Thank you for your very reasonable and gracious response.
I have no interest in arguing against single payer. I have an interest in arguing FOR what I consider to be a much more rational system, and that is triage-based, locally managed care organizations that have federal backstop funding.
Suffice it to say, we need to end “fee for service,” if we are going to bring healthcare costs under control.
We also need to ensure that while the resources and ensurance of equality that only the Federal government can bring are applied appropriately but that the programs themselves are managed locally. (Note “ensurance” is not a typo — it is the same relationship to “ensure” that “insurance” has to “insure.”)
We cannot simply make “fee for service” illegal. We need to provide an alternative structure.
Not only can we not solve the problem until we eliminate “fee for service” but we cannot eliminate the problem until we make the basis for delivering healthcare “triage” — delivering medical services on the basis of order of medical need.
Those who wish to go outside the system may do so, but Federal financial aid to medical students and to medical schools should be tied to participating in these locally managed care associations. In other words, if you take federal financial aid to attend medical school, upon graduation you will have to participate in the public system, not merely repay your loans, and medical schools, as a condition of having their programs funded, will have to demonstrate active cooperation with local, managed care associations. This is perfectly acceptable as these would be conditions of a contract, and the Federal government would be purchasing these services. Don’t like it? Pay your own way, or don’t have your school accept Federal Financial aid.
Federal Financial aid for education should be provided to medical schools for a certain number of MD and other medical professional graduates, and should be competitive — again with the provision that if you receive financial aid, you contribute to the local system.
We would also need to loosen the restrictions on nurse practitioners being primary care providers.
One element advocated by the left would be appropriate — negotiating bulk purchases with drug providers and medical equipment providers.
Extraordinary, end of life measures would have to be privately funded. I know people will scream “death panels” but we already have those. We always will have them. It is unavoidable and we should grow up about this fact. We need to discuss how to implement this and it must be by law.
This would not make health insurance for private care illegal, but we need to remove the tax preferred status. Actually, if we went with the tax reform I advocate, this would be a non issue, but in any case there should be no tax preferred status for health insurance. This creates huge distortions in the provision of healthcare, and it needs to end.
Local, managed-care associations would receive their funding from a combination of Federal, State and Local taxes, sliding scale fees based upon income (set by law in relation to local median income.) Also excise taxes on health-problematic substances (alcohol, tobacco and unhealthy food) would add to the finance mix.
Those are the major parameters. There are other reforms I would advocate, but they go beyond the scope of purely healthcare reform.
