[Oe List ...] some proposals for real health care reform

[W. J.]

OK, so I waited to hear Obama's speech. Not much new there. So now's my turn.

Here are some fairly radical proposals for bringing the cost of health care down from one sixth of GNP to maybe as little as one tenth, while moving toward universal coverage (excepting, of course, those pesky undocumented workers).

1. Start with Congress itself, which is captive to 'special interests' who provide generous campaign and lobbying issues funding.

a. Cap corporate contributions to Congress @ $1,000 total per year per candidate/officeholder for all corporations and their executives. Ban all corporate perks such as free flights on corporate jets, etc.
b. Drastically reduce the cost of political campaigns by banning paid television advertising on commercial networks. Unpaid news coverage and public affairs television exposure would be encouraged.
c. Substitute extensive free political issues exposure on the PBS system for all candidates/officeholders with massive coverage of debates, town meetings, speeches, position papers, books, articles, proposals, etc.

2. Squeeze both marketing costs and profits out of the major pharmaceutical companies.

a. Ban all commercial television advertising of medical devices and prescription drugs ("Ask your doctor about . . . ").
b. Change Medicare Part D to mandate federally negotiated drug pricing (the Republicans won't stand for this, 'cause they're protecting these special interests with a massive give-away program).
c. Require pharmaceuticals to offer the Medicare negotiated drug pricing through all insurance companies.
d. Encourage all prescription drug users to seek the lowest cost options outside the USA, for example from Canadian sources.
e. Require Medicare and all other payers of prescription drugs to use the lowest cost approved suppliers of generic drugs in the global marketplace.
f. Require FDA oversight of all approved foreign drug manufacturers.

3. Take the health insurance companies out of the 'for profit' insurance business and place them in competitive positions to lower the costs of health insurance.

a. Place all health insurance in not-for-profit spin-offs, breaking the hold of consolidation in the insurance industry.
b. Force competition among insurers by making insurance available across state lines.
c. Place private insurance companies under federal, as opposed to state, regulation.
d. Set up federally sponsored alternative insurance programs.
e. Give federations of small businesses the same negotiating leverage to drive down group insurance rates enjoyed by large corporations.
f. Require licensed insurance companies to offer individual health insurance at a rate that is the average of all their group health plans.
g. Make health insurance a right, not a privilege that can be denied to the 'undesirable.'
h. Lower all monthly Medicare payments to Medicare Advantage plan insurers to an annually negotiated rate (the Republicans won't stand for this, 'cause they're protecting these special interests with a massive give-away program).
i. Require Medicare Advantage plans to offer dental insurance in their benefits package @ zero premium to the policyholder.

4. Wring excessive costs and huge profits out of for-profit medical practices and hospitals.

a. Set up alternative medical practices like the Cleveland Clinic model based on salaried personnel, rather than fee for service payments, and give preference to these providers based on lower costs and higher quality of services.
b. Set up alternative specialty hospitals, clinics, and medical services companies with lower operating costs to compete with outdated and underperforming institutions.
c. Set up an alternative form of liability insurance with federal panels of physicians to sift real malpractice from spurious/inflated claims, and severely punish those who violate medical norms.
d. Put an end to defensive medicine, duplicative testing, and the 'anything goes' mindset by making physicians annually accountable to review boards for substantially inappropriate, wasteful 'overtreatment' of patients, with significant penalties for patterns of abuse.
e. Study systemic regional differences in cost and practice patterns with control mechanisms to rectify exaggerated distortions in the costs of medical care.
f. Offer standard fee-for-service procedures at Medicare approved rates throughout the nation through all insurers. 

That's just a few of the things you probably won't get in Obamacare.

Marshall
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