I propose that we reform the health care system by permitting physicians to set two (or more) rates for the same procedure. The lower rate(s) would mean that the patient would have a settlement "cap" in place if he/she had to sue the doctor. Such a cap would reduce the malpractice insurance that doctors pay and hopefully this savings would be passed along to the consumer in the form of lower procedure rates (and eventual lower insurance premiums).
-- BMCCUE, Sep 26 2005

1996 HMO exec salaries http://www.harp.org/hmoexecs.htm
While salaries are not considered profits, I believe that they should be after a certain dollar amount. These have probably doubled since 1996 [Zimmy, Sep 27 2005]

I've said it before and I'll say it again - paying for health care: fucked up. Suing the people trying to cure you (though a predictable corollary from point 1), even more fucked up. I guess that means this idea is good [+].
-- DocBrown, Sep 26 2005


There's nothing currently stopping a doctor from requiring prospective patients from signing contracts limiting how much they can sue for, or requiring binding arbitration in the events of disputes.
-- DrCurry, Sep 26 2005


First, let's have a series of speaking engagements to promote the Idea. We'll advertise in medical risk management journals and through association life credit groups, and dry run at the local level in several regions prior to the weekend seminar at some time TBD, possibly in Dallas. The dry runs should consume about two years. We can tailor future presentations to valuable data gleaned on the dry runs.

Simultaneous data gathering from actuarial firms and lobbying efforts in DC should draw a nationally recognized face for the weekend seminar. We want to develop a clear indication to what participants generally will acquiesce is their cost of doing business as it stands today, in light of adversarial and punitive litigation threats. Given enough motivation, participants may join an effort to affect national policy.
-- reensure, Sep 27 2005


[DocBrown], do you pay for health care? What's your tax rate?

[DrCurry], the enforceability of such an agreement could be questionable if the patient was seeking treatment at the time the contract was signed.
-- bristolz, Sep 27 2005


Hey [bris]. I don't pay for health care directly, no. The UK NHS scheme (while horribly flawed in many ways) does endeavour to offer treatment to all who need it, "free". Of course we all pay for it in our taxes - for me that's 23% of earnings I think - but this seems to me a better way of doing it. I believe medical care when sick is a basic human right so it makes sense to me for everyone to pay to maintain the system according to their means, and for us all to receive the same level of care. It's far from perfect and private treatment is available for those that want to pay, but the principle seems sound to me.
-- DocBrown, Sep 27 2005


//we all pay for it in our taxes//
Not quite. Those of us who pay taxes pay for it in our taxes while those of us who don't pay taxes sit on their asses hoovering up the benefits. I'd prefer to pay for my own medical care when I need it, and not have to pay for other people's. You see, I have the sense to realise that I might get sick so perhaps insurance might be a good idea.
BTW, if you think you're paying 23% tax, I suggest you recalculate; you'll probably find it's closer to 40%.
As to this idea, do I understand that the physician is saying "Pay me $4,000 for the procedure and you can sue my ass off if I screw up, but if you agree to accept a maximum settlement of $10,000, you can have it for $2,000"? Sounds like a perfectly good market option to me.
-- angel, Sep 27 2005


I should imagine that the enforceability of any such contract would be eminently challengeable in the UK courts. Not sure that that would be the case in a punitive-damages jurisdiction.
-- calum, Sep 27 2005


Hmmm...benefits. Well, there's another system that I think is worthwhile, subject to abuse yes, but worthwhile. You're probably right about the tax, once you factor in VAT, council tax, fuel duty etc....

I suppose it comes down to which general leaning you find yourself subscribed to. I suspect you may be more a "I'm alright Jack" self-sufficient type [angel].

I don't agree with that attitude, but I can understand the frustration with abusers of the system. I think benefit frauds should be conscripted, screw giving them a nice comfy jail sentence. I also think the obese and smokers should contribute more towards the NHS than others do, simply because statistically these groups are/will become more of a drain on resources than others. I suppose something like the current system but with greater accountability for personal choices would be ideal in my opinion.
-- DocBrown, Sep 27 2005


//I suspect you may be more a "I'm alright Jack" self-sufficient type [angel].//
That's not really the point. In UK, we're compelled to pay for a service provided (poorly and inefficiently, as are all such enterprises) by the state even if we don't use it. Why? Because everyone needs healthcare? The state doesn't have a monopoly on shoe manufacture, even though everyone needs shoes. What's wrong with a system whereby we all save a few pounds a month and buy our own shoes as and when we need them? If we save more money, we can buy more expensive shoes. If someone can show that he really needs shoes and can also show that he's unable to buy them, then there's a case for some other shoe provider to step in (no pun), but it still need not be the state.
Don't forget that health care was available, free at the point of use, long before the NHS was thought of. All the 1948 Act did was to close some hospitals, bring the remainder under state control, and make contribution to its own scheme compulsory.
Incidentally, smokers *do* contribute more because they pay far more tax. The obese are not necessarily so voluntarily. It is actually an illness, not a lifestyle choice.
-- angel, Sep 27 2005


I don't think the need for shoes can be compared to the need for healthcare without being a bit disingenuous.

