Note to mods: in spite of my username, this is not a throwaway account.
I'm interested to hear everyone's thoughts. I think we can drastically improve healthcare in the US with a few simple changes, four to be exact.
Criticism of M4A: In general, I'm against Medicare-for-all. I think there are some good things about the system, but I think there are some bad ones as well. If you are curious about how single payer healthcare would work in the US, look at the VA system. I think M4A would be like having the VA everywhere. I think Medicare-for-all makes things better for one group only – patients who currently have trouble affording healthcare. For everyone else including patients who currently can afford their healthcare as well as providers, I think things would be worse under a Medicare-for-all system. I think that holding up personal freedoms, opening the door for individual exceptionalism, and putting more responsibility on individuals to make good personal choices are some of the values that sort of define the United States and none of those values are well supported in a Medicare-for-all system. Furthermore, I think that Medicare-for-all requires a drastic overhaul of our current system and there are sure to be significant growing pains. I think we can do better. I think we can get healthcare to everyone who needs it while preserving the majority of our current system and supporting values like individual freedom, opportunities for individual exceptionalism, and personal responsibility.
So here's my plan:
- Transparent pricing of healthcare services. Anyone who renders healthcare services should be required to clearly, simply, and publicly disclose the price for those services. This not only includes clinics and hospitals, but pharmacies. Some patients would use this information to shop around for cheaper care, some wouldn't. Many doctors would use this information to reduce the cost of care for their patients. Aggregate/comparison sighs would quickly pop up so that you can just type in what service you want and it will show you all the local places that provide that service and how much it costs. I do think that this would help to drive down the cost of care in the US. Whenever healthcare is consumed or provided, the two people who should have the BEST idea of what that care costs (the patient and the provider) often have no clue what it will cost until after it is processed by the healthcare institution and insurance company.
- A national EMR. If I access the chart for John Doe in San Francisco, I should get all the same information that I would get if I accessed their chart in Boston. In order to provide the best possible care, I need to have accurate information about what tests have been done, what medications you are on, what diagnoses you have, etc. Patient self-report can be unreliable, HIPAA is restrictive, and it is 2019 yet we are still faxing important medical information. In order to cause minimal disruption and preserve individual EMR vendors, the national EMR would be simply the backend. All EMRs, regardless of who makes that EMR, retrieves and stores medical information in the same national backend/database using a common, agreed upon format. Individual EMR vendors can then create a product that accesses, displays, and allows interaction with that information in ways that are unique to the needs of each individual healthcare institution. Think of the internet – the backend is the same, but how you access it (Chrome, Safari, Firefox, IE) is different and can provide additional layers of benefit on top of the information you are accessing. A national EMR should work like that. I think that this aspect, above all else, would have the most growing pains. But by preserving individual vendors, they may be able to transition where that information comes from without causing a significant disruption of your daily workflow.
- HSAs for all. Ben Carson's plan from 2016 was a bit like this. Every citizen should have an HSA they can contribute to. Anything contributed to the HSA can be spent on "healthcare", and we can let that be a fairly broad range of things including spending your HSA money on the monthly premium for health insurance. The type of health insurance you have would not affect your HSA in any way. Contributions still reduce taxable income, just like today, but yearly limits would be much higher. HSA money can be passed on through a will and can be transferred between the accounts of family members. In general, #1 above and #3 here would create more opportunity for people to pay cash for services, reducing the bloat of a system that requires a 3rd party payer. If someone does not have health insurance, there is no penalty, but if they need emergency medical services a lean can be placed against their HSA so that contributions are garnished until debt is paid off.
- A national public insurance option. Some people, based on income, age, disability status, etc automatically qualify for it, but anyone can have it if they want. If you don't automatically qualify, there is a monthly fee just like any insurance company. The care covered by this national insurance then can provide a competitive standard by which all private insurers will be compared against. If the cheap national insurance covers pre-existing conditions, it would be hard for a private insurer to get any business without also covering pre-existing conditions. This allows for a loosening of restrictions on private insurers by letting the market drive what standards they need to adhere to regarding coverage. Between this option and the HSAs for all, the door is now open to a "universal if you want it" model where the federal government can deposit funds into HSAs for all Americans every month equal to the monthly cost of the public option. If you want to use those funds to buy the public option you can, but you can also use those funds to buy private insurance or just save them and pay cash for services.
I think these options can each, if enacted in isolation, improve our current system. None of them are too controversial and take a fairly middle-ground politically. I think these changes would make things better, yet allow for continued personal choice/freedom, allow for individual doctors to do their own thing and charge cash for it if they want, and it allows the patient to be the one in charge of their healthcare, not an insurance company.
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