UNTYING THE GORDIAN KNOT—PUTTING IT ALL TOGETHER

Here’s a summary of 15 recommendations to help mitigate the many problems of our health care debacle in a rational way: 

  1. Cap “pain and suffering.”
  2. Establish an impartial body from the medical and legal community to review legal complaints for a summary judgment based on merit; if denied, it can proceed but contingency fees are disallowed.
  3. Establish nonprofit health cooperatives owned by the patients.
  4. Pursue fraud and abuse.
  5. Encourage teaching of cost-effective practice patterns in medical school, internship, residency and fellowship training.
  6. Continue to develop guidelines for good medical practices.
  7. Continue to fund and expand cost-effectiveness research.
  8. Establish a centralized medical records database.
  9. Invoke a windfall profits law for insurers.
  10. Increase competition by allowing patients to obtain coverage from out-of-state insurers.
  11. Encourage transparency on the part of hospitals.
  12. Reward lifestyle modification, possibly through reduced insurance premiums.
  13. Enact a government-enforced individual mandate for a basic level of insurance.
  14. Establish boards comprised of citizens, clergy, medical and possibly legal professionals to review end-of-life cases to help physicians provide appropriate care immune from legal reprisal.
  15. Establish review boards to allow graded access to prisoner care that takes offenses and sentences into account. 

 

Next: Some Final Thoughts

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3 Responses to “UNTYING THE GORDIAN KNOT—PUTTING IT ALL TOGETHER”

  1. rantsramblingsravesandothersignsofmentalillness Says:

    #3 A healthcare co-op is a really interesting idea. What type of services do you think could be handled in the co-op without stretching resources too thin: PCP, OB-GYN, specialists, inpatient/outpatient procedures? How many co-op members/patients would you need to support such a venture? What mechanisms/fee structure would be in place to deter over-utilization of healthcare? What mechanisms would be needed to prevent people from joining when they know they’re sick – would there be limitations on how much service you could receive for a certain number of years to prevent people from dropping in and out of a co-op?

    #12 Reward Lifestyle Modification: People have different metabolisms – just because someone is skinny doesn’t mean they have necessarily exercised or eaten healthy. So how do you measure lifestyle effectively? Are there some blood tests or something that would be a good indicator of health – where someone couldn’t just fast the day before to limit things that fluctuate daily like glucose?

    Sorry for all the questions, but they are your ideas. Plus one of us is a doctor and it’s not me. 🙂

  2. rantsramblingsravesandothersignsofmentalillness Says:

    Also, do you think patients as co-op members would be more likely to sign one of those arbitration agreements before joining the co-op?
    http://www.medicalnewstoday.com/articles/97084.php

  3. heartheaded Says:

    I envision a health care co-op as an alternative to having insurance tied up with one’s employment, i.e., a large diversified group that’s able to contract with insurance carriers for reasonable rates. What you’re describing sounds more like an HMO. The issues of health care overutiitzation are complex and I’ve addressed them in part, but even more radical realignment of the system may be needed to combat this. A problem with the legislation now being proposed is that without a pre-existing condition limitations, fines for not having insurance would need to approach insurance premium fees to prevent people from entering the system only when they are ill.
    Regarding your second point, while the tendency for obesity clearly varies among individuals, it’s hard to deny that the problem has reached epidemic proportions never before seen, arguing for a prominent environmental role. (We don’t see obesity in food-starved countries.) We’ve simply become accustomed to eating the wrong things and too much of them. I think it’s reasonable to have a surcharge for things like obesity and smoking, which have a voluntary component, just as is done for people choosing high-risk lifestyles such as sky-diving, mountain climbing and extreme skiing.
    Arbitration agreements might lower the cost of health care, but comprehensive tort reform is needed.

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