OK, they're both requirements. Going without new shoes may mean your feet aren't quite so chic as they might be, or that they get a bit wet but there's nothing life-threatening or even seriously detrimental to quality of life about that. Contrast this to the potential for a debilitating/crippling condition to develop or for death to result if healthcare is denied.

I can't forget that free healthcare was available prior to 1948 because I wasn't around to see it in the first place. What was the situation then?

Your point about smokers is well made, but I refuse to accept that the majority of obese people are ill. Some do suffer from glandular problems or psychological difficulties but most are simply host to an unfortunate surplus of laziness and greed.
-- DocBrown, Sep 27 2005


I didn't suggest denying healthcare; see the end of my first para.
Prior to 1948 (when I wasn't around either), healthcare was provided free at the point of use by charitable trusts (charitable hospitals have been around since the 12th century, and all of the major teaching hospitals in London were founded as charities - in 1936, 60% of acute care was in charitable hospitals) and occupational insurance; this latter often covered family members also. Most consultants spent a lot of their time treating poor patients free of charge. Significantly, a report produced in 1943 (by the Labour Party) offered no criticisms of the then-existing system; the NHS was introduced in the form that it was simply because Bevan was a Marxist.
Neither did I suggest that the majority of obese people are ill, hence the word 'necessarily'. Note also that the non-lazy who suffer fractures while engaging in sport or other leisure are also an unnecessary drain on NHS resources.
-- angel, Sep 27 2005


You may not have suggested denying healthcare but you implied that said denial could occur in the (reasonably plausible) case that a poor person isn't able to afford the treatment they require and charitable institutions have insufficient resources to offer treatment. This circumstance is unacceptable in my view.

It is very interesting to hear of the way the system used to work, from your description it sounds functional but I wonder whether it would carry over to today's world (consultants working for free etc).

Your use of "necessarily" was noted, as was your contradictory use of the phrase "It is actually an illness". Had you written "It can be an illness", I wouldn't have argued. I would say that sporting injuries are an acceptable tradeoff for the beneficial effects of exercise and therefore sporty types should not be penalised for their activities - if they weren't out being sporty they'd be more likely to develop the kind of obesity-related conditions we were just debating. A careful sportsperson may enjoy a whole lifetime of delicious sport without recourse to medical treatment whereas an extremely slothful type will inevitably run into some sort of medical difficulty as a result of their lifestyle, be it sooner or be it later.
-- DocBrown, Sep 27 2005


If lawyers, through their representatives, object to this tack ... compromise is possible under the rule guiding physician conduct after informed consent. Prospective patients, hereafter referred to as "the consumer", to apply for reduced charges for health care will watch a 15 minute video depiction of the dogged attempt by a lawyer to claim what is alleged due the consumer for a breach of contract.

The practice of tort law in product liability cases is more lucrative on a per case basis than is the practice of tort law in medical malpractice, but the opportunities to misrepresent a consumer in other than product application abound, and this is where bread and butter is to be had. Expect other lobbies to be unwilling to grant concessions in defiance of rational consumerist logic.
-- reensure, Sep 27 2005


[DocB]: Have you considered that "charitable institutions have insufficient resources" because what people may consider giving to them is being coerced from them by the state? They certainly had sufficient resources in 1936.
My phrase "It is actually an illness" is not contradictory; illnesses are sometimes self-inflicted.
Please explain the beneficial effects to me of you exercising, particularly in view of your probable increased need for medical intervention (which I pay for). However careful the sportsman, his injuries may be caused by circumstances which he cannot control (other than by avoiding sport altogether). Do you consider the tradeoff to be acceptable because you benefit from it? In a situation where we each paid for our own healthcare, an athlete's hazardous lifestyle would be at his own cost. Other, non-compulsory, forms of insurance tend to take some account of the risk involved.
I am neither sporty nor obese (and have never been either), and I have visited a GP on less than a dozen occasions in my life.
-- angel, Sep 27 2005


//that's 23% of earnings I think//

If you calculate your tax rate + annual insurance expenses + annual employer contribution to your insurance expenses (which would possible otherwise be part of your pay), you will probably come out with a higher percentage than 23% of your income in the US.

This doesn't account for what you will get billed for as "not covered" and deductibles.

I am enraged at combinded bills of over $1000 USD that my health insurance won't be paying for 15 minutes of being seen in the Emergency Room & then sent home with a sling & ice pack. I'm most unimpressed with the quality of care I recieved as well.

