Reforming healthcare

I've come up with a way to completely reform healthcare and make it more affordable and more effective. It won't happen, because doctors and insurance companies would hate it.

I am going to be talking about old-fashioned general practitioners here, mostly family/general practice and internists. These are the kinds of doctors that most of us use as 'our' doctors.

Each doctor would be assigned a certain number of patients in certain age groups. 25% would be 18-35, mostly young and fairly healthy. 50% would be 35-60, middle-aged with some problems. 25% would be 61+, some with more problems than others. For sake of argument (and smaller numbers) lets give this doctor (let's call him Dr Paul) 150/150/50 patients from each group.

Furthermore, these patients pay Dr Paul every month for their healthcare. First group pays $25 a month, next group $50, and the last group $75. This makes Dr Paul about 15,000 per month or 180K a year. Not a bad pay rate huh?

Ah, but there is a catch, a huge one. Dr Paul gets paid only as long as a patient is healthy. I'll explain more as I go on.

Let's say you are a 30 year old man, about 20 pounds overweight. You don't smoke, but you drink every weekend and you don't exercise much at all. You come in not feeling well and Dr Paul finds that you have marginally high blood pressure. Now today, the doctor might tell you to lose some weight and write you a prescription for high blood pressure meds. Now though, the doctor doesn't want you to just take meds. Because meds are paid for by the doctor. After all, you're sick and he's not healing you!

So, Dr Paul is very much into prevention. He will talk to you about diet, about exercise. He will refer you to a dietician and a fitness trainer. Since these are people he would need a lot, he would have set up either individually or through a physician's organization (like a businessman's organization) to have set referral fees to people like this. This sort of payment for referrals would apply to all types of specialists, from physical therapists, massage therapy, acupuncture, chiropractic, surgeons, and other specialists.

Now this may sound strange, but think about it from a fair market point of view. If you are a surgeon, you are not going to get any patients (mostly) except by referrals. And if you charge too much, you aren't going to get many referrals and therefore, not make a lot of money. And if you are Dr Paul, you want someone who will do a good job, but also not charge you too much.

That's the problem today. Doctors don't worry much about how much things cost, or even how much it costs their patients. That is unlike any other type of business, where cost control and efficiency is very important.

Continuing our example, if you do need blood pressure medication, Dr Paul won't just automatically give you the latest, greatest (and most expensive) medication. There are a lot of slightly older medications, with less side effects and yet still are about 80-90% as effective as newer drugs. And cheaper. Again, the doctor would have an agreement with a pharmacy for them to buy in bulk and pass on the savings to the doctor.

Remember, it is now in the doctor's best interests to keep you healthy. So Dr Paul will have to follow up with you, see how the diet is working. encourage you to work out. It won't just be handing out a copy of a diet, a prescription and 'see me in 3 months'. There have been some experiments with many caregivers doing ongoing followup and the patient's outcomes are much, much better.

Now, to followup about getting paid while the patient is healthy. If you do come in with something short term, like a cold or blister, or broken finger, the doctor will take care of it and you keep paying your regular rate. But to take our example patient, the first month after his complaint and diagnosis of high blood pressure, the payment remains the same. Then the payment goes down, if the complaint continues.

2 months - 90% of payment
3-4 months 80% of payment
5-6 months 70% of payment
7-9 months 50% of payment
10-12 months 35% of payment
13+ months 20% of payment

There would be much more detail than this of course. But I think you can get the general outline from this.

Barbara

Social Security - Big changes

The next big government program I want to talk about is Social Security. Notice the capital 'S'. This indicates an 'important' program. It takes in and gives out a huge amount of money yearly. It has grown out of control and needs to be scaled back. And no, I will not promote throwing widows and orphans out on the street.

First, the Social Security (SS) tax rate needs to be increased. Not sure how much, perhaps about .5% every two years for the next 15 years. We simply need more money in SS to cover those who are receiving benefits.

Next, the never mentioned means test. Here is my proposal: right now, based on your total income some of your SS benefits can be taxed, up to 85% of them. This needs to continue, with a higher breakpoint, say $100K in total income, you pay taxes on 100% of your SS income. Then we need to extend this. You would continue to pay tax on 100% of SS income, but that income would be reduced by percentages as your total income increases. At a point of say... $250000, your SS would be ended. If your income were to be cut for whatever reason, you could reapply to start receiving some or all of your benefits again.

I would also raise the earnings limit for payroll taxes back to its 20-year average level. And all government workers, federal, state and local would be required to pay into SS.

These changes would result in enough money to pay benefits to those who really need them. Those who don't, will make do without them.

Oh and one more change. The SS Trust fund will be left alone, completely. No current or future federal government will be able to use its surpluses, on paper or in reality, to offset deficit spending or to make their budgets look better. 

Barbara

(Some of the information in this post was gathered from this link.)