mandates are hugely expensive for employers. Every employer with more than 50 employees must comply. We don’t even have to change the mandate but simply permit options for the workers. Allowing their workers an extra $5-10 thousand or so in salary and wages would be accepted by many and give the direct primary care industry a boost. This would lower costs and boost job options.”
That would leave people uninsured and things like accidents can happen. US 41 is the greatest risk I face.
Women face regular risks, childbirth when younger and breast cancer when older.
Ping
“Permit insurers to offer catastrophic-only plans to people of all ages. For that matter, health insurers need to be free from the shackles of predefined plans that are inclusive of services that most people do not want or need. A catastrophic-only plan would be selected by many. This might be the worst aspect of Obamacare, and it needs to go. We should be able to buy health insurance the way we buy any other good or service, which is to say, according to our own perceived needs, risk aversion, and willingness to pay.”
If people regularly bought $10K deductible plans, hospitals would pad their bills by $10K so they would get paid what they need to function.
People should only be allowed to buy high-deductible plans if they place the deductible amount with the plan provider, who might pay 4% interest on it.
I’m not in favor of catastrophic plans. I do think co-insurance plans, so the plan issuer has the incentive to control provider scams, are the way to go.
“Nearly every time I call to may an appointment with my primary care doc, they refer my to the ER.”
IMO, you need to find another primary care doctor.
Make being an independent doctor affordable again.
Allow the number of med student slots in med schools to increase.
“There has to be a reason why foreigners are encouraged and Americans are not.”
I suspect the pre-med curriculum needs to be pruned of things like organic chemistry.
No doctor I know cooks up drugs in a back room but writes a drug name on a piece of paper.
And cut out the milligrams stuff.
SAD standard adult dose
SADplus 1.5 times the standard adult dose (i.e. three 50% of SAD pills)
SADmax maximum adult dose
CD20+ child dose, 20% of the SAD (or the lowest higher percentage available)
CD40+ child dose, 40% (if available) or 50% of the SAD
CD80+ child dose, 80% (if available) or 100% of the SAD
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