Healthcare

Fixing health care is simple

  • Eliminate all provider networks; patients go where they choose.
  • Eliminate all deductibles.
  • Set fee payment schedule initially based on 85th  percentile of actual charges (85 of 100 providers will have fee within schedule)
  • Increase fee schedule at maxiumum rate of CPI (or similar benchmark)
  • Health care providers compete on price and quality and can choose to accept fee schedule docopleratingor not
  • Saves large portion of administrative costs for insurers and providers.
  • Prescription drugs reimbursed at 80% of Rx manager negotiated fee; 85% for generics
  • Implement universal ID cards with coverage and health record chip

Simple huh? The fact much of this is right from the 1970s playbook is quite irrelevant, right❓😷

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10 replies »

  1. I agree that the moral hazard has to be fixed unless the people decide that fate is a factor and some people just must die because of the cost. By what I mean is take some one who lives a good life style, is hard working middle class person, goes to the doctor once a year and then a medical disaster strikes. Maybe it is a premature baby or cancer and they survive and now face a lifetime of very expensive drugs. Now it becomes only the rich survive and the poor die. You say that was what major medical was for back in the 70’s & 80’s and I agree that seems like a good solution but what if you are less than middle class and can’t afford to buy major medical? Who pays now or do you die? So now we are back to the government picking up the tab. As a person who has insurance and some money why should I go bankrupt with an illness and in the end I still die, leaving my wife penniless when the poor still get treated? Is the poorer person better off?

    I do not know what the answer is but I want to see fair posting and pricing of all drugs and medical services. Why are there so many back room discounts permitted? Why does a person without insurance pay 70% more than a person with insurance? You cannot do anything about price until you know what the true cost and pricing is.

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    • The problem is no one knows the real price/cost of services. Take a simple office visit. Each private insurance pays a different amount, Medicare pays less and Medicaid even less and the private payer pays the most. In other words, some payers are subsidizing others.

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  2. Mr. Quinn – I am not well enough informed on this subject to understand what you mean by “the 1970’s playbook”? Please explain that. Thank you.

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    • In the 70s and before health benefits were mostly fee schedule, not reasonable and customary or negotiated fees payments to providers. You could go to any doctor, but the could bill you if they had not agreed to accept scheduled fee. Many people had only hospital and medical surgical coverage and no coverage for outpatient services or Rx; eventually a major medical component was added to most plans with a modest deductible and payment at 80% for office visits, etc and Rx.

      Then there was a shift to paying reasonable and customary fees which naturally kept rising as providers increased their fees each year. The added coverage for Rx and and even what was the modest cost of an office visit, encouraged more spending and health care costs took off. To cope; late in the 70s and into the 80s HMOs were supposed to be the solution … They weren’t.

      And you know the rest of the story; ever increasing costs and now more cost – shifting.

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      • Alright, Mr. Quinn, thank you. I have read literally years of commentary and opinions on this subject, from your postings and elsewhere, I know that you are opposed to the PPACA and you are opposed to “old Bernie’s” (your words) single payer proposal. So given your knowledge of this subject and years of corporate experience in health benefits, When you are king, what are the details of your executive order to solve this situation?

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  3. Doesn’t address most basic question – who pays, how much to get coverage card; who pays for those who don’t buy coverage; who bears burden for cost over-runs (when fee schedule is inadequate); who pays when provider rejects fee schedule; who pays when remuneration inadequate for development of orphan drugs, … And on and on and on and on ….

    Sounds like Canada – they tried that in Vermont and concluded thatcher was right: Socialism workswelluntil you runoutofother people’s money!

    And,finally,how do you transition 75 million baby boomers who paid into medicare part a all their lives – who bears that burden?

    Americans want the best health care your money will buy, but good health, and the higher quality of life it brings, is still not enough of a daily life priority for some to lose weight (myself included), to stop smoking, drinking,using drugs, driving recklessly…

    Simple solutions are simple, but not effective unless the apportion risks – to individuals, where they should bear the risk and where they control outcomes, groups (employers, insurers) to a great extent for accidents and routine, and to society (taxpayers, providers) where it is chronic or catastrophic, and where saddling individuals or groups with such costs is not reasonable.

    Solutions exist, no one wants to pay! That was true in 2009/2010, and it is still true today!

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  4. This is a logical revamp of the healthcare mess in this country. This could have been accomplished anytime over the last 40 some years, and I cannot imagine a lot of resistance to this type of program. And congress has NO say in this whatsoever. Our Constitution is clear about the matter: the people of the United States have the right to set their own health care priorities, to pay for what they choose to pay for, to direct the paths of their own lives, and to live with the consequences of the path they take—without interference from the nation’s central government.

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    • That may be true and ideal, but all too many people are not responsible, do not plan for the future, do not obtain various forms of insurance to protect themselves and then expect society to pick up the burden. Not the way it should be, but what does society do, turn them away from health care, let them starve in the streets? Until we can fix human nature it seems we have no choice but carry the burden for those who don’t do it themselves.

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      • No. You have to address the moral hazard. If we give health care priority, it must come with accountability. So, I believe you should run a tab, so those who benefit from entitlements, like Medicaid, accumulate a tax burden – if they never pay it off, so be it, but that debt ensures taxpayer burden is as low as it can be. Similarly, absent truly disabling health, there should be a maximum time limit on access to entitlements that are not paid for. So, 30 months of Medicaid, for example, which can be replenished by repaying the cost from earnings – as a tax.

        No uncompensated care. All who do not have coverage would be defaulted into medicaid.

        But, it has to be comprehensive, it has to properly allocate risk, between individuals, groups and society to be successful – and to minimize moral hazard.

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