A few days ago I submitted a diary suggesting that single-payer was not the key issue in health reform, and got a bit beat up. I have got up, brushed myself off and am going to have another go at it.
We have to provide health care for all Americans. To afford it, we must do something to control costs. The ideas going around about controlling costs are like filleting a salmon with a hatchet: likely to damage the good stuff.
If we want to control health care costs, we have to put a mechanism in place to allocate resources efficiently. Yes, I'm talking about rationing, I guess. We might as well face it. We can't all get a weekly MRI just to see if anything's changed.
What I want is a sensible, fair way to allocate health resources. The one thing I know for sure is it should NOT be something insurance companies do. Even a single payer one. I do not want any organization that profits by withholding health care to make decisions about who gets health care or what care they can have. Period.
How are we going to reduce health care costs?
You can argue about how much CIGNA and rest skim off the top, but there are many ways to minimize the overhead costs of insurance programs. We have to focus on the actual medical costs. Our rapidly rising medical costs are not solely a result of rapacious executives.
Here's some ideas I've read:
- Reduce medicare payments
- Reduce medicaid payments
- Get some vague voluntary concession from some gigantic hospital association.
- Get some vague voluntary concession from some giant organization of doctors.
Fooey.
The first 2 of these are just arbitrary cuts. They have the potential to hurt the providers that are serving people best. They have no apparent relationship to medical needs or actual costs; just axing the payments.
The second 2 are pure fluff. Without some binding agreement with Dr. Sawbones in your town, or the Slice and Chop Memorial Hospital in your town, this is all spin.
I want Local Health Boards
I think medical costs need to be controlled in large measure by local community health boards, just like education is controlled by local community school boards, and the fire department is run by a local community fire district. There is, in my opinion, no better way to manage health care in my community than through a local health board that consists of people that live and work in my community and that is responsible to the citizens of my community. Every community should have a local health board consisting of elected representatives, providers, institutions, public health workers, and payers. Their job is to provide the best care at the lowest cost by negotiating with providers, setting local rates, and participating in public health and capital investment decisions.
The way you prevent the atrocities of rationing is that you have an appeal process. You appeal to a board of people in your community. A jury of your peers.
The way you control costs is partly by monitoring and comparing what is actually being spent, a la the El Paso/McAllen comparison. And publish the results. What a great thing to do locally.
The way you reduce costs is to decide locally what the right mix of nursing homes, icu beds, and MRI units is. In your town. Decided by your neighbors.
Sounds messy? You bet. Will be lots of conflicts and arguments. But in the end, decisions will be made because they produce the best outcomes for the community, not for some insurance company trying to pay for it's multi-million dollar bonuses.
Whether you like the idea of local health boards or not, we must take the ability to make medical decisions out of the hands of insurance companies. Even a single payer. Even a public option.
That jerk that runs the Conservatives for Patients Care is right about one thing: We don't want bureaucrats between us and our providers. Starting with insurance bureaucrats. That's how we stop killing and bankrupting people in this country.