Sunday, February 01, 2009

Thoughts on Health Care Reform

Although looking for government involvement/intervention/deep regulation to solve a problem is usually a last resort, the problem of ravenously increasing healthcare spending does not appear to be an ordinary problem. This has been considered a major problem for pretty much my entire adult life (20+ years). It only seems to have gotten worse. I am afraid, now, that Republicans/conservatives have completely ignored this situation too long, to their detriment.

However, I dearly hope we will not just dump more $ into system that we already agree consumes too much money and resources. Let's experiment with some kind of alternative, much leaner systems. Some ideas:
  • Employ salaried doctors, not independent contractors, like the famous Mayo Clinic does
  • Implement super, super aggressive management of prescriptions. It goes without saying that only generics should be used, where they are an option. In all cases, have a bias toward starting with the most cost-effective medicine, before escalating to the latest and greatest.
  • Pass special tort reform, to eliminate defensive medicine.
  • Consider aggressive, HMO-style gate-keeping. For instance, perhaps patients should always have to call the "nurse line" before coming to the doctor's office, to eliminate visits for routine colds, etc.
  • Make aggressive use of the most cost-effective skill-set: don't use LPNs for stuff RNs can do, don't use Physician's Assistants where RNs can do, etc.
  • Make aggressive use of wellness coaching--participation is not optional.
  • Implement disciplined regionalization of procedures. Patients have to go to the approved, efficient facility in the region, not the one they might find most convenient.
  • Keep some element of the first-dollar motivation that HSAs provide, even if it has to be on a sliding scale.
  • Obviously we want to look at streamlined administrative options.
  • Use expensive infrastructure 24x7.
  • Take a very tough line on necessity of treatments. Just in my extended family, I know of a number of cases where prescribed treatment has been unnecessary or useless. This article that suggests most TMJ suffers might do best with no treatment is a good case study. Or back surgery!

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