A sensible healthcare plan

With all the debate going on about Health Care Reform, I thought I'd throw in my two cents.

First of all, I agree that reform is needed. Healthcare is too expensive and too complicated. While much has been made of the 'who pays' question, the 'why the heck is this so expensive' question really hasn't been asked or answered. No matter if the government acts as a single payer (i.e. we all pay via taxes) or we have a network of insurance companies (i.e. we all pay via payroll contributions) no system can compensate when costs go up 10%+ per year. A major component of any healthcare reform needs to be net reduction in total cost.

Now obviously a healthcare system needs to ensure that high-quality care is available for everyone, so we need to find areas of costs to eliminate that won't jeopardize quality or availability of care.

Here are some cost contributors to health care that add little/no quality or availability of care:

1. Lawsuits (doctors and hospitals need to be accountable for mistakes, but this should be performed by the criminal justice system, not by lawyers)
2. Insurance overhead - go in to any doctors office and you will see a whole gaggle of people who do nothing but handle insurance forms (be it private insurance or public insurance). Additional costs can be found in the entire health insurance industry. While necessary in the current system, these people don't make anyone healthier.
3. Medical records - we have been talking about this for some time; making electronic/online medical records would be a huge cost savings.
4. Pharmaceutical marketing - drug companies spend millions on advertising, free lunches for doctors office staff and free samples (which effectively acts as universal perscription coverage in some cases) trying to push expensive drugs onto patients. The choice of prescription drug should be solely that of a doctor and patient, without persuasion on either party.
5. Unnecessary ER - We have universal healthcare in the United States. Every hospital ER must treat incoming patients regardless of their ability to pay. What this means is there is a whole class of people who don't have the ability to pay for (or simply don't pay for) normal preventive care (say a diabetic who can't afford insulin) so they end up in the ER regularly. ER care is expensive and money would be saved if these people could access preventive care. As it is, hospitals absorb all of these 'freeloaders' and pass the costs onto the rest of us.

Problems #1 and #3 could probably be solved regardless of what type of health reform we peruse.

So in my estimation there are two potential systems that could make a real difference in reducing cost. They are at different ends of the political spectrum and both have weaknesses and strengths.

Option #1 : Medical Savings Accounts

This idea has been circulating in conservative circles for quite some time. The idea is simple. Instead of traditional insurance plans, employers would give employees money in a special fund that they could spend exclusively for healthcare. Additionally employers would provide high-deductible insurance for catastrophic coverage (like cancer). So for example, you get $3000 and an insurance policy with a $3000 deductible, so you have 'complete' coverage. You would get to pocket any money that was left so it would be to your advantage to shop around for doctors, prescriptions, etc. It would introduce cost competition to health care, which would lower costs. You would be able to choose any doctor or treatment. Right now, similar plans (sometimes called 'Cafeteria Plans') exist however disallow the employee from receiving any extra dollars.

Advantages:

1. Introduces Competition to lower costs.
2. Similar to existing system, so transition could be easy.
3. Could be done with no new tax dollars.

Disadvantages:

1. What about the poor/unemployed? We could still have the ER problem mentioned above in #5, also this plan would leave the Medicare/Medicaid/VA care untouched - and still inefficient. Also most proponents of this plan would not force employers to provide a plan to their employees, so many (including self-employed) would be left out.
2. This plan would not reduce the Insurance overhead as you would still need to track things because of the catastrophic coverage. Also you might not have total coverage as the insurance company may not count everything you choose as going towards their deductible. Additionally an employer could provide you with a plan with a gap (say $3000 MSA but a $10k deductible catastrophic coverage).
3. An employer-based system leaves US employers at an economic disadvantage in the global marketplace.
4. Competition could introduce a 'race to the bottom' with quality of care becoming in jeopardy.

Option #2 - Completely Public Healthcare

The idea here to make healthcare function like other public services such as police and fire protection. Communities (cities, counties or even states) would run hospitals and doctors offices with the doctors and nurses being public employees. Private hospitals could still exist (for 'elite' care or things like non-reconstructive cosmetic surgery) but would be a minority part of the system (much like private schools today). Tax dollars (rates, types and collection method determined by the community) would support the system. Medicare/Medicaid and much of the VA could be done away with since everyone (regardless of income, age or military service) would be able to access public health care. There would be a small national tax (likely far less than the current Medicare/Medicaid tax) that would fund grants to poor/rural communities, oversight to make sure communities are providing quality care and scholarships to medical students or funding for medical schools (since the pay would be lower than the current system). Additionally patents on prescription drugs would be done away with, reducing the cost of medicine. The government would provide funding for new medicine research. This would be an improvement on the existing system where pharmceutical companies have an incentive (i.e. small piece of a big pie) to research drugs for common conditions even if good drugs already exist and if their new drugs offers little difference for the existing ones (they rely on marketing to convince people, see #4 above). The government could ensure the research occurs for drugs for rarer conditions.

