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Politics : View from the Center and Left

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To: Katelew who wrote (51928)	3/6/2008 9:02:29 AM
From: Lane3	Read Replies (1) of 540746

Maybe you have some personal thoughts on making the system less costly and less adversarial while keeping the current network of private insurers? OK. My brain doesn't seem any more willing and able to deal with the cost part this morning than it was last night but I promised so I'll give it a try. I took up much more than my fair share of thread space yesterday. I never want to take more than my share of anything. I'll try not to do that today. The costs of malpractice insurance are an obvious target. Some sort of tort reform is needed. That would be the case even if we went single-payer. There's too much defensive medicine going on and its costly. We need to find a way for doctors to practice efficiently without so much overhead. I don't know enough to analyze it any better than that but there's clearly lots of opportunity there. Automation. The medical arena is so backwards. If you are taken to the emergency room, they shouldn't have to do tests you just had done last week simply because the results aren't available to them. You shouldn't have to go produce another history every time to see another doctor. And providers shouldn't have to work so hard to figure out who is eligible for what under their health insurance or what drug interactions or allergies you might have. And providers shouldn't have to deal with fragmented coding schemes. Lots of work is involved in getting the coding right. Insurers could share a coding scheme. Again, this would be the case even with single-payer so fixing it wouldn't obviate any moves in that direction. I don't know what products are being developed and sold for medical practices. I did read recently that Google is testing a program for storing patients' medical records. So there's some interest out there in fixing this. Profit. A lot of people get exercised over profit like it's something disreputable. I don't feel that way. But we could usefully have some watchdog to monitor profit in a coordinated way and get some sunshine on it. Since the profit aversion seems to be directed at the insurance industry, why not have non-profit insurance companies competing with the for-profit ones? We don't have to nationalize the industry to get rid of the insurance profit. Again, I don't know enough to see how that might work but enough to know it's worth a look. Insurance formats. HMOs save money. So do major medical/catastrophic policies. Fee-for-service comprehensive policies don't. (That's what I have.) We shouldn't encourage them of we want to save money. This is a demand issue. Another demand issue is transparency. If costs are hidden from us, how can we choose wisely. Published schedules of fees would help. So would some in-your-face feedback to employees on the cost of their health benefits, maybe a line item on the W-2. Maybe even paying tax on them. Another demand issue is cheap alternatives. Walmart is putting clinics in its stores as are others. There are lots of little things that they could handle. That's a start. There are lots of urgent care facilities. Do we even know where they are? Maybe insurance could forgive co-pays when we use them. And free clinics. Encourage more of them. I'm sure that list isn't finished but I'm running out of steam. I'll add to it as things occur to me. Hopefully others will, too.

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