Wednesday, December 19, 2007

Pretty Lady's Universal Healthcare Plan

Someone has nominated Pretty Lady for President! Thank you, David and Franklin!

Unfortunately, Pretty Lady has more sense than that. Presidential politics are terrible for one's complexion, as Hillary Clinton may attest. Pretty Lady prefers the Private Life, making draconian pronouncements from the sidelines. However, since her friends have expressed an interest, she will so far unbend as to elaborate upon her plan for Universal Healthcare, Unsocialized.

Part 1: Health. Care.

...Pretty Lady suspects that one very large reason that the "Healthcare System" is so stingy on Prevention is that it is so heavily interested in selling cures. That, and in covering its own butt; there is a reason that doctors these days compulsively order masses of expensive and, in most cases, useless diagnostic tests. They are not nearly so concerned about your financial well-being as their own, and medical malpractice lawsuits cost them money.

Part 2: Health Care, Part the Second
1) It is in the best interests of Society At Large to have healthy citizens, and as few destitute diseased persons dying in the streets as possible, spreading germs and and despair far and wide.

2) It is in the best interests of Individual Health and Economic Well-Being to seek out the best care at the lowest prices, and laugh in the faces of incompetent dentists who present them with deadpan $13,000 estimates.

So then, what is wrong with individually managed medical savings accounts, coupled with catastrophic coverage in a pool?

Part 3: Pretty Lady Gets Everyone's Knickers In A Twist.

Because what Pretty Lady proposes is, simply, universal government-subsidized health savings accounts.

Yes, she proposes that the government freely give its low-income citizens money, to spend upon their own health. Rather like EBT vouchers.

This, of course, violates all established precendents of Condescension, Patronization, and Punitive Reinforcement. It presupposes a dangerous Lack of Control, and irresponsibly opens up the system for instances of Flagrant Abuse by the least deserving among us. It amounts to a Robin Hood philosophy of robbing the rich to reward the poor.

Or does it?

The key of Pretty Lady's plan is that this subsidization will not be unlimited. Persons shopping for health care will be presented with the challenge of frugality; they will be forced to make their own decisions. They will try things and see if they work; if they don't work, and are expensive, they will try something else. Meanwhile, healthcare practitioners who charge exorbitant rates for nothing at all will be forced into another line of work.

Note, furthermore, that the government is not running this system. Note that Pretty Lady has said nothing at all about Medicaid, Medicare, or prescription-drug plans. The only 'insurance' plan which makes sense to her, as she has said in the past, is a universal catastrophic-coverage plan, payments to be subsidized below a certain income level.

The universality of this plan, moreover, is key; this obviates any need for layers and layers of bureaucracy, put into place for the sole purpose of denying coverage to people in need. Once denial is no longer an option, the wit and wisdom of plan-managers will have nowhere to go but toward the efficient managing of resources for absolutely everybody.

Pretty Lady blushes to admit that she likes her plan even better than the plans of her two favorite Presidential candidates. It seems to her that it takes into account both the free-market libertarianism of Mr. Paul's philosophy, and the universal compassion and social responsibility espoused by Mr. Obama.

The only questions which remains, of course, is: how do we pay for this?

Well, Pretty Lady has heard a rumour that the U.S. of A military budget is a teensy bit overinflated; it strikes her, frankly, as overkill. Were the country at large to heed the admonitions of both Mr. Obama and Mr. Paul, and refrain from intervening militarily in areas where we do not belong, it could conceivably free up a lot of resources, which could then be used for healing, rather than attacking.

11 comments:

barak said...

I have two questions to start with.
a) how do you determine how much credit to give to a given patient?
b) who exactly administers it?

prettylady said...

Barak, those are Piddling Details, which must be worked out by Those Who Know Best, after the general principle has been agreed upon. Pretty Lady is a Visionary, not an Administrator.

However, there is already an EBT program in place; why not model it after that? Income level determines eligibility, voucher goes into account every month. Unused healthcare dollars roll over, and accrue interest. Simple.

Pretty Lady further notes the fact that the EBT program has not, to her knowledge, caused food prices to skyrocket, nor food quality to deteriorate.

Also, bear in mind that the Health Savings Account vouchers are primarily for use on preventive care, maintenance, and minor emergencies. Once people come down with something nasty like cancer, they go into the Catastrophic Coverage pool.

BoysMom said...

How on earth do you intend to keep meddlesome beaurocrats from messing with the funds and what can be done with them?
First thing you know, someone will propose that these monies can only be used for FDA approved treatment procedures, not for, say, buying higher quality food so as to avoid the need for said treatments. (I do believe that you would agree with me that proper eating does a great deal to alleviate health problems.)
All in the name of protecting the innocent children from their confused and misguided parents. Of course. Just look at what happens when a family with a child with cancer goes crosswise with medical doctors because they want to try some alternate therapy like apricot pits. The child gets forcibly taken from the parents and hospitalized for chemo. And the vast majority of people other than the immediate family think that this is a good thing. (This very scenario played out in my home town not too many years ago.)
You are, in my opinion, counting entirely too much on the goodness and open-mindedness of human beings, and not nearly enough on their meddlesomeness and the firmly and widely held belief that 'I am smart but everyone else is an idiot.'

Desert Cat said...

