If you were going to design a perfect health care system, how would you do it?

I would place a lot of emphasis on preventative health care.

Free at the point of use. ie however it is paid for in the end(taxes or whatever) the patient doesn’t have pay for the service when they are recieving it.

Care prioritised on medical need not the ability to pay.

Consistent care accross the country ie when you go the doctor you should get the same (or similar) care/treatment irregardless of where you live

@Lightlyseared Okay, I’ll let the “taxes or whatever” pass for now—although it’s really important. I completely agree with the latter part of what you say, care should be standardized regardless of where you are. My question for you is should it be rationed? Let’s say I have an ache in my shoulder and I want an MRI, but it’s not necessarily necessary as I can get it treated with physical therapy. Some places will give me the MRI. Some won’t. Should I be able to get the MRI I demand?

Single-payer modeled loosely on the French system. Doctors are not employed by the state and can opt to conform to the fee structure established by the state, or set their own rates. Patients can go to the doctor of their choice, choosing one who has agreed to the state rates (in which case the fees will be covered 75–100%) or one who has not, if they feel that will offer some advantage. They can purchase private insurance, if they want, to cover non-participating doctors.

In France, the patient typically writes a check to cover the doctor’s fee at the time of service in the case of a routine office visit, then the state issues a reimbursement check a couple of weeks later to the patient. For hospitalizations or larger expenses, the procedure is cleared with the state in advance, and payment made directly by the state.

The government should largely finance the medical education of students who agree to participate in the state plan for a minimum of 15 years, so that they will graduate without heavy student debt to repay.

@Harp The problem with the fee structures is that many state Medicaids pay $.20 on the dollar so most doctors opt out, so these patients get sent to public health systems. The fee system would have to be competitive to compete with private markets.

Therein lies a major problem.
The private market for insurance and drug companies have enjoyed the fruits of favorable legislation for the past eight years so the change ,as it applies to the competitive market, must begin with legislation that can reign in the negative impact of the recent past.

@basp Okay, can you be mores specific as to the negative impact you want to reign in? If we’re going to design a regulatory system we need to figure out what we’re trying to regulate and how.

@Stanley By “state”, I mean “the government” in general. The fee structure would have to be drawn up from scratch by whatever office administers the federal health care system (not based on Medicaid). Private health insurers currently do the same thing, setting rates that they consider acceptable for each procedure. Only this would apply on a consistent and national scale.

For starters, we need to lift the ban on negotiating lower drug prices for Medicare recipients. Another major shift would be to rebundle services for payment. Overturning those two pieces of legislation would be a great start.
I have more to add, but my iPhone is running out of battery so I’ll check back in later.

@Harp Do you set state fees to be congruent with private fees, or do you regulate the private sector such that both the state and private fees pay more or less the same?

@basp Sorry about your phone. I do fluther from my blackberry very well—the interface is clunky. So by lower drug prices for Medicare recipients, are you saying that Medicare recipients (like Gramma Molly) should pay more for their drugs? That’s often hard to do on a fixed social security income.

Stanley
You have the drug/medicare thing backwards. Currently the Medicare system has no mechinism to negotiate for lower drug prices for recipients. The drug companies are free to set the price as they see fit.
And now my hone is giving me dead battery notices so I really must go but remind me to discuss the donut hole, the trend for employers to cut back or discontinue benefits, and the duel eligibles… All important components that have had devastating impact on an already broken system.

@Stanley State fees would be lower than current private sector rates. This would be feasible because doctors would have lower costs by participating in the state system. For one thing, they would not have massive school loans to pay off. And doctors currently suffer enormous administrative expenses from hassling with private insurers.

There would be no need to regulate fees of non-participating doctors. The competitive pressure from the system would keep their rates reasonable. In France, the majority of doctors opt into the system because most patients find the system works well and they have little incentive to pay higher rates for non-participating doctors. But if they ever find that they can’t get what they want from the state system, the private option is always available.

@basp Good luck with the phone. Sign back in when it charges back up again!

No, I know how the Medicare payment works. That’s why I was confused by your response. I thought you were saying that you wanted the patient to pay more for their drugs, which wasn’t congruent with previous comments you made.

A good while back while out of work I chose to buy catastrophic and major medical insurance and it worked great for us. I paid less then my company’s supposedly “great” plan I was paying thru the nose for.
Even the out of pocket expenses and premiums were still cheaper, and we had a baby.
Today, it’s impossible to find anything comparable.
All I know is when they shove this European Health plan down our throats starting in July, if anything serious happens to my family, or myself; we will probably end up going to Mexico to get treatment.
My experience today with doctors, medical organizations is awful, I don’t trust half of them, they are influenced by drug company’s and insurance company’s and are mostly incompetently trained doctors-they aren’t allowed to get competent unless they are with Mayo, John Hopkins, Beth Israel.
Personally, I have eliminated and reduced health concerns and problems thru diet, nutritional supplementation (which will they destroy via legislation) and alternative medicine.
When we finally get our socialistic healthcare system the service will be comparable to going to a McDonald’s in Newark for dinner-no thanks.
One paramount requirement, no matter what, if our corrupt politicians shove this inevitable great healthcare plan down our throats; they must be required to participate equally in the exact same health care as most Americans will be required to.

Stanley,
No, my response was not incongruent with my previous statement. As I stated, the Medicare system (Thanks to the medicare reform act) has no mechinisim to negotiate lower drug prices for recipients. We need to lift that ban.
And, if you understand how medicare payments work for the recipient, then you already know about the donut hole.
As for duel eligible recipients, those are individuals who are eligible for both medicare and medicaid (typically our most vulnerable population, the mentally ill and the elderly who are dependent upon assisted living). Used to be that when one is eligible for both, the medicaid would be used like the primary insurance and medicare would kick in as if a secondary insurance. Thanks to the Medicare reform act, it is now flip flopped and medicare is used as the primary insurance. Since the cost to the patient is much more when medicare is used as the primary insurance, the financial burden is placed upon those who have no means to meet that obligation.

Stanley, I have spent years working with and working toward health care reform. If you are seriously interested in more discussion, we can zero in on a particular aspect of the issue. The issue is huge and I’m not sure how conducive this format is for extended discussion, but, I’m willing to go the extra mile if this is important to you.
My main contention has always been that we already have a nationalized health care system that works in the most ineffective and inefficient way posssible. (our medicaid system). If we put the money up front instead of chasing our health care problems after the fact we would be far ahead. Also, the current system has no preventative health care in place and I believe that is essential.

@basp Thanks, that clears up your point of view. Sorry, I’m having a really busy day at work, but I really want to get back to this.

Have a great day at work!

@Garebo Got it. You don’t like American doctors and trust Mexican doctors more. But I don’t see anything in your answer that offers a solution—only complaints about our system, our doctors, and our government. Do you see a solution?

Yes I do, it was inferred; major medical medical and catastrophic health insurance only. Prescription drug only for those whose life depends on medication. Outside of that you have to pay on your own, you know, shop around like we do for a new Ipod, and live healthy – that means you are your own to get your clamidia treatment, birth control, and sore throat antibiotics, etc.
Insurance company’s ruined everything, along with government intervention; they ended up bringing everything down to the lowest common denominator. I predict the government will continue on this path except they will hide the costs to you that you ultimately will pay either thru fees, fines and taxes up the ying yang. At first, it will seem awesome, but in 5 to 10 years, us sheeple will be complaining, and we will all be in the same boat, except those in government with their golden health care paid by us.
Market forces need to participate, without which, we will lose one of this countries best technologies because there will be no incentive for a company to bring a product to market.