The Solution to Health Care

Sammy G's picture

In case anybody is interested, I have the solution to the health care problem. It's not a new solution. I've touted my idea before on the site. But here it is again, in a more succinct delivery, for anyone willing to put the solution in action.

The problem with the current range of health care solutions getting proposed by government is that it is based on the current system. This system is broken. If something is broken why try to refocus a cracked lens? Stop trying to build a solution out of a broken system and approach from anew.

My solution is born from the recognition that the issue isn't about care. The issue is about health. I finally saw a stat today from the Minnesota Blue Cross CEO who wrote in an opinion piece that 'most' of the costs of health care come from preventable conditions. He gave a dollar amount in the billions to quantify 'most'. This isn't new. But it again demonstrates how health care is riddled by costs arising from personal choice - smoking and obesity.

My solution for health care is to change the nature of the proverbial carrot and stick. Right now, the stick in this country is a progressive tax system. You want to fix health care? Make health the stick.

Everybody gets public health care in this country. Unless you smoke. Then you don't get health care. If you are obese by choice then you don't get health care. You want to reduce the costs of health care and make it fair and accessible for everyone? Stop making tax benefits and tax breaks the stick and make health care the stick. Then institute the flat tax. With those two moves we change the entire landscape of government incentive away from ridiculous loopholes and bloated waste in a 9M word tax code and focus on a health society.

Comments

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.
Sammy G's picture

Making It The Real Stick

I'm the guy that comments on his own thread.

Just realized something - to make health care truly the stick then punishment for societal transgressions should involve health care. Above I touted about taking away health care for health-related choices. That's not enough. Health care becomes the universal punishment. You get arrested for drinking and driving? No more public health care (in addition to jail). You get your second misdemeanor in as many years? No more public health care. Fail to pay taxes on time? No more public health care.

You go and pay for it on your own.

matthew's picture

Incentives for good behavior

In general, I'm more a person who believes we should provide sufficient incentives for good behavior, rather than focusing on bad behavior.

Still chewing on the health-care debate here.

--
Matthew P. Barnson

Timpane's picture

The problem

The problem is, though..

If you look at the people who smoke, the number goes up as people get poorer. Add to that, how do you define "people who smoke"? I have a cigar twice a year.. do I count? And what about drinking? How do you define or enforce how much a person can and cannot drink? What about eating? How do you know who is obese "by choice" (again, fatter as you get poorer). What about sunbathers? Bulimics? Race car drivers? People who eat too much salt? What about people with legitimate addictions that need treatment?

Even if you go ahead and find answers to those questions: how do you enforce? A person comes to the hospital.. they can't pay. Who pays? As it is now.. the hospital pays the brunt of it, and offsets it by making everything so unreasonably expensive. And what if someone quits smoking.. when do they get their health care back? What about the person who smokes, gets COPD, then quits, but has COPD for the rest of their life because they smoked.. its a long term condition, and they can't work half the time. Who pays of the treatment?

I agree with your goals, but you can't have punishment based health care. The optimum plan would be a system that rewards people for improvement, routine checkups, lifestyle changes, etc. (Possibly a tax break for a healthy checkup?) make it so people can afford to stay on their meds so that they don't re-enter the acute care system. Subsidise the physical rehab and nursing home system so that people don't languish in hospitals at higher rates. Make it mandatory to admit patients seven days a week in order to get a tax break (yes, folks stay an entire weekend in the hospital cuz their point of discharge isn't available till mondays - at a total increased cost of 700-1500 a day. This happens ALL the time.)

When it comes to healthy folks, double the tax on cigarettes and sweets and fast food and stuff, but allow certain menu items to be excluded. (If that grilled chicken sandwich is a dollar less than the fried one, it might make a difference.. and if they choose the fried one, well then its more expensive). This pays for the care AND discourages the bad behavior.

Finally, revisit "Health Class" as a required high school senior level and college course. Have tax breaks available for folks who know CPR, who complete classes. ("Get $10 bucks off your taxes if you attend this free class.. etc")

Anyways.. I think there are some simple first steps.. and if there's something in particular I wish this president would do.. its tackle one problem at a time.. like universal prescription drug coverage. Just cover that, take care of that and suddenly a LOT of folks have a LOT more money in their pockets.

NVZ: NINJAS VS ZOMBIES - THE MOVIE - www.nvzmovie.com
THE OFFICIAL JUSTIN TIMPANE WEBSITE - www.timpane.com

Sammy G's picture

Good Dialog

Justin, good dialog, and I like to read comments from somebody who works within the health field and sees the industry first-hand on a daily basis.

Writing that you can't have punishment-based health care doesn't make sense to me. I believe that a punishment-based system isn't ideal and charred with inhuman elements. However, we're facing a massive system that's wildly broken. To bring real 'change' (now a word that means - 'until the election is over, and then status quo') to the health of this country by a government led faction requires looking at all options. Dismissing something because it seems like punishment is wrong, but you're doing an excellent job of amplifying Matt's title branding. You should be a Republican (see: Death Tax).

Second, writing that we should have a system that uses tax incentives to reward good behavior is the exact opposite of the direction the country needs to go. In many ways, that point exemplifies everything I find wrong with our capitalist system. Using tax incentives isn't rewarding good behavior, it's dangling money in the face of people to get them to act a certain way. That's the wrong stick to use. That's perverse capitalism. Trying to pay people to get healthy won't work. The majority of your points revolve around money, and going down this path is the wrong move to make, especially when it comes to health.

Justin, you make a great point that the actual execution of my concept isn't clear. No question, there will always be hiccups in the roll-out of something like I propose. Just like any new program in any environment, the details are always hard. But it's the heart of my approach which you seem to agree with -- it's not t about health care; it's about health. We need healthier people not a healthier health care system. I would wholly welcome something other than the federal government to usher in a new era of health and health care. It's not likely to happen, though, which is why the government is leading the charge. And so if we are to seriously change health in this country then I offer health care should become the stick and choice-based outcomes would result in the loss of publicly-subsidized access.

daniel's picture

So, your "fix" requires the

So, your "fix" requires the assumption of a single payer system? That's where I'd start to disagree with you.

If it doesn't, how would one go about denying healthcare for smokers? Would it be illegal to treat them as a doctor? Illegal to create risk-mitigation vehicles for them?

Who "chooses" to be overweight? If one eats to much because of emotional trouble (say depression), isn't the weight a symptom of another disease? How would a doctor know?

Why stop at the obese and smokers? How about no room in th ER for car accidents that involve speeding? No care for people that ate too much sugar? People who aren't college-educated (since education is highly correlated with better health)?

Sammy G's picture

More than one payer

Sorry if this wasn't clear - probably because I forgot to write - private health care systems would continue to exist. Everyone has a choice as to which system they want to go with, but like private schools, you're paying additional for a private health care plan.

As to your point about stopping at the obese and smokers - exactly. You want to speed and get in a car accident and harm others? We take away your government subsidized health care. Go find your own.

daniel's picture

complicated

This seems too add more complexity and fix nothing. It brings the baggae and problems of a public option. If you let insurers price risk into plans, and get the employer benefit out of the picture, this has the same disincentive effect on smoking, obesity, etc.

I think calling Justins's issues (such as an exsmoker with COPD) hiccups is like jumping out of a plane without a parachute--there may be some hiccups when you reach the ground....

Now, I hate meddlesome government as much as the rest of you, but what if we required single prices from providers? Whatever rate they gave the best insurer they would give to everyone. Then these prices could be published and understood in advance by patients. You would introduce, gasp, price competition, which in every other market leads to innovation and lower real costs (personal computers, anyone?).