Saturday, July 7

What features should U.S. health care have?

Recently there's been a growing chorus from the liberal media along the lines of "If those stupid, knuckle-dragging, bitter, clinging, Neanderthal Rethuglicans were to somehow --totally against the will of the overwhelming majority of Americans, ya know--manage to repeal our wonderful Obamacare, what do they propose to replace it with?"

While the best answer is probably "Not a thing," I'm pretty sure the wafflers and RINOs will be cowed by the libs and MSM and will quickly agree that they need to keep most of what's in Obamacare and simply tweak the worst parts to make everything rosy. (Gotta worry about re-election, dontcha know.)

In that spirit, let's see if liberals and conservatives can agree on anything re health care:

I'm confident virtually all conservatives will agree that no one with a potentially life-threatening emergency should be denied emergency care because of poverty. And I don't know anyone who's suggested that.

And as I would hope every liberal knows, that was U.S. law long before Obamacare.

What we have to do is figure out how to pay ER's for providing emergency care for people who can't pay. I'll describe one way to do that below, called Plan E.

Next: What to do about people who can't pay, but because they know they can't be denied care, go to the ER for routine, non-acute problems? Here's a heretical but effective response: Don't treat 'em at the ER. Instead, give 'em a pre-printed, one-page list of walk-in clinics in the area and send 'em on their way. The list should be divided into clinics that will take the uninsured and those that are willing to accept monthly payments, and these should be at the top of the list.

Guess what? Local clinics will instantly do the math and some will decide that they'll be able to make a small amount by getting on the top of this list.

Better yet: News of the new policy will spread with amazing speed, such that I expect the number of people seeking ER treatment for non-threatening conditions will drop by half after the first week, then half again by the end of the second. Even people who are poor and/or low-information don't want to waste their time.

Oh, and ER to also give these folks a short writeup of what the staff has found concerning their medical condition and tell the patient to present this to the clinic when they go. This will give the clinic staff a second data point.

Third: Exempt all walk-in clinics that agree both to treat uninsured patients *and* to be put on the list handed out by the ER from all Health Privacy Act regs, and any other regs that could be deleted without affecting *medical* efficiency.

Fourth: Encourage clinics to keep records of everyone who presents for treatment but both lacks insurance and claims to be indigent. Then pay a college kid to collate this info. (Hell, for a measly $50-grand a year I'd do it myself.) Anyone found to be abusing the system--such as by failing to make agreed monthly payments for services rendered--will go on an on-line list attesting to this. Abuse it too much and no one will treat your routine problems. You get put on a pay-cash-in-advance status.

Okay, that's enough for now. Now for "Plan E" --how to pay for the cost of ER's treating uninsured/indigent patients for acute conditions: Have the feds, state and local gummints split a quarterly tab three ways. The split could be equal, or more like 40-40-20. Point is that the locals--including local reporters--would be far more able to monitor local ERs to ensure they're not padding their treatment claims.

The reason for making a cash-strapped local gummint participate is that making the local gummint have some skin in the game gives them an incentive to ensure honesty in the accounting. Conversely, if they don't pay something they have zero incentive to keep the local hospital honest.

Since this is already too long, I'll only note one more point for now about a beneficial change to health care: Pass a fed law allowing insurance companies with more than a few million customers to sell health insurance in all states. The nominal reason most states require a company to have a physical presence in that state to sell insurance is that state regulators know from experience that if an out-if-state company commits an egregious wrong, they often duck and dodge inquiries seeking to determine the facts.

And I don't believe opening health insurance to all companies regardless of state was addressed in Obamacare.

More later.

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