Friday, November 28, 2008

Health Care System

The incoming US administration has the capability and possibly the will to introduce a universal health care program that will surely take its lead from the experiences of other countries. I will share some ideas that may provide an anchor for the program’s design.

First, distribute control and management of the system to the States with a fifty-fifty cost and revenue sharing formula. This immediately removes the whole subject from the National legislature, rarely to be heard from again. It also gives the states a high level of responsibility and localized management under the pressure of state to state competition.

Second, design the program around a broad palette of authorized core services. There will always be someone unhappy and complaining, but good investments in future human productivity can certainly be identified and nurtured. Let the States manage this. Failures will attract censure and keep them all honest.

Third, permit premium services but do not allow anyone holding a medical license to provide such services to more than a third of his practice. Ensure that all practitioners are trained in modern scheduling methods to eliminate wait times.

An umbrella organization can be set up and extended to each State as it adopts the program and sets up. Ensure that licensing and all individual rights are completely transferrable between States. Some States will have to solve funding issues, and some will be more restrictive than others, but in time this will all sort itself out without wasting further effort on the part of the National government. Private insurers will be allowed to provide extended services not covered by the basic coverage.

I have kept this as short and simple as possible. The idea is to lay this off to the States as quickly as possible. They want State rights – let them have the hot potato. It will keep them on their toes for the next century or so. It certainly worked forty years ago in Canada and a noticeable result is that medical profession has forgotten what bad debt is and they rarely let themselves be dangerously overworked.

Of course, young surgeons will complain about the long waiting times that they are subjected to because the old boys have first dibs.
I do not think it was ever fully appreciated in Canada how first one province made it happen (one of the poorest) which triggered a couple of more provinces to bend to popular demand. That then led to a National system that was quickly adopted by all provinces. It really came from the bottom up and in the face of virulent opposition from the medical industry.
The same has not happened in the USA while the status quo has actually worsened. Remember, the USA pays fifty percent more per capita while excluding a third of the population than Canada for essentially the same core service. So called wait times apply only because of imperfect planning and could easily be taken out of the system but has not because of the usual political howl.

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