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View Diary: Why can't we start our OWN Public Option? (215 comments)

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  •  We could do it, and Howard Dean should run it! (32+ / 0-)

    I'm serious.  I've been thinking about this a lot lately.  We can start a non-profit, and we can get our seed money from political donors.  Just call a halt to political donations for a year, and once we have clients, all the money paid by them goes straight to funding health clinics for at-cost care.  Or paying doctors who charge fair prices.  (Of course, the hospitals are still astronomically expensive, but once we have a critical mass of clients, we could negotiate the rates.)  Meanwhile, there would be no shareholders, and the company would simply pay operational expenses and overhead

    Building the infrastructure would be the hard part, and convincing people that the company would be there in the future, so that they join.  But when I think of all the money wasted lobbying and donating to politicians -- for nothing, obviously (with few exceptions) -- I wonder why we don't just invest all that money in solving the problem ourselves.

    All politics is class-warfare.

    by dhfsfc on Sat Dec 19, 2009 at 08:09:07 PM PST

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    •  GEMs (7+ / 0-)

      Read this article about GEMs are "Groups Employed Models". Clearly this is the real way to go. Figure out some way to affiliate with hospitals like the Mayo Clinic or Geisinger here in Pennsylvania. I don't know much about Kaiser Permanente, but Geisinger hospital in Danville is very very good. And the Geisinger doctors here are excellent. Any kid in any health plan anywhere in Centre County with are rare disease gets seen by one of their pediatrician, Dr. Lela Brink, who used to be the director of UNC hospitals' pediatric intensive care unit.

      You stand with Dean or crawl with Lieberman.

      by Grassroots Mom on Sat Dec 19, 2009 at 08:56:47 PM PST

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      •  Note from this that there are two big problems (4+ / 0-)
        Recommended by:
        meg, dhfsfc, koNko, Deoliver47
        1. Determine the nature of the risk pool, what sort of people and dependents would be covered.
        1. Determine and negotiate with 'network providers'.

        I'll assume people understand #1, that a risk pool able to limit participants to known most healthy types, will of course have the lowest claims experience expenses.  A risk pool expanded take in all workers healthy enough to work, will bring a number of dependents or workers who have some expensive care needs.  A risk pool that takes anybody without regard to employability, or requires no preconditions, will have highest costs since it has no way to maintain a consistent group profile for its plan participants.  They cannot avoid rising costs.  The optimal goal here would be to have the healthy and sick agree that we are all in this together, and design plan enrollment to take in everyone.  Then costs could be averaged across the existing population, but would more fairly reflect the costs of participating over the terms of one's life.  Our private insurance companies are working hard to keep shrinking their end of the risk pools, artificially excluding those of us they don't want,  and push hard to divide and conquer us.  Now, unless we allow every human into the risk pool, and can take them from the private pools too, our ability to compete will be limited..  For overall pool averaging to work, we need many (okay, ALL) workers in, who, even while health and covered, generate sufficient premiums  to cover costs of those who actually need the care.

        And #2 has it's own complexity.  This is our boots on the ground sets of providers, and the big bad boys are organized horizontally and vertically and feature members of the boards who are often relatives or spouses of members of Congress.  So, they already have been organized into groups of clinics, doctors, specialists, hospitals, physical and respiratory therapists, medical durable equipment providers, visiting nurses.  They may have 'formulary' agreements with pharmacy suppliers and other agreements with medical supply vendors. These groups will negotiate rates with an insurance company, our public option, as a group, and will likely put down a catalog sized set of rates and indicate the deal is take it or leave it, your group isn't big enough to rate open negotiations.  You have to bring to their table a good number of new patients, or it's not worth their negotiating anything to get this group.  A big enough group would be one which enables them to expand, build, perhaps even suck up another competitor.