So then, what is wrong with individually managed medical savings accounts, coupled with catastrophic coverage in a pool?

Not a darn thing and is the plan I most favor. And not coincidentally I just signed up for exactly this option--through my employer!

My employer will now contribute the difference between what they would otherwise pay for the PPO plan versus the high-deductible plan into my account. I will contribute another sum (pre-tax), and from that pool I will take care of whatever health care I deem necessary.

Of course the high-deductible insurance policy still gets to decide what expenses that I pay for out of that pool applies to the deductible, but I am not *prevented* from getting a massage or acupuncture or naturopathic care using that fund if I so choose.

I have a couple concerns about the universal government plan. First of all, the market seems to be pushing us in that direction anyway. I'm pretty sure my employer isn't *that* avant garde. Turning this into a universal plan will kill off any further innovation in the private sector (why fund an attractive health plan for your employees if they're going to be eligible for the government run version and you're being taxed extra anyway to cover it?)

Second, any "limited" funding will instantly be demagogued as brutal heartlessness on the part of the fiscally responsible thinkers. Bread and circuses always wins elections, and this will certainly end up as one more olive loaf to pummel those evil conservatives with. "The Gap" (between the limited HSA fund and the deductible for the catastrophic coverage) will be made to loom large in the imaginations of the perpetually struggling middle and lower-middle class. And if recent history is any indication, they *will* capitulate, even stumbling over each other to show how "compassionate" they are.

The end result will be full funding of The Gap up to the point where the catastrophic plan kicks in, and no need to make the hard choices.

Now mind you, in theory this is far preferable to any of the "universal managed healthcare" ideas out there. But would the end result be that different?

prettylady said...

First thing you know, someone will propose that these monies can only be used for FDA approved treatment procedures, not for, say, buying higher quality food so as to avoid the need for said treatments.

Yes, this is an enormous concern of mine. In Pretty Lady's perfect world, Health Savings Vouchers would be legal tender for any health-related procedure on the market, including massage therapy. :-) A cornerstone of Pretty Lady's health plan is that maximum control should be in the hands of consumers, to be as smart or as foolish with it as they like.

Turning this into a universal plan will kill off any further innovation in the private sector

Why should innovation in the private sector be killed off if people are controlling their own money, and choosing what healing institutions to patronize, all by themselves without government intervention?

The fact is, 'health insurance' used to be a perk provided to attract employees, until it was legislated that employers had to provide it, at which time it became a burden to industry, and in particular on small businesses. Catastrophic health care works best in a large pool which is completely portable, not as a perk tied to one's job; routine health care is much more economically efficient and healthy when it is in the hands of the individual.

why fund an attractive health plan for your employees if they're going to be eligible for the government run version

My notion is that funding will be on a sliding scale based on income. People who make decent salaries won't get such fat vouchers. Thus there will still be incentive to create 'attractive plans' for the middle class and the wealthy, who disdain to pay for their massages with EBT vouchers. :-)

any "limited" funding will instantly be demagogued as brutal heartlessness on the part of the fiscally responsible thinkers.

And it is precisely this sort of 'all or nothing' thinking which has led to 45 million people without any health insurance at all, including myself. Pretty Lady is heartily tired of it. She is on a strict budget, and she doesn't see why this is a terrible thing to expect of anyone else.

barak said...

OK, I finally went and googled EBT. "Food Stamps" I understand. Excellent idea PL.

Pretty Lady for President! (Kidding, of course. I wouldn't curse you with that burden.)

k said...

I remember this post ever so well, Pretty Lady. You and DC and Livey were my scooter heroes. You got together a scooter club and - quite literally, I am firmly convinced - saved my leg and my life.

To my dying day, I will never forget that.

Anonymous said...

I have been suggesting this to people for quite some time.
I usually get a blank stare as it seems that no one understands what insurance is anymore.

I recently had an exam that was required to get a certain license.
I have no insurance and simply paid out of pocket $150.
Upon telling a friend he was shocked that I paid $150 for a checkup.

This same fellow pays $6000 per year for 'insurance' so that he can see a doctor for a small co-pay.

He is shocked at my $150, but doesn't mind his $6000 yearly fee to get to pay a small co-pay.

Catastrophic coverage with a large deductable is the way to go. I'll pay for the small things myself.

P.T.

BoysMom said...

You know, I was looking into catastrophic coverage just recently. Roughly $500 a month for a $10,000 deductabile. For a family of five.

That's big chunk of income each year going into that catastrophic coverage, and judging from past medical costs (over six years of marriage and including three pregnancies) we'd never use the coverage (the highest medical bills we've ever had never hit $10,000 in a single year). It seems quite unreasonable, but what's a person who intends to be self-employed to do?

prettylady said...

It seems quite unreasonable, but what's a person who intends to be self-employed to do?

It IS unreasonable. The system must change or we will bankrupt ourselves.

Pretty Lady recommends putting that $500 a month into a money market account (she can refer to to one, if you're interested) and if one of your family members is catastrophically ill during the next 10 or 15 years, before compound interest has made you a millionaire, she recommends taking out a lot of credit cards, getting cash advances on those cards, putting the bills through the microwave, filing for bankruptcy and moving to Sri Lanka.

Seriously.

prettylady said...

k, you have given my entire life its meaning, in more than one way.