The Curmudgeon’s Health Care Reform Plan

NEWS of The Controversy is slow today, so we’ll go off-topic and give you our thinking on one of the problems currently vexing the Congress — health care reform. This is a bit of a stretch for us because we have no expertise in this area; but we have far more sense than Congress, so we can’t possibly do worse than they’re doing.

What we suggest requires no congressional action whatsoever. Nor should there ever be any, because the Constitution gives Congress no authority over non-military medical matters.

We propose three simple ideas, any or all of which can be implemented by the states. Unlike the bill currently in Congress, our proposal isn’t 2,000 pages long; it’s only one page — this one. Here it comes:

1. Tort reform legislation. This isn’t a new idea. Wikipedia has an informative article on it: Tort reform, which includes a section specifically on the healthcare industry. To illustrate what we have in mind, the Wall Street Journal, in this article about the latest congressional health care bill, says:

Huge contingency fees and damage awards are the mother’s milk of frivolous lawsuits. That’s why 30 states have adopted caps on awards as the core of their reform, with huge success. Texas imposed malpractice caps in 2003, and the state has been rewarded with fewer lawsuits, a 50% drop in malpractice premiums, and a flood of new doctors. [That is, doctors are moving to Texas from states with high malpractice insurance costs.]

2. Reciprocity statutes to encourage interstate insurance competition. The concept is simple. One model would be state statutes that provide reciprocal recognition of concealed-carry handgun laws. All a state needs to do is pass a law saying something like this: “Any insurance company authorized to do business in (for example) New York, California, or Texas, may sell in this state any health insurance policy approved by any of those states, under the same conditions.” That would allow more competition and an increase of available choices. Reduced cost to the consumer — or at least a lower likelihood of cost increases — would be virtually assured.

3. Scholarships to increase the number of doctors and nurses. Why? It’s simple economics — if we increase the supply of qualified people providing medical services, we reduce the cost of those services. (Conversely, if we merely increase the number of bureaucrats in the system, as Congress proposes, that will inevitably increase costs.)

Speaking of cost, if a medical student’s scholarship with an adequate stipend costs $50K per year, then a thousand such scholarships would cost $50 million. Instead of a grant, the student aid could be in the form of a loan, to be forgiven, say, at a rate of 20% per year for each year the recipient practices in the state. Every state can afford this. A few states do it now, at least to some extent. See: Loan Repayment/Forgiveness Scholarship Programs.

We can even make a state’s scholarship program financially painless for the taxpayers, but here’s where it gets Curmudgeonly. For every scholarship granted, the state can fire a mid-level bureaucrat in some obscure and unnecessary state agency. Every state has thousands of such employees (Florida, for one tiny example, regulates Colonic Irrigation). Could we somehow survive without such state services? For the most part, when clerks aren’t harassing the citizenry they’re sitting in their cubicles consuming jelly doughnuts and producing flatulence. What’s preferable — thousands of new doctors and nurses, or thousands of government functionaries? By reducing the number of such drones, the state will gain medical practitioners, break even financially, and everyone will benefit. If the dismissed bureaucrats are as wonderful as politicians claim they are, they’ll find jobs in the real world.

That’s our plan. As we promised, it didn’t require 2,000 pages. We don’t pretend that it will solve all problems, but by increasing the number of doctors and nurses, and lowering malpractice premiums, we’ll bring down the cost of medical care. Interstate competition will make medical insurance more available and affordable.

Unlike the bill in Congress, our plan doesn’t cost a trillion dollars — it costs nothing except for the scholarship program, and we’ve shown how the cost of scholarships can also be zero.

The increase in state bureaucracy is another zero; and if our method of paying for scholarships is adopted, there will actually be a decrease in bureaucracy. Best of all, the intrusiveness of the federal government will be zero.

The politicians keep telling us we have a health care “crisis.” If so, the states can adopt or expand these measures now. What are they waiting for — a miracle cure from Congress? You know that ain’t gonna happen.

Copyright © 2009. The Sensuous Curmudgeon. All rights reserved.

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21 responses to “The Curmudgeon’s Health Care Reform Plan

  1. retiredsciguy

    Brilliant!! I love it!

  2. Thanks, retiredsciguy. Alas, I misspelled “Health” in the title. It’s fixed now, but I donno what chaos that’s causing with Google, etc. If anyone searches on “Heath Care” they’ll find it.

  3. americancentrist

    Good ideas all. You might enjoy my light-hearted analysis the House Health Bill:

  4. BRAVO!

    Wild applause!

    I would one additional action at the federal level: stop Medicare from underpaying doctors and hospitals for care rendered to Medicare patients, which is a de facto transfer of cost to the private sector, as doctors and hospitals increase the amount they charge private patients (and their insurance carriers) to make up the loss.

    How would I do this? Easy: REPEAL MEDICARE. If you still think the federal government should pay for health care of people over 65, give them a voucher to buy health insurance privately, or similarly enable them to set up a Medical Savings Account + catastrophic health care insurance.

    Stop the madness… stop the madness NOW.

  5. If you still think the federal government should pay for health care of people over 65, give them a voucher to buy health insurance privately

    Umm, this is already done. It is known as Medicare Advantage (Medicare Part C). And get this, it costs the government more than traditional Medicare (Part A and B), mainly due to higher administrative costs.

