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Thu 11 Jun, 2009 07:00 am
I had an idea.
Instead of the government acting as a healthcare insurer, what if the government, instead, acted as a healthcare provider?
Instead of acting as an insurance company, fighting with private doctors and hospitals, the Government hires doctors and pay them a set salary based on experience and skills. Offer to pay for education for future service, ask for volunteer help from existing doctors, etc.
By setting up a government medical practice, they could then set prices for services rendered which would then bring down the cost of medical expenses as competition is created. The government has experience in this through the military medical program. For the most part, military doctors and nurses are top notch. They could use that experience opening practice to the general public.
At first, they could have income/insurance limitations based services. If you are below a certain income level or have no insurance you could use the government medical facilities. Then, as services expand across the country, open it up to more people.
This way, people still have the choice of using private insurance and private doctors of their choice. I doubt many doctors with existing practices would rush to work under the government as they would then be working for a set salary, but on the other hand, they would have guaranteed income. It would be their choice.
I believe that in the long run, this would be a less expensive alternative then insuring people and being at the mercy of private medical expenses.
Just a thought I had while trying to work.
What do you think?
@McGentrix,
It's an interesting idea, but I don't think it would address the particular market failure that makes America's healthcare system inefficient.
That market failure is adverse selection between health insurers and their clients: a vicious circle where insurance companies maximize their profits by denying coverage to sick people, and healthy people minimize their premium payments by buying minimal insurance coverage, or none at all.
There is no market failure of comparable scope in the market for providing healthcare: doctors, pharmacies, hospitals, etc. So your solution would fix something that's not broken (providing healthcare), while preserving America's broken health care system.
Just my two cents.
@McGentrix,
McGentrix wrote:
I had an idea.
Instead of the government acting as a healthcare insurer, what if the government, instead, acted as a healthcare provider?
Instead of acting as an insurance company, fighting with private doctors and hospitals, the Government hires doctors and pay them a set salary based on experience and skills. Offer to pay for education for future service, ask for volunteer help from existing doctors, etc.
By setting up a government medical practice, they could then set prices for services rendered which would then bring down the cost of medical expenses as competition is created. The government has experience in this through the military medical program. For the most part, military doctors and nurses are top notch. They could use that experience opening practice to the general public.
At first, they could have income/insurance limitations based services. If you are below a certain income level or have no insurance you could use the government medical facilities. Then, as services expand across the country, open it up to more people.
This way, people still have the choice of using private insurance and private doctors of their choice. I doubt many doctors with existing practices would rush to work under the government as they would then be working for a set salary, but on the other hand, they would have guaranteed income. It would be their choice.
I believe that in the long run, this would be a less expensive alternative then insuring people and being at the mercy of private medical expenses.
Just a thought I had while trying to work.
What do you think?
I had this idea as well while discussing health care with my brother. I think insurance is inherently inefficient as the middle man, and it doesn't matter whether it's privately or publicly run. I told my brother that when we decided to do public education, we built schools and hired teachers. We didn't set up an elaborate ponzi scheme of education insurance, whereby some third party decides how much an education should cost and reimburses private schools for it. So what if we built hospitals and medical centers and hired doctors instead of setting up a reimbursement bureaucracy?
I also think your example of military health care is the more appropriate model of government provided health care as opposed to medicare.
@Thomas,
Thomas wrote:
It's an interesting idea, but I don't think it would address the particular market failure that makes America's healthcare system inefficient.
That market failure is adverse selection between health insurers and their clients: a vicious circle where insurance companies maximize their profits by denying coverage to sick people, and healthy people minimize their premium payments by buying minimal insurance coverage, or none at all.
There is no market failure of comparable scope in the market for providing healthcare: doctors, pharmacies, hospitals, etc. So your solution would fix something that's not broken (providing healthcare), while preserving America's broken health care system.
Just my two cents.
Mark the day -- I disagree with Thomas. Government provided health care would remove two of the causes of our broken system. 1) The profit motive and 2) the administrative costs associated with the middle man. The problem of adverse selection is eliminated by (1) and by the universality of a government provided benefit. Both (1) and (2) bring the costs down, hopefully enough to make universality affordable to the government.