Advantages:

1. Insurance overhead eliminated
2. Local oversight, national accountability
3. Preventive care would eliminate unnecessary ER cost
4. Universal access to quality care
5. Employers no longer required to provide insurance (think of the $ they would save on HR) thus putting them on a better footing in the global marketplace.
6. No insurance means that employees can change employers without worrying about healthcare. Even better more may opt to start their own businesses since they don't have to worry about expensive health insurance (this is a major deterrence to many potential entrepreneurs I know).

Disadvantages

1. Stark departure from existing system - conversion may be difficult
2. No competitive element (could be an advantage depending on your outlook)
3. Possibility for corruption.
4. New taxes required (though some of this will simply be a shift from existing taxes and payroll deductions)

Now it should be noted that the current proposal being debated by Congress is not 'Completely Public Healthcare' but rather an extension of the current insurance-based system whereby employers would be forced to give insurance to employees, new taxes would help poorer people pay for insurance and the government would run their own insurance company. So aside from move around the 'who pays' question, little actual savings occurs (possibly un-necessary ER visits to some extent may be eliminated).

What are your thoughts?

Satisfied

One of my favorite activities is reading Wikipedia. This is ironic because I used to make fun of my mother for reading the encyclopedia for fun. I guess we are destined to become our parents. Oh well.

So I was reading the article about the Amish. I've always been sort of a fan of the Amish since they seem to stick to their peculiar way of life despite the rest of the world. But one thing really struck me as I read. Their reasoning for not using certain technology is not out any belief that the technologies are evil but rather that they allow people to be evil. For example, why do they not use motorized tractors but do use modern chemical fertilizer? Because the tractor would allow a farmer to farm more land thus possibly depriving another farmer of that land. They are satisfied were their simple standard of life and want to ensure that no one gets greedy.

So why am I not satisfied? I have far more material possessions than the Amish. I have a car, an apartment and a satchel I take with me pretty much everywhere. Yet I envy people with other cars and imagine myself living in a big house. The problem tends to be that I make up in my head (with the help of our society's mindset) that my life would be substantively better if I had one of these things. These other people with their better satchels seem so much happier than I. But I know it is the poor who are happy and the humble who are blessed.

So for at least today I am satisfied. I have a beautiful wife to wake up to each morning, work that I find rewarding and friends to laugh with. For everything else, I know I am loved more than sparrows or lilies.

Policies vs. People

I've had a couple of recent conversations that have caused me to think about the reasons for poor leadership. How come so many organizations have overbearing policies? A friend related to me that at his workplace they recently implemented a strictly defined dress code - a list of what constituents appropriate attire for the office. When I inquired about what caused the policy, he explained that a co-worker routinely dressed in a very sloppy manner. So management's response was to develop a 'complete' description of the boundaries of office-wear. Now in reality this dress code does little to improve the sloppy employee (who was unable to follow the simple dress code let alone this complex one) however causes much frustration for his fellow employees who now feel oppressed by the 'legalistic' rules. Further, other employees may blame the rules on the offending employee. This is another example of the classic management failure - the solution that fixes no problems but causes more.

What is the better solution? Simple. The manger should discuss the offending employee's dress with him. This makes it clear to the individual employee (who is the real problem) without involving other employees. Most likely the individual will improve his dress.

So why do mangers not have these conversations? Fear. Simply put it is easier to 'draft a policy' than to have a difficult conversation with an employee. In reality the conversation doesn't need to be that difficult.

Facial Hair

So it is kinda lame that I've have not posted anything for a very long time. So I'll give all those so interested an update of sorts.

First of all, after almost 6 years, I've decided to change up the ole' goatee. I shaved of the mustache part and may do more, not really sure yet. See the picture Any suggestions in this department would certainly be welcome.

Second, I am happy to report that for the past few weeks, I've been doing WeightWatchers for Men online with some good results. I've been able to lose 20 pounds since November (not all of those are with WW, but most are). I have to say I like the system, it seems like something I could do long term without feeling deprived.