  6. Good article, americancentrist.

  7. Longie says: “How would I do this? Easy: REPEAL MEDICARE.”

    If it were up to me, I’d repeal most of the legislation of the 20th Century. But what do I know? I’m still loyal to the Constitution.

  8. You must be bored if you have to write about something that you really have no idea about. Stick to the controversy.

  9. RogerE wrote:

    “You must be bored if you have to write about something that you really have no idea about. Stick to the controversy.”

    Roger. I think Curmy has as good or better grasp of basic economics and how the market functions than 90% of the bloggers on the Internet. He prefers sticking it to Creationists, it’s true, but he ain’t a one dimensional green frog.

  10. Tort reform won’t solve the medical malpractice problem. It only shifts the costs to the victims. The costs are still there.

    What we actually need is true malpractice reform to reduce malpractice in the first place. National Practitioner Data Bank data shows that in most states only about two percent of physicians have been responsible for over half of all the money paid out for malpractice since 1990. NPDB data also shows that quite often these two percent have multiple payments in their records but no action by state licensing boards to revoke their licenses or restrict their practices. Similarly, most often no action has been taken by hospital peer reviewers to revoke or restrict their clinical privileges. So the “repeat offenders” continue commit more malpractice.

    To have true malpractice reform the licensing boards and peer reviewers need to get serious about protecting the public from physicians with a pattern of malpractice.

    It is also worth noting that there are fewer than 20,000 malpractice payments each year for all causes although the Institute of Medicine estimates that there are about 100,000 deaths each year from malpractice. Other sources double that number. Only about 28 percent of malpractice payments involve patient death. Thus we can estimate that at most only about 3 to 6 percent of all malpractice victims receive any malpractice payment.

    The real problem isn’t malpractice payments. To save money — and more importantly, to save lives and prevent injury — we need true malpractice reform that reduces malpractice itself. We need to stop treating the symptoms — malpractice payments — and instead treat the disease — malpractice.

  11. Excellent. Of course the inimitable Michael Egnor would object, but I would require that, to obtain the scholarship, students would have to have a solid background in evolutionary biology. Enough for any honest person to admit that ID/creationism is a scam.

  12. Tort reform? Not with the Obama folks at the helm. Look at Madame Pelosi’s concept of tort reform. In her bill (bipartisan as she snagged a single GOP vote) she gives incentives to states to study tort reform but they may not consider caps or attorneys’ fees. What’s left? We’re wasting billions of dollars on defensive medicine and exposing patients to unnecessary risks. Who can defend this? See under Legal Quality.

  13. Health reform?

    Just give everyone a large bowl, a scalpel and instructions on bleeding.

    Oh, and a leech or two.

    Don’t forget the spleen pills if they are female and prone to the vapors.

  14. You could also remove one of the major sources of abuse in your current system by de-linking health cover and employment. The simplest way to do this would be to make premiums paid by individuals tax-deductible.

    As a matter of policy, you would improve the incentive to insure and reduce the potential for abuses if you require some sort of community rating (at least, if premiums are to be allowed as tax-deductible). So you have personal incentives to insure and reasonable assurance of cover, and all at minimal cost to the taxpayer.

  15. Amadan says: “You could also remove one of the major sources of abuse in your current system by de-linking health cover and employment.”

    Agreed. I think the practice began back in World War II when wages were frozen by government decree, so employers started handing out “fringe benefits” instead of extra salary. It’s been with us ever since.

  16. Amadan: You could also remove one of the major sources of abuse in your current system by de-linking health cover and employment. The simplest way to do this would be to make premiums paid by individuals tax-deductible.

    Like Curmy, I agree with your first sentence…but there’s no logical connection from the second to the first.

    If tomorrow the government gives me a$100 tax break on a $300/month premium, how is that going to suddenly change who covers me or what companies will be willing to cover me?

  17. retiredsciguy

    I’m reading this for the second time as I’m watching the bipartisan health care debate live on C-Span 3 on Feb. 25, 2010.

    Curmy, your proposal makes even more sense now.

  18. Aaaagh. As a soon to be retired govt. scientist I have an objection to the, …sitting at my desk eating jelly donuts and the flatulence thingy remark. I never have and will never eat a jelly donut at my desk. Other than that …not bad.

  19. Aufwuch says: “I never have and will never eat a jelly donut at my desk.”

    Then you’re a Fritos man.

  20. retiredsciguy

    Hey, Aufwuch , got a lot of time on your hands that you can sit at your gov’t. desk surfing the web?

    Hey, I’m not blaming you. I was in the same position once myself in the Dept. of Transportation. I won’t go into great detail, but suffice to say we had more than ample personnel on staff to do the job at hand.

  21. Gabriel Hanna

    Change our concept of insurance. Auto insurance doesn’t pay for gas or oil changes or new brakes–imagine how much those things would cost if nobody had to pay out of pocket for them, and imagine how much auto insurance would cost if they did. If you are worried about poor people getting hit by a car and going bankrupt, we can pay for that without everybody being dragooned into a complicated and expensive insurance scheme.

    But the President just said at the health care summit that catastrophic health insurance isn’t REAL insurance–presumably he thinks auto insurance isn’t either.