Disclaimer: First, I'm a physician from a third world country so I may not be 100% familiar with some of the problems/controversies that the US healthcare system has, but this is based on what I understand from the news reports

On one side of the debate are the people who cant afford private insurance. * No treatment, we die. Simple

On the other side are the people who are against universal health insurance. Their reasons are more complex like: * who's going to pay for it? more taxes probably * this will drive private insurance out of business * when government health insurance is a monopoly because private insurers are out of business, then it will not be inclined to improve itself because of lack of competition. what if it decides to enact harsh requirements to cut costs? If its a monopoly you have no alternative. Its too late

I propose a hybrid healthcare system based on my own country's healthcare system.

* There is some sort of universal or semi universal health insurance but private insurance still exists as a sort of upgrade or total replacement. If you can afford it and you want it you can purchase an "upgrade"

* This universal health insurance still has a small annual fee

* Visits to the doctor will be partially covered so you have to pay a small fee to the doctor when you visit the clinic. For patients that have to be confined in the hospital, the coverage is also partial so whats left is a small fee to be paid by the patient. This small fee exists so that the human psychological reaction of "its free, lets abuse it" wont happen.

* how partial is partial coverage? Make it socialized. By default say only 50%. But you can ask to be re-classified, all dependent on your income. A social worker will investigate you and the amount you eventually pay will be dependent on your income. A rich guy pays a large percentage of his hospital bill but a homeless person only pays a few dollars.

* There are 3 kinds of hospitals: "pay" and "charity" to use the terminology of my country. The 3rd category is "pay" hospitals that have a separate wing or building that is run as a "charity" hospital

* Pay hospitals only accept people who either pay in cash or who have the "upgraded" private health insurance. As to their organization, infrastructure and the equipment, it would resemble a current run of the mill US hospital. * Charity hospitals pimarily cater to poorer people who do not have private health insurance and only rely on the government universal health insurance but they in theory will accept anyone even those who have private insurance and those who pay in cash because they are rich. * To reduce costs, some services in charity hospitals would be removed (like in no frills budget airlines). - In my country laparoscopic surgery is so expensive compared to the savings regained in productivity and shorter hospital stay so old fashioned open surgery might be standard but you would need to compute the cost/benefit ratio for your own situation. - Frills like airconditioning, TV and private rooms would go. Charity hospitals in my country have large wards with > 50 beds per ward, 2-3 nurses per ward, open to recieve fresh air and mosquito netting and bug zappers for mosquito control. Fresh air and electric fans would cool the patients in summer and if you have snow, then the windows would close and since the building is insulated, minimal heating is required. The ward would look like a US hospital in the 1920's or ww2. - Being ugly is not a health hazard so aesthetic surgery would not be covered. Reconstructive surgery would be covered of course. - Surgeons would use cheap nylon or silk sutures to close the skin. The trade off for lower price is a worse looking scar. But if you want a better looking scar then go to the pay hospital. - No more meals in bed so unless you are too weak to move, you eat in a self service cafeteria or ask a relative to fetch you the meal - since private doctors are expensive, residents (doctors in training) and nurses in training (they both have lower salaries) would primarily be used. Of course, each resident/nurse and each patient eventually has an experienced private doctor/nurse that oversees all the medical treatment.

* the ICU should be more or less the same in pay and charity hospitals except maybe for a worse nurse/doctor to patient ratio

* oh and to reduce costs, the number of beds and number of staff would be cut, so expect long lines in a charity hospital

With all the frills gone, there is a powerful incentive for people to work hard so they can buy private insurance. But no one dies because coverage can be universal. Also include the social prestige of having a private health insurance and staying in a private room. The money saved by removing the frills enables more poorer people to be treated

so what do you think????
-- vmaldia, Nov 18 2009

Three bones and no comments?
-- MaxwellBuchanan, Nov 21 2009


//no one dies//

It's a miracle! Where do I sign?
-- BunsenHoneydew, Nov 21 2009


The US has the worst healthcare/$ in the entire world. As Winston Churchill once said "You can always rely on America to do the right thing, after it has tried everything else." We still have quite a way to go before we can have humane and effective healthcare., we have a lot of bad ideas to work through before we can design nice cars, formulate great cuisine and have great holidays. We need to rapidly try things that don't work so we can get to the things that do. Be patient.
-- WcW, Nov 21 2009


correction, no one dies from lack of health insurance
-- vmaldia, Nov 23 2009


I wonder how many people die from the lack of car insurance.
-- theircompetitor, Nov 24 2009


I dislike this, but I dislike the status quo more, so [+]. I don't like paying for the system that recently gave me ~$3000 worth of tests (MRI, treadmill, EKG, ultrasound, all of which were normal) for $80 in copay for slightly high blood pressure, but didn't suggest diet or exercise.

It's a problem: doctors/hospitals have the right and obligation to treat everyone who comes, regardless of ability to pay, as people have a right to life, but as the best care keeps getting more expensive it becomes harder to keep this up.
-- sninctown, Nov 24 2009


I can't say I completely understand this, but it seems to go in the right direction.(+) It sounds like seats on a plane and that might work.

I'd like a business class appendectomy please. :-)

I don't know about the large rooms, you are the doctor, but large rooms full of sick people sound like a BAD idea.
-- MisterQED, Nov 24 2009


People do die because they don't get proper healthcare. People also die because they want to save their families from bankruptcy and the cost of care would leave their offspring no inheritance. People die because they do not get any preventative medicine. People die because their insurance simply fights paying for needed treatment. All of these problems are prominent the US reliance on private insurance. These problems are also a major drag on innovation and productivity, they prevent workers from becoming entrepreneurs, changing jobs, retraining, relocating to superior employment, they cause an ineffective and unstable workforce. Our current system of health care is a poor value to every consumer, a poor value for the tax dollar, a poor value to employers, a poor value for research. In every metric we are getting screwed by the current system.
-- WcW, Nov 25 2009



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