Building Medicare4All

UPDATE: HR676 is out. We have some comparative analysis based on this blueprint over here.

UPDATE #2: I gave a talk about this (and some of the other blueprints) in Dallas and it is now up on YouTube

As an engineer, watching the debates around the ACA, it became quite clear that the correct solution to the problem of healthcare was Medicare4All. The reason is quite simple: it was already built. With some additional processes and minor adjustments to existing processes it would be far more efficient than the ACA and could have been built in half the time it took HealthCare.gov to get online.

Instead of dwelling on all the problems of the ACA and the inefficiencies of the market to deal with healthcare, we will outline the simple adjustments needed to our existing Medicare infrastructure that will easily bring it to Medicare4All.

1. Negotiate Prescription Costs

This has shown to reduce costs to medicare by up to $155B over 10 years. Germany has shown that it can drastically reduce its health care expenditure growth rate by simply forcing pharmaceutical companies to prove their price hikes based on the benefits and innovativeness

2. Add Mental Health, Dental, Vision and Home Healthcare to Medicare Coverage

We should add ALL medical care types to Medicare. By reaching for the highest quality care we can conceive and create we will significantly reduce the cost for that quality of care simply by economies of scale.

3. Tune Medicare’s Mission

We should direct Medicare to focus on High Quality Preventive Integrative Health Care. Preventative healthcare has been shown over and over to save massive amounts of money over the long term and not just in direct health care cost but also in lost productivity due to sickness and poor health.

4. Nutrition IS Healthcare

Over and over and over we see that eating foods rich in nutrients keeps us healthy. We should take all funds from all nutrition assistance (SNAP, TANF, WIC, etc) and combine it into M4All and then give every person $100 per month to spend on truly healthy foods. From there we can add more subsidies based on income. Here is an example table to start with:

$/month

We also need to ensure that the food supply is free of synthetic chemicals and other pollutants. If we follow the Third Plate style of farming and aid the farmers in increasing their soil health we will end up with a better tasting and healthier food supply which will also drastically lower our healthcare costs. We can either pay the farmer on the front end or pay the doctor 10–20x more on the backend.

5. Allow Medicare to build/purchase hospitals

Medicare should be allowed to purchase and build/staff hospitals in order to control their costs. They can use the Mayo model of salaried doctors and staff to reduce the costs even more and dramatically improve the patient outcomes. They can also harness the power of the scale of government and offer a GI like scholarship for doctors and nurses and provide free education for those that wish to staff these hospitals.

This does not mean that private hospitals cannot exist, this just allows MMS to make/purchase their own hospitals to vertically integrate and bring costs down.

6. Add QoS Feedback Mechanism

Allow Medicare to be reviewed by every patient for every visit and by the providers, medical staff and by Medicare personnel itself and use the constant feedback as a continuous improvement process that keeps tightening the efficiencies of healthcare delivery and increasing patient, provider, staff and MMS personnel quality and satisfaction

7. Make the Medicare taxes progressive

Bracket the taxes and go beyond $1M. Add 10M, 100M, 500M and 1B brackets and grade them appropriately. They should be marginal like income taxes. Here is an example rates table:

Please note that these numbers have not been calculated yet. They are examples to start from.

8. Make Medicare completely independent of politics

Separate MMS from politics and create a council of physicians and a council of nurses that advise MMS on all medical related problems (including expenditures). Their advice should be completely independent of politics. In fact, we should separate the funding for MMS from politics by ensuring all tax funds for medicare go into an account/trust that can only be accessed by MMS. MMS leadership should be drawn from professional experience in healthcare. There should be no political appointments for this position. An independent commission should be created to find top level candidates and present them to Congress directly for an up or down vote. Congress should only have oversight powers over MMS and that power must be in the form of an independent IG or commission free from politics.