Originally Posted by Piobaire
Okay, I'll deal with some issues of the US system for ya'll (as I see it, of course.)
1) Medicare. Holy fuck is this a boondoggle and in so many ways. I've talked about the waste here for years and what type of system incents its doctors to just keep treating/billing vs. actually minimizing patient pain and suffering?
2) Med-mal. It's like in no other country. It's part of what drives so much of medicine. Now, I know there's that one study in Texas where utilization didn't drop after some state caps were reformed but do we really think doctors practice differently in Texas? Nope.
3) Duplication. Holy fuck, how many parallel systems does a country need?
4) Publicly traded insurance companies. Do we understand where the intrinsic interests are in publicly traded companies?
5) Not letting people die/not placing service restrictions.
I know you're a big fan of the Bismark system, and since you started talking about it years ago, I think it makes a lot of sense and think it could be effective here.
If we just apply an 80/20 rule, I think we would focus on doing three things:
1. Eliminate Medicare/Medicaid and replace with public hospitals that provide services free of charge to people. Ideally these would be run at the state level (I think federalism improves processes and gets to best practices faster). Most hospitals/clinics won't be public and free, but this gives an option to all citizens.
2. Decouple insurance and employment. The downside is that it encourages some people to make bad employment decisions and it hides costs from people. Ideally you want costs to be visible to consumers so they have price sensitivity and can make their own trade-offs. For insurance bought individually, you should be able to deduct that rather than having to reach the 2% floor before deducting - that's a huge disadvantage to people who don't get employer based insurance.
3. Allow people to buy any insurance plan they want. Places like MN require insurance cover all kinds of moronic things that drive costs up and provide no benefit to most consumers.
After those three, we can talk about fixing the FDA's approval process that creates such distorted drug and medical device markets.