+ for the idea, but you may want to check out the mind boggling profits listed by major insurance providers if you think they will reduce rates as a result of lower costs.
-- Zimmy, Sep 27 2005


Have you a link to something that details the "mind-boggling profits" of health insurance providers?
-- bristolz, Sep 27 2005


[angel], you make an interesting point, however, if we assume that charitable healthcare is to treat all people too poor to afford private care you still have the problem of uncertain resources. How are you supposed to operate when you don't know from year to year what level of income you can expect to receive? You can't predict whether there will be a sufficient level of donations to sustain care for those who need it. For this reason, I would oppose a return to charitable healthcare.

What I meant about the benefits of sport/exercise was that the proponents of such are helping themselves to stay healthy as part of their activities. Thus, although they may suffer the occasional injury, the strain put on the health services by treating these could be viewed as negated by the fact that these types of people are unlikely to be in treatment for conditions encountered with more frequency and persistence (not to mention near inevitability) by slothful types. I'm pleased to hear you have a clean and consistent bill of health but I don't think it's relevant to the argument since, by your own admission, you have never been particularly obese/sporty! I have played a variety of sports all my life and have a notched up a similar number of GP visits to yourself.

[Zimmy] I'm sure I might arrive at a higher percentage, were I there, but I'm UK based.
-- DocBrown, Sep 27 2005


Gotta love the Brits. Word up to the Bailey, and the lot scurry off to grumble about taxes and sports.
What's next ... beheading? I'm sure Lloyd's has actuarial tables to support the economy of snatching off a few heads. |-)
-- reensure, Sep 27 2005


//charitable healthcare is to treat all people too poor to afford private care//
You're missing the point; *all* healthcare would be private, some funded by (voluntary) insurance and some - the safety net - by charitable giving.
Most of the charities that I'm familiar with have a fairly good idea of their projected income, as, apparently, did those which were running hospitals prior to 1948.
//the proponents of such are helping themselves to stay healthy as part of their activities.//
As I said, I manage to stay in sound health *without* risking injury. The fact that I have never been particularly obese/sporty is precisely why my record is relevant. I have avoided what appear to be the major causes of the need for medical attention. (I suspect, by the way, that I am conspicuously older than you; let's compare GP visit figures when *you* hit fifty!)
We both agree, I imagine, that we'll never agree on this matter, simply because you're a socialist and I'm not.
[reensure]: What does "Word up to the Bailey" mean?
-- angel, Sep 27 2005


[angel] ... about the same as 'before the court'. I'd not use that phrase when being civil to a lawyer; I'd substitute 'after you', but oftimes one may be friendly to a court servant.
-- reensure, Sep 27 2005


OK [angel], but even if we assume that charities are able to accurately predict their level of income, there is nothing in place under your proposed system to provide for the case where said income is not enough to treat all patients. This is the point where you seem to be prepared to let people go without treatment. I find that intolerable and if that makes me socialist so be it, although I think that's a bit of a broad label to apply to someone who isn't also supporting state control of farming, industry, transport etc.

You suspect correctly regarding our respective ages, by the by. I hope if my hazardous lifestyle allows me to reach 50, we can compare GP visits and find the totals unchanged!
-- DocBrown, Sep 28 2005


From 2004 Congress of Cities
Indianapolis, Indiana
December 4, 2004: "WHEREAS, the costs … are being exacerbated by cost shifts from under payments for health services by Medicare, Medicaid and the growing number of uninsured."

Point being, the cities want to be able to collect business taxes to support their health insurance plans, and there is strong opposition to this at the local level which would seek ways to shift the payment responsibility to the US federal government. [BMCCUE]'s Idea proposes a cost shift, in line with other negotiated health care contracts and in effect similar to disease prevention and economic generation outside the health care system.

The line of reasoning leads one in a predictable direction, into a landscape of special interests. Peoples' needs may differ, but their choices are based on economics. I'd like to see more creative and diverse health insurance plans, that allow me choice based on how I feel about the system I'm insuring myself against. Let's say I schedule my week around the clinic; me, the kids, their friends ... who has appointments, needs prescriptions and excuses, will be in a game and thereupon require emergency treatment, and when to find time for all my diagnostic, elective, and exploratory procedures? Let's on the other hand say I only want to see the word 'doctor' on the headlines, where I can have a private laugh when 'another one bites the dust'.

Does the fact I may eschew any trust in the profession free me from the monopoly power they have when I show up on the hospital doorstep with a gunshot wound or leprosy? No. I should be able to insure myself against catastrophe without paying premium to subsidize flu shots for myself or for anyone else. Alternately, I should be able to budget a large enough policy to subsidize my own cure seeking behavior, well pad my docs' accounts, and slough off money into the local welfare system so others who feel as sick as I may follow my lead -- if we so choose.
-- reensure, Sep 28 2005



random, halfbakery