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

[Susan Fertig]

I like a lot of what you say in this message Marshall (I know - can't
remember when I ever agreed with you about anything!!).  I am particularly
interested in your first set re: Congress.  I worry a little about your
second set, because the incentive for invention (i.e. new cures) is profit
-- those pharmaceutical companies just need better oversight to break the
link between doctors and pharmaceutical companies (why isn't it a conflict
of interest for doctors to own pharna stock --and then prescribe from those
companies' products?).  I'm curious about your comments on Medicare Part D
-- I opted not to sign up for it, for instance, because I couldn't see how
it would be better than what was available commercially.  And why 2E?
Again, I want those pharmaceutical companies doing research and finding new
drugs and new cures. If there is no profit, who will do the research?
Taxpayer funds are not a bottomless resource or a tree that just grows
money.
 
On your third point: I recently found out that Blue Cross Blue Shield is a
non-profit.  I was quite surprised, because they compete with Aetna and all
the others.  (Actually, BCBS is my carrier). Why do you want to force
everyone to use a non-profit, though?  Oh well, I guess we'll never agree on
socialism vs. capitalism. (And i don't mean that having non-profits vs.
commercial companies = socialism, just that requiring everybody to be
non-profit = socialism).
 
And finally, on your fourth section, what is excessive?  Who defines that? 
 
Susan
 

  _____  

From: oe-bounces at wedgeblade.net [mailto:oe-bounces at wedgeblade.net] On Behalf
Of W. J.
Sent: Thursday, September 10, 2009 12:39 AM
To: oe at wedgeblade.net; dialogue at wedgeblade.net
Subject: [Oe List ...] some proposals for real health care reform


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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