I believe Cook County runs public hospitals in this manner. I wouldn't call them efficient in the least. Hopefully joefromchicago will stop by and give his views on this.
@McGentrix,
McGentrix wrote:
I had an idea.
Instead of the government acting as a healthcare insurer, what if the government, instead, acted as a healthcare provider?
Commie! Why do you hate America?
@joefromchicago,
joefromchicago wrote:
McGentrix wrote:
I had an idea.
Instead of the government acting as a healthcare insurer, what if the government, instead, acted as a healthcare provider?
Commie! Why do you hate America?
O.o
I think this is a better solution.
@McGentrix,
McGentrix wrote:
I had an idea.
Instead of the government acting as a healthcare insurer, what if the government, instead, acted as a healthcare provider?
Instead of acting as an insurance company, fighting with private doctors and hospitals, the Government hires doctors and pay them a set salary based on experience and skills. Offer to pay for education for future service, ask for volunteer help from existing doctors, etc.
By setting up a government medical practice, they could then set prices for services rendered which would then bring down the cost of medical expenses as competition is created. The government has experience in this through the military medical program. For the most part, military doctors and nurses are top notch. They could use that experience opening practice to the general public.
At first, they could have income/insurance limitations based services. If you are below a certain income level or have no insurance you could use the government medical facilities. Then, as services expand across the country, open it up to more people.
This way, people still have the choice of using private insurance and private doctors of their choice. I doubt many doctors with existing practices would rush to work under the government as they would then be working for a set salary, but on the other hand, they would have guaranteed income. It would be their choice.
I believe that in the long run, this would be a less expensive alternative then insuring people and being at the mercy of private medical expenses.
Just a thought I had while trying to work.
What do you think?
Actual, government-run businesses are the definition of Socialism.
Cycloptichorn
@McGentrix,
Looks to me Joe and Cycl are not interested in addressing your question. I wonder why they bother to respond in the first place?
Anyway, my experience with the VA and medicare do not give me confidence but the general framework of your suggestion does have merit. I would agree that basic medical services could be provided in this manner, but additional coverage must be made available from the Private Sector at additional cost to those who want to buy it.
Many states already have public health clinic systems -- some more efficient than others. I know Florida had a pretty good one when I was a teenager. I think the idea is that we have to agree on some level of basic care that should be provided to every American. Everything over and above that can be provided by private industry and private insurance.
@FreeDuck,
The same argument would seem to apply to all goods and services. So why not introduce a universal food service, consisting of government-run farms that hand out food to everyone who asks?
@Yankee,
McGentrix wrote:Anyway, my experience with the VA and medicare do not give me confidence but the general framework of your suggestion does have merit.
Why? I always thought Medicare and the VA pay for your doctors' visits, but don't, at least not in general, employ the doctors. Did I have that wrong?
Well, if we are going have some sort of public healthcare, I'd just as soon see the money spent wisely. It seems foolish to provide insurance when the money could instead be spent providing services.
I am not opposed to government run health care. As a military child, I had access to military provided health care. It was more then adequate. We could use the money that would be wasted through insurance fraud, excessive payments, non-negotiated fees and expensive pharmaceuticals to build a government provided health care system.
Offering education to doctors and nurses in exchange for dedicated service, say 2 years service for every year paid (at an affordable institution, I see no need for Yale medical school, but better then a Grenada medical school). We could get a base of doctors and nurses rotating through the system. Also, having some doctors donating time in exchange for some kind of reciprocal reward we could have mentors for younger doctors. There is certainly a nursing shortage right now, and I think a system like this would help alleviate this shortage. Guaranteed schooling, followed by guaranteed employment through the government.
Eventually, we could see the government run medical system as effective as private run medical systems. At some point, the government could then offer a program of PAYGO for people who do not qualify for services. Or, perhaps an insurance program for companies to use their facilities. This would be completely optional as many people wouold be opposed to seeing government doctors or paying for government services. This would have no impact on private practice or personal/company provided insurance as it exists now.
Is this socialist? No. It's a wise choice to not throw good money after bad by not changing the current problems presented by current medical needs of some Americans.
The immediate problems I see is availability throughout the nation, getting the needed staff to start, building facilities or acquiring them (there have been many hospital closings in upstate NY due to financial concerns, don't know about everywhere else though), having sufficient staff to handle the immediate case load, getting people to understand that not every single medical condition is a required visit to a doctor and I am sure there is a long list of other issues that will be encountered.
