Saturday, May 30, 2009
Monday, May 25, 2009
We all vote on the major health care restructuring/reform ideas that have been discussed. Any proposal that can get 40% of the votes of either house should be submitted as a possibility. (The Republicans won't feel left out.) Also, President Obama should get one that is solely his idea. And lastly, we should set up major industry groups and groups. Each of these submit a proposal as well.
We vote by approval voting. That is, the citizens can vote for more than one proposal that they like; The one which gets the most votes wins.
Part Two: Parameterize the Structure.
For example, tax rates, penalties for not choosing a planet, reimbursement rates, the percentage of money going to rural providers, different specialties, teaching hospitals are all parameters.
Each year the population gets to vote on each of the number. The final number is the median of whatever everyone selects. To prevent wild gyrations and to allow health care firms to plan, there will be plus or minus five percent cap.
Part Three: Introduce Sortion for allocating funds.
Each of the categories get a fixed amount of money and providers are batched. That is, we have bathces of rural-based orthapaedists, batches of oncologists in teaching hospitals, batches of primary care physicians in low-income areas, etc.
Each provider submits statistics on what they did, who they treated, who they chose not to treat and outcome measures. Of course, the patients submit satisfaction numbers. Patients who have a particularly bad outcome can bring their complaint to the sortition manager. This replaces the current malpractice system. But in addition, patients who particularly think the doctor did a good job (saved their live when noone else could), can raise this as well.
Part Four Extension to Private Health Insurance FundsAll of our private health/HTMO bueauracracy is based on one of two models
- Fee for Service
- Capitation (Fixed fee for keeping this person well)
The problem with the first is that it provides an incentive for care that isn't needed. Studies have demonstrated when a physician could reasonably make a decision either way about a test, they will order the test.
The problem for the second is the incentive to ration and limit care.
People don't like either because the insurer or HMO bureaucracy gets in the way of the physician/patient relationship. Insurer requires precertification. HMO's require approval to refer to a specialist.
The fixed model with sortition distribution is the third way. The Insurance company says that it will spend x dollars. It tells doctors to provide health care that they feel are needed. The insurer rewards the providers that help the most people, do the least harm with the most dollars. This is based upon ingo and outcome (how sick or injured were the patient; how were they treated, what were their outcomes.)
The sortition juries can help decide, along with the aid of biostatisticians and physicians, how to distribute the funds. The insurance companies provide the structure for the system and provides the medical and statistical experts. They get a percentage of the amount distributed, and do not get rewarded in any way for rationing care. The sortion jurie can also pay a bonus to the experts evaluating the care as well as patients who bring their evaluations. Instead of having paid expert witnesses and lawyers in the malpractice settings, the juries determine who provide the best information.
Autonomy to the physicians in providing the health care; autonomy to the payer (us) in paying for the health care!