Healthcare For All
Dear President Obama
I am sorry that you lost that nice man Mr. Daschle. He would probably have been OK, but I don’t think he would have been able to do anything about your health care system. So, no harm done. I know you are going to have a hard time finding a good replacement, but don’t bother to try too hard. All of your nominations will have a critical flaw. Tom Daschle had it too, and I’m not talking about his sloppy attitude to tax. Everyone you choose will be American.
Now don’t get me wrong here, Mr President, I like Americans. It’s just that, when it comes to health care, you don’t seem to be able to see the obvious solution sitting in front of your noses. In the interests of the 47 million people with no health insurance, I thought I should just help you see the solution. It’s vaguely possible that, if you can get passed the vested interests and the ideological idiots, you might be able to do something of lasting good for your people.
Here is your 10 step plan. Follow it to the letter. Do not attempt to have bright ideas of your own. History shows that Americans do not understand the fundamental nature of Health care. Here we go.
- Scrap every piece of restrictive or “enabling” legislation you have ever made on health. Yes, that includes CORBA. Don’t even think of keeping it. Yes, I know your heart was in the right place. But your brain wasn’t.
- Scrap every subsidy on health. The whole lot. Yes, even the good ones, Barack. The fact that you think they are good is part of the problem.
- Scrap Medicare and all of its subsidiaries. Go on. Do it. You know you want to. Don’t worry, we are going to put something better in its place.
- Fire everyone in the FDA. Go on. Do it. You know you want to. Now replace them with doctors and pharmacists that you know are not tainted by drug companies. Avoid academics who have never seen patients or been in business for themselves. Give them free reign to sweep the FDA clean. Smell the fresh pine.
- Take all the money you were using for subsidies and medicare and place it in a big pile marked “Health Only”. No, Barack, you can’t bail out some more banks with this. It’s for a far more important use.
- Divide the pile into three. Place half in one pile and a quarter in the other two piles. Call the first pile “universal” and the other two piles “old” and “sick”.
- Give the money in the universal pile to the people. No, not the cash, Mr. President! People are dumb when it comes to health and Americans are worse than usual. They will spend the cash on big-screen TVs. Good for the economy (in china) but bad for health.
- Put the money into a smart card. The people can only spend it on health insurance. It disappears at the end of January. People who have not spent the money by the end of January will be issued an insurance from the nominated supplier for that state. Policies extend from February to end of January next year. The baseline insurance must meet minimum federal criteria but can exceed these (typically the nominated one won’t). People can add money to the policy to improve it (reduce co-payments, reduced need for approvals).
- Put the money from the “old” pile into smart cards belonging to the over seventies. You will probably need to stagger this, as 85-year-olds are likely to be more expensive than 70-year-olds.
- Put the money from the “sick” pile into the smart cards of those who have expensive diseases. Resist the impulse to give more money to the elderly for diseases that are common in older people. You have already compensated insurance companies for the added risk, no matter how hard they whine. Note the nominated insurer has to accept the bad risks if no-one else wants them (swings and roundabouts, guys).
For the first few years very unpleasant things will happen in health. Hospitals, even chains of hospitals, will close, Insurance companies will mushroom and then die. Nasty things will happen to a few patients. Doctors will gang together and complain. Congressmen and women will moan and the Senate toadies will make threatening noises.
Resist all attempts to change the 10 step plan. Resist your natural impulse to try and alleviate the birth pangs of your new health system. Resist, above all, putting extra money into it just because someone with a vested interest in health dollars says so.
At the end of your second term, Mr. President (a second term which you will have richly deserved just for this); at the end of it, you will have delivered an equitable health system that works better than the old one and costs half as much and is for everybody. Expect a statue next to Lincoln’s.
Yours Sincerely
MacDoctor
P.S. No, I am absolutely NOT interested in the job, Mr. President.
Related posts:
- Patient-Driven Healthcare There are two health articles in the Herald today about...
- Waiting for Healthcare Cactus Kate has a long tale of woe about her...
Feb 7 09 9:24 pm
Brilliant!
Feb 7 09 10:12 pm
I’d love to see a New Zealand Healthcare plan. Care to write one so I can cross post it, hand to Tony etc
Socialised medicine is a LOT harder, Whale. There’s so much more to fix. And privatising it would go down like a bucket of cold sick, as my chief nurse used to say. Pity, really…
Feb 7 09 10:38 pm
Well we could always microwave the bucket of sick and water it down some with cold lard.
Feb 7 09 11:10 pm
Whaleoil’s idea of a healthcare plan will include adapting the old American one, and letting people die because they cannot afford insurance. But WhaleOil never cared about humanity anyway…
I doubt your plan is a good one mac……
I supposed you would insist Obama socialises American Medicine. That, of course, would mop up the entire $800 billion stimulus package. Unless you want to go Stalinist on us and nationalise the health industry without compensation.
Feb 8 09 7:51 am
“I’d love to see a New Zealand Healthcare plan.”
If I remember correctly Alan Gibb wrote a brilliant one up about 25 years ago, and yep, cold sick is about how it went down.
Unfortunately that’s probably how Americans (with guidance from their pork barrel politicians) would greet MacDoc’s plan, though I’m not an expert, Mac, you obviously know far more about the American health care system than I do.
Feb 8 09 8:33 am
Amazing what you can find on-line these days:
Unshackling the Hospitals
Feb 8 09 12:47 pm
I remember that report. Didint it come out about the time Lange was ‘having a cup of tea”?
Feb 8 09 10:24 pm
Actually Mac, I was not suggesting a whole scale nationalisation of the health system there, because the hospital system is very fragmented and extensive there…
Anyway, this would be my plan for Obama:
1) Cut defense spending.
2) Cut the farm subsidies.
3) Get rid of Medicare, etc like you said..
4) Use the money freed up in 1,2,3 to set up a huge investment fund thing, and provide single payer public insurance through that…..kinda like our ACC system, but for both accident and sickness…the public pays, the private sector runs the hospitals…the whole administration can be handled using the Social Security system, so if you go to hospital, you only need to quote your social security number and bang….all better….this can be funded using the payroll tax, and releasing busineses from having to provide health insurance would be a god-send….esp in these times…
I suppose you think thats a crap idea, but its just my 2c
+++++++++++++
And Andrew – really the Gibbs report — one step to imposing the American system on our country….
Feb 9 09 12:15 am
Millsy: I suppose you think thats a crap idea, but its just my 2c
No actually, I think it sounds quite reasonable, apart from point 1) which couldn’t happen until America is out of Iraq and Afghanistan (the latter probably many years away). America has a large enough economy for proper market forces to keep health insurance relatively cheap. A state monopoly insurance would almost certainly cost more than a smart card system and be considerably less efficient. Medicare is already substantially less efficient than any HMO.
Feb 9 09 8:37 am
Its because that Medicare isnt really that comprehensive, Dr Mac. Its full of examptions and topups and everything….
And mind wouldnt be a monopoly. It would be like here with private insrance companies still existing, but filling more niche roles (ie cosmetic surgery, etc)