I believe this could be accomplished though. It would just have to start small instead of trying to immediately be all things to all people. If only we could keep congress from getting involved, I think it would be a successful venture.
@Yankee,
Yankee wrote:
Looks to me Joe and Cycl are not interested in addressing your question. I wonder why they bother to respond in the first place?
It was surprising to me, that's all. I mean, this idea is far more socialistic than anything that Obama has proposed, yet he takes crap from the right-wing for turning our country into a Socialist paradise all the time. So something doesn't square with this idea...
Cycloptichorn
On edit, from McG:
Quote:
Is this socialist? No. It's a wise choice to not throw good money after bad by not changing the current problems presented by current medical needs of some Americans.
Um. Yes, it is Socialist. But it's also a wise choice. The two are not mutually exclusive.
@Thomas,
Thomas wrote:
The same argument would seem to apply to all goods and services. So why not introduce a universal food service, consisting of government-run farms that hand out food to everyone who asks?
Because we are not discussing a plan to do that. Government health care insurance is. I do seem to recall a time of government cheese though...
@Thomas,
Thomas wrote:
McGentrix wrote:Anyway, my experience with the VA and medicare do not give me confidence but the general framework of your suggestion does have merit.
Why? I always thought Medicare and the VA pay for your doctors' visits, but don't, at least not in general, employ the doctors. Did I have that wrong?
The VA runs their own hospitals. My dad visits the VA hospital in Syracuse regularly.
@Thomas,
Thomas wrote:
The same argument would seem to apply to all goods and services. So why not introduce a universal food service, consisting of government-run farms that hand out food to everyone who asks?
You could certainly take it that far. The short answer would be that, up until now, there hasn't been a problem in this country with people getting enough to eat. There aren't, for example, 46 million people who can't buy food, or a large number of people declaring bankruptcy because of their grocery bill.
@FreeDuck,
FreeDuck wrote:
Thomas wrote:
The same argument would seem to apply to all goods and services. So why not introduce a universal food service, consisting of government-run farms that hand out food to everyone who asks?
You could certainly take it that far. The short answer would be that, up until now, there hasn't been a problem in this country with people getting enough to eat. There aren't, for example, 46 million people who can't buy food, or a large number of people declaring bankruptcy because of their grocery bill.
Oh, I dunno. From Wikipedia -
Quote: *
[edit] Food insecurity
Food insecurity has been described as "a condition in which people lack basic food intake to provide them with the energy and nutrients for fully productive lives." (Hunger Task Force) In 2005, 35.1 million Americans, which includes 22.7 million adults and 12.4 million children, lived in households that were unable to afford the food they need for the year.[22] Households that are more likely to experience food insecurity are female-headed with children, those with incomes below the poverty line, and those that reside either in principal cities or within rural areas.[23] The top three states ranking in prevalence of food insecure households between 2003-2005 were New Mexico (16.8%), Mississippi (16.5%), and Texas (16.0%).[23]
Not quite 46 million, but close.
Cycloptichorn
Because they "can't afford" something, they should suddenly have a "right" to something?
I think McG's concept has merit, but it needs more substance. We need to learn from the mistakes of other countries' health policies and start from scratch in fixing our own. I would personally be willing to pay more taxes if it gets me healthcare. Taxes are how we invest in our country and I am willing to invest in the health security of every American. I think we have to stop viewing the government as our enemy and instead recognize it as our collective voice - and insist it functions as such. Free is not really an option. When people feel they are getting something for free they abuse the privilege. Ideally, I would like to see a single payer plan enacted and all the insurance company CEO's end up on food stamps.
I wouldn't worry about doctors rejecting such a plan. I have an relative who is a heart surgeon and he recently moved to Canada (where his wife was born) from Michigan because he could not stand dealing with American insurance companies. He makes about 25% less income, but he says he doesn't have to worry about children dying while waiting for an insurance company representative to decide if a procedure he is recommending is worthy of their dollars. He says the cut in pay was worth every penny because his stress level has gone down and his quality of life has gone up.
I probably have more to say, but I have to get back to work to pay for what little healthcare I can afford.
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