Chartered by Feds and given limited tort protections, the members(those who receive the health care) elect board of directors who guide an org that provides end-to-end healthcare to members. Doctors are employees or contractors, protected under org's tort umbrella. Rules to be defined by Board of Directors. Employer does not have to provide health insurance anymore, just offer a montly amount of $ to pay for membership. The headache of employers trying to shop for insurance is gone for employers. If employer contribution is not enough member pays difference or spouse can contribute his/her contribution from employer for membership fee. Govt pays membership for poor/elderly, totally redefining Medicare/Medicaid. Healthcare is now portable and in control of members. Insurance companies are out of the health care cost equation. Not saying this should be a mandated system but another alternative.
-- tomyaz, Aug 06 2004

Differences:

Not-For-Profit. (But not "Non-Profit) Elimination of the desire of insurance companies (and HMOs) to squeeze more and more profit for the sake of shareholders is eliminated, reducing costs.

Members are the "shareholders" that is they vote on the people who set policy. Folks are on the board would do it for no salary and must be a member. The mission statement is to provide Healthcare services to members as the members direct via the Board they choose. So unlike HMOs, memebers have control over what their healthcare provider does.

Employers no longer have to "shop" for healthcare providers, be it HMO or traditional. (BIG PLUS for employers) All employers need to know is where their contribution to the cost goes to; that info is provided by the employee. Thus the employer may be cutting checks to several different organizations of this type depending what provider the employees are using at the time of their hire.

Also, If my spouse and I choose to go with club "X", instead of my wife having her own policy from her employer, Her employer instead can funnel the $ to the club we choose as does my employer. Therefore we are pooling resources to one provider. Good for people whose companies dont offer much $ for healthcare or dont make a lot of money. Or if My wife so chooses she can join another "club" and uses her employers contribution to pay for that membership.

As you can see is very portable. I can be a member of this club, quit my job,go to another employer and tell them to send the healthcare contribution to the same club. Simple as that.

HMO's are not "portable" if your HMO is provided by your employer. (Unless you want be raped by COBRA rates)
-- tomyaz, Aug 09 2004


I see this in the future. Doctors/hospitals are already forming Provider-Sponsored Organizations (PSO's) and contracting directly with employers instead of going through an insurance company or HMO as a middle-man. This way, there is no intermediary to load on profit charges and drive up the price.

It is only a matter of time before PSO's become entities that can, theoretically, deal directly with the public and even do the *enrolling* of people themselves, instead of collecting enrollment information from the peoples' employers.

But. Physicians and hospitals are not licensed as insurers, and they lack capital and expertise. They may even have to charge *more* for health coverage than an HMO would, just in order to compensate for the risk of undercharging or underestimating healthcare expenses (and to cover the costs of hiring consultants to do the work that the partnering HMO would have done before.)

Physicians and Hospitals aren't good at evaluating their own quality of care. The government would have to step in and do the quality management work that HMO's currently do with their tightly-controlled physician networks. This is tough for the government, especially when Republicans believe (?) that taxes should be abolished and that each citizen should simply pay his/her own health care bills directly to private fee-for-service providers on an as-needed basis for life.

It would be tough to develop national standards of data reporting to enable all physicians/hospitals to submit the information to the government that the gov't would need to do the quality assessment.

Would the healthcare organizations seek out and market to all individuals equally? Currently, health insurers market to groups -- and mostly big groups -- so as to achieve a favorable average healthiness of the members. Marketing to individuals is difficult, and some providers may try to cheat and market only to healthy people, and not market to unhealthy, already-sick people.

I like the "pooling" idea, where you and your spouse and both of your employers can pool the contributions into one account. I know that lawmakers are working on this idea, but it hasn't "made a splash" yet.

Agree with your assessment of current portability problems (COBRA is limited in time extent). Your idea would fix that.

Sounds ideal in principle, but the challenges are really, really, really tough.
-- phundug, Aug 09 2004


Quality evaluation is an issue. Perhaps a national accreditation program would do the trick. There is already one similar JCAHO?, Mfg has ISO 9000.

I think as terms of granting a chrter the Feds should say they cant exclude anyone. As long as they pay, they are to be accepted.

Another way to save some money would be the appeal to Doctors to say "come join us as an employee and just worry about taking care of the patient"? Pay a fair salary and save Docs from liability insurance by being having them under the clubs limited tort protection granted by the charter. Another thing they could offer is to pay for some or all of Docs med school bill in exchange for x amount years of service. By grouping together docs together in outpatient facilites you can alos save a lot of overhead.Assuming the population can support this number, Why not have one building w/ twenty dentists? You can save by economy of scale. Todays practioners in all areas, MD,dentists still operate like little Mom and Pop businesses. In the age of Wal-Mart economics, getting hard to make it. but hey I dont have all the answers; just a wild imagination.
-- tomyaz, Aug 09 2004


What you're proposing, [tomyaz], sounds to me a bit of a cross between a peer review organization and a community association. A minor change in today's system that would have nearly that broad influence on patient outcomes would be to amend the second opinion statutes to forbid any MD agreeing to consult for a second from offering to perform or to profit from any alternate procedure derived from that second opinion. Providers would not have to seek out competing treatment options prior to referral, and MD could get by with learning less about ancillary treatments with which they have limited experience and little confidence.

Oh, what do patients get in return? Usually, you'd get what you asked for initially or you'd refuse treatment.
-- dpsyplc, Aug 10 2004



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