{"id":2477,"date":"2011-12-04T20:59:28","date_gmt":"2011-12-05T01:59:28","guid":{"rendered":"http:\/\/jimgworld.com\/blog1\/?p=2477"},"modified":"2011-12-04T21:00:26","modified_gmt":"2011-12-05T02:00:26","slug":"healthcare-future-without-the-shock","status":"publish","type":"post","link":"https:\/\/jimgworld.com\/blog1\/?p=2477","title":{"rendered":"Healthcare Future, Without The Shock?"},"content":{"rendered":"

I previously wrote in favor<\/a> of using vouchers as a means of reforming the increasingly dysfunctional and economically threatened health care system in America. I feel that a federal voucher system could be fashioned in a way that meets both Republican and Democratic concerns. I.e., employer-provided health insurance would be abolished. Taxpayers (especially corporate taxpayers and rich taxpayers) would instead pay into a pool used to provide an annual voucher to every American, good for so many dollars worth of health care insurance each year (health care spending is presently around $8,000 per person). The annual voucher could be adjusted so that rich people get smaller vouchers and the poor and working class get bigger ones (i.e., worth more $$). This would allow insurers to compete in an open market for voucher customers. The federal government would regulate this competition so as to discourage \u201ccreaming\u201d, i.e. trying to attract only young and healthy participants. The government would also require that every policy meets some minimum standard of benefits (e.g., it can’t be a bare-bones \u201cbig emergency only\u201d policy).<\/p>\n

I’m not the only one that believes that a voucher-based system is the best (although certainly far from a perfect) way to deal with the health care crisis. A recent article by economist Robert Samuelson<\/a> mapped out the current economic and political dimensions of the crisis. Samuelson came to the same conclusion \u2013 vouchers are the best way to get a handle on this distressing situation. <\/p>\n

I fully anticipate (along with Samuelson) that such a system would change the nature of health care for everyone. For the time being, the present dis-coordinated system of having separate insurance companies, private doctors, corporate-owned hospitals and clinics, along with a variety of disconnected government partial-subsidy programs, could be maintained. But over time, the incentive would be towards \u201cone-stop shopping\u201d, i.e. using your voucher with a care company that acts both as insurer and primary provider; i.e., an organization that would provide and coordinate all the healthcare that you need over the next year, in return for your voucher (and possibly a separate charge, if you wanted added features). <\/p>\n

This could eventually put the local doctor’s office out of business, making it go the way of the corner grocery store. (The local drug store is vanishing too.) Health care would become \u201csupermarket-ized\u201d by clinical networks. Perhaps 95% of all services would be provided by the network, and any highly specialized services for particular diseases would be fully coordinated by the network and provided by secondary doctors or clinics. <\/p>\n

A lot of people would hesitate before accepting this deal; right now most of us (over the age of 40, anyway) have a private doctor who we trust to guide us regarding our health care needs. Under my voucher system, we would put that trust into the hands of a corporate entity (which could be a non-profit, but probably would usually be a capitalist business). We might or might not have a regular doctor to talk to; if we needed hospitalization or other clinical services, that would be set up by a \u201ccare coordinator\u201d working for the corporation. I myself wonder if this is going to risk lives and compromise human dignity, in a Faustian trade for profits and efficiency.<\/p>\n

But a recent article in The Atlantic<\/a> gave me some hope that perhaps such a system could work in a humanistic fashion, in a \u201cwin-win\u201d way that provides profits for investors, very good health care to individuals, and lower overall health care costs for our nation and our economy. In a nutshell, a California company called CareMore was formed by a doctor in the 1990s to provide medical services to Medicare patients differently than most \u201cmanaged care\u201d HMOs did. HMOs typically try to contain costs by restricting patient options and denying coverage for as much as possible (perhaps even more than legally allowed, given the \u201cdeny first, reconsider only if challenged\u201d procedure that insurers and care companies use). <\/p>\n

However, CareMore decided to try reducing hassles for patients and providing preventative care measures especially for patients with chronic conditions like heart disease and diabetes. For example, free transportation was arranged for some patients as to cut down on their appointment no-show rate. As a result, hospitalizations and misdiagnoses dropped, and even though CareMore employs more staff per patient than other companies, its average cost per patient is 18 percent below the industry average. Most CareMore patients are paid for through the Medicare Advantage program, a fixed yearly per-patient payment system that comes close to being a voucher system. It replaces the usual fee-for-service system, which is blamed for much of the health care system’s high costs.<\/p>\n

The CareMore approach and its success offers evidence that providing coordinated preventative care can control health problems early and keep them from festering into serious, high cost situations. Arguably, it could actually lower national health care expenditures. This is one of those ideas that seems to make sense to the point of being obvious; but during and since the big Obamacare debates back in 2009, I have read many articles saying that it ain’t so, that there are studies proving that preventative care hardly does anything to \u201cbend the cost curve\u201d, (Example here<\/a>) and perhaps it only increases overall costs<\/a> due to higher utilization. (I.e., people will go to the doctor more often once they have dependable coverage). CareMore’s experience seems to counter this notion.<\/p>\n

The Atlantic article admits that CareMore’s success in reducing costs while increasing service levels might not be reproducible to all age groups and environments. Furthermore, other corporations or non-profits may not have the same culture as CareMore did (unfortunately, CareMore had been merged recently into a bigger care conglomerate, although that company supposedly plans to expand the CareMore model). But other companies are willing to give the CareMore model a try. If it were to become the industry standard, I might then feel that we could trust our health to a voucher system, resulting in controlled and affordable costs while maintaining high life expectancy and quality for the American public. <\/p>\n","protected":false},"excerpt":{"rendered":"

I previously wrote in favor of using vouchers as a means of reforming the increasingly dysfunctional and economically threatened health care system in America. I feel that a federal voucher system could be fashioned in a way that meets both Republican and Democratic concerns. I.e., employer-provided health insurance would be abolished. Taxpayers (especially corporate taxpayers […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,8],"tags":[],"_links":{"self":[{"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=\/wp\/v2\/posts\/2477"}],"collection":[{"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2477"}],"version-history":[{"count":2,"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=\/wp\/v2\/posts\/2477\/revisions"}],"predecessor-version":[{"id":2479,"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=\/wp\/v2\/posts\/2477\/revisions\/2479"}],"wp:attachment":[{"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2477"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2477"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jimgworld.com\/blog1\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2477"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}