Wednesday, January 28, 2009

A Better Healthcare Solution

Yesterday I took a look at the universal healthcare bill introduced onto the floor by Representative Conyers a few days ago. There are a myriad of things wrong with it that I detailed fairly extensively in that post.

Conyers and company have been working on it for two years now and apparently decided, in what is actually a fairly brilliant political move, to bring it to the floor while the hugely debated economic stimulus plan is battling head-to-head with Rod Balgojevich for every headline in the land.

The tactic has worked, as a bill that should be garnering more attention than God on Sunday is slipping largely under the radar, with a first page Google search of "universal health care bill" yielding only the slim Huffington Post article I initially referenced as the highest profile "news source" reporting on the bill's introduction.

In the current anti-free market fervor that is encapsulating those that would rather not actually think about the way markets really work, indeed most everybody, and in conjunction with a largely supremely far left Congress and a supremely far left President, this bill seems like it might actually stand a chance to pass this time.

This would be a travesty, in my opinion. But that doesn't mean I'm against everyone having affordable health care. So what is a better solution?

The Cato Institute provides a great analysis here, calling for and explaining in a brief and straightforward manner how deregulation and a move toward corporatizing healthcare would be the best option in terms of delivery.

The basic argument is made in the executive summary:

The traditional model of medical delivery, in which the doctor is trained, respected, and compensated as an independent craftsman, is anachronistic. When a patient has multiple ailments, there is no longer a simple doctor-patient or doctor-patient-specialist relationship. Instead, there are multiple specialists who have an impact on the patient, each with a set of interdependencies and difficult coordination issues that increase exponentially with the number of ailments involved.

Patients with multiple diagnoses require someone who can organize the efforts of multiple medical professionals. It is not unreasonable to imagine that delivering health care effectively, particularly for complex patients, could require a corporate model of organization.

At least two forces stand in the way of robust competition from corporate health care providers. First is the regime of third-party fee-for-service payment, which is heavily entrenched by Medicare, Medicaid, and the regulatory and tax distortions that tilt private health insurance in the same direction. Consumers should control the money that purchases their health insurance, and should be free to choose their insurer and health care providers.

Second, state licensing regulations make it difficult for corporations to design optimal work flows for health care delivery. Under institutional licensing, regulators would instead evaluate how well a corporation treats its patients, not the credentials of the corporation’s employees. Alternatively, states could recognize clinician licenses issued by other states. That would let corporations operate in multiple states under a single set of rules and put pressure on states to eliminate unnecessarily restrictive regulations.

Cato suggests that medical project managers be implemented into the system to act like general contractors in construction, planning the treatment process and utilizing separate specialists like subcontractors as and when they are needed.

As someone who works in construction management for a general contractor myself, I really couldn't agree more with this approach. When you have a lot of specialized subcontractors, you need to direct each one of them to do the correct amount of work, so that one doesn't do too much, or that between two of them, something doesn't get done that should have.

Conyers' bill wants our country as a whole to go to a single-payer system similar to Medicare, which Cato outlines is prohibiting efficiency by making it so that each individual is more likely paid directly, rather than being employees paid by a corporation.

Here's hoping some people with some much better ideas, like this one, start paying a little bit more attention to what's going on right under their noses!

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