        I know a bit about putting together the administration and start up of a new health care system.  I'd be happy to help as I could.  I help design small and large software systems to manage plan design, plan enrollment, network management, and process claims.  Some parts require subcontracting out to a 'third party administrator' unless we can build our own benefits and claims processing center.  

        If we're thinking national in scope, we'd probably be wanting at least $200 million to gear up, and this might be a very dedicated 25 staff team with top manager and of course a board of directors.  Then, assuming we could at first pull together a risk pool of 100,000 participants (plus dependents), we be able to price and set plausible premium rates, initialize billing & collections, and determine what to do when premiums exceed expenses, or when expenses exceed premiums (borrow until rates are increased).  Linking in Section 125 plans, Health Savings Accounts, and whatever else we can to fit with the definition of qualified plans, would help make it attractive to businesses, schools and trade groups.  The problem is always bringing in the young health folk who don't imagine themselves likely to incur any expenses for decades.  They don't imagine that have a kid will generate $20,000 to $50,000 bills for relatively routine care and much, much more if neonatal care is needed, or mother has post-delivery complications (or dad...okay--it'd be mostly psychological).  

        And we have many needing real mental health care, where the problem are seen as brain chemistry issues as deserving of good treatment and fixin broken leg, removing malignant tumors, or endocrine dysfunctions requiring hormone treatments.

        When life gives you wingnuts, make wingnut butter!

        by antirove on Sun Dec 20, 2009 at 01:12:46 AM PST

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        •  All good thinking plus one more thing (2+ / 0-)
          Recommended by:
          meg, dhfsfc

          The insurance industries control the price of our medical bills.  Our drugs cost way more than they do in Mexico, Cuba or other nations purchasing the exact same product.

          The former problem would have to be addressed somehow.  We'd have to purchase our drug supply outside the U.S. and somehow be able to bring it in.  Of course, the U.S. would never allow this.  So we're stuck paying their exorbitant prices unless we can find a legal means of overcoming this onerous unfair market condition.

          "Take whatever you can, Steal whatever you can't take, Kill what you can't steal so no one else can have it." - Republican Business Philosophy

          by Pen on Sun Dec 20, 2009 at 03:15:36 AM PST

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          •  Well, that's almost right. The Pharma Industry (0+ / 0-)

            has set things up to maximize profit in the US industry, and apparently has the White House agreeing to protect their special US market.  The insurance companies negotiate with the drug chains, clinics and hospitals, against the very high bar set by the pharmacy companies--which have been making record profits for the last few decades.

            Our hospitals use drugs as a profit center as well, and have no compunction in adding a 500% to 3,000% mark up over their costs, when adding it to your hospital bill.  They may get a drug in bulk for $5 per 100 doses, but their internal pharmacy then 'packages it' for 'unit dose'.  When it hits your bill, it will show up as a $25.00 charge, $125 charge if given in post-op, or more...just because they can.  The insurance companies may negotiate these down, but that hospital still walks off with a very padded mark up.

            When life gives you wingnuts, make wingnut butter!

            by antirove on Sun Dec 20, 2009 at 05:58:36 PM PST

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    •  To get providers on board (3+ / 0-)
      Recommended by:
      meg, dhfsfc, rogereaton

      the main thing you would have to do is not to pay high fees but to make collections easy.

      I was sitting around the doctor's lounge in our fairly conservative community hospital when the conversation went toward single payer.  The doctors were all for it, even if our payments went down a bit, if the system would pay us promptly and easily for the work we do.  

      Medicaid runs low on funds and not only cuts payments, they delay payments by putting in new hoops to jump through.  The new electronic system required my biller to figure out that she had to put in my first name, not my last, and my individual NPI number, not the group one, to get paid.  Changes were made on two days' notice and no one would tell us what we had to do, we had to do trial and error until we figured it out.  

      Just make it simple and tell doctors honestly how to get paid what they are due and providers would buy in at reasonable rates.  Now, keep in mind our costs have gone up like those for everyone else.

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