Guest Post: To Fix Healthcare, Let 100 Solutions Bloom

Tyler Durden's picture

Submitted by Charles Hugh-Smith of OfTwoMinds blog,

There is no one solution to something as complex and costly as healthcare; the solution is to let 100 solutions blossom and compete openly for citizens' money and trust.

I have addressed the systemic ills of U.S. healthcare, a.k.a. sickcare, for many years, most recently in ObamaCare: The Neutron Bomb That Will Decimate Employment (February 22, 2013). Over the years, I have presented a number of options to the present unsustainable, fraud-ridden, costs-twice-as-much-per-person-as-other-nations system that ObamaCare leaves intact:

The "Impossible" Healthcare Solution: Go Back to Cash (July 29, 2009)

Healthcare: A Large-Scale Solution (January 4, 2011)

A Sustainable National Healthcare System: Prevention Only (August 20, 2012)

How to Cut America's Healthcare Spending by 50% (August 21, 2012)

Nobody likes any of the practical solutions because everyone wants unlimited care and unlimited choice. Expectations in a system where the government can just borrow another $1+ trillion to pay the bills are high, and the feedback from reality, i.e. price, has been eliminated in the cartel/fiefdom system that is sickcare.

Everyone talks about "reform," but real reform is impossible in a bought-and-paid-for "democracy" like ours: Why Reform Won't Work (February 7, 2013).

Even more profoundly, the Central State and ObamaCare are the wrong unit size to provide healthcare that is transparently priced, accountable to the consumer, adaptable and decentralized.

What If ObamaCare, Too Big To Fail Banks and the State Are All the Wrong Sized Unit? (February 25, 2013)


We are so brainwashed by centralized models of authority ruled by the State that few can even imagine a system where the solution is not one centralized monstrosity ruled by a political/financial Aristocracy but a competing profusion of opt-in, transparent solutions.

Rather than have a single system, we need dozens of choices.

If there is a political desire for a national prevention-only system of clinics, then fine, let the State offer this, but with two stipulations:

1. It is voluntary/opt-in; nobody need participate if they choose not to

2. there is a cash co-pay for every service, medication, test. etc. Nothing is free, because nothing is free. What is presented as free is abused and squandered.

If a national superstore chain opens clinics that accept only cash, great. If employers want to offer healthcare insurance, fine; if they don't, that's also fine.

If some insurance companies want to offer medical insurance, fine. The only requirement is that the fees and coverage must be transparent enough and clear enough to fit on one piece of paper.

Every service offered by either the State or a private insurer or provider must be transparently priced on the web.

If the Central State does offer healthcare of any sort, it cannot be open-ended, because the funding is not open-ended. It must be strictly limited, either in what is offered or in the sum of money that can be spent on any citizen/patient.

You see the guiding principle here: patients are given the costs, the limits and the choices. There are often hard choices to be made, and rather than empower a State-run cartel/fiefdom system to make those choices, let each citizen make their own choices.

If a person wants to spend more than the sum allotted by the State or insurance, then they are free to spend their own money or appeal to charity.

There is no one solution to something as complex and costly as healthcare; the solution is to let 100 solutions blossom and compete openly for citizens' money and trust. If there is a political will for some sort of State-operated healthcare, then it must contain limits on the sum that will be spent per person and the care that is offered, and it must enable transparent pricing, wide-open competition and patient choice.

Perhaps cities want to offer some sort of public care; it's the choice of the city's voters and taxpayers. Maybe local private clinics want to offer their own limited form of insurance; they should be free to do so.

Centralized, top-down systems are quickly shorn of innovation and cost control as the political and financial Aristocracy soon capture the regulatory and governance machinery for their own benefit.

As I noted in The Pareto Economy (February 18, 2013), 80% of the benefits could be reaped for 20% of the money squandered on our corrupt, fraudulent, ossified centralized systems.

We suffer from a systemic failure of imagination. This is a theme I have explored many times:

Questioning "Progress" and the Poverty of our Imagination (June 11, 2010)

Oversupply of Old Failed Ideas, Undersupply of New Pragmatic Ideas (July 16, 2010)

Our Dust Bowl Economy (November 20, 2012)
When the present path cannot possibly lead to success, regardless of the labor and treasure poured into the effort, then risking the unknown by trying something different is the only way forward.

We Have No Other Choice (March 15, 2012)
America is just going through the motions because we have no other choice--or so we believe.

What If We're Beyond Mere Policy Tweaks? (February 6, 2012)

Spoiled Teenager Syndrome (January 3, 2013)

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.
pragmatic hobo's picture

Healthcare insurance industry is a multi-billion profit generating industry. That money comes out of everyone's pocket seeking healthcare. Healthcare insurance industry is a vampire squid industry. Get rid of that industry and save that hundreds of billions on healthcare. Problem solved.

knukles's picture

It is past being un-fucked-up-able.
Like considering an optimal speed for QE.

FL_Conservative's picture

I'd create a "pay for service" medical service business model, but I'm sure that would get harpooned by HHS when the medical staff tried to re-license in the future.

Texas Ginslinger's picture

Once again another thread talking about the health care problem, but not offering the basic solution.

The basic solution = Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ 

Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ Diet & exercise........ 

Zap Powerz's picture

Yep. Pretty much.  The reason health care is expensive is because Americans are very sick people.  Americans have the highest rate of obesity and obesity related illnesses that just so happen to cost a shit ton of money to "treat".

If Americans were more healthy, health care would be cheap.

That is the solution.  Now, getting the fat, lazy Americans to that solution is an entirely different challenge.

nmewn's picture

Minus one for taking up an entire screen to say two sentences.

Go on a word diet ;-)

atomicwasted's picture

That'll do a lot of good for a broken leg, or Parkinsons, or pregnancy, or tuberculosis, or any number of expensive medical issues that have squat to do with diet and exercise.  Prevention is well and good, but people get way too wrapped around the axle of diet and exercise preventing everything.  It's like Christian Science wrapped with a bow of sanctimony.

Zap Powerz's picture

My broken leg is not your responsibility.

akak's picture

Unfortunately, under Obama(don't)care, it now is.

Are you not your brother's keeper?  Yes you are!
So sayeth the Lord Obamessiah!

smlbizman's picture

the answers are not the problem....hell, we all know most the answers....the problem is man, and his greed.....everything that looks good on paper will not work once man gets involved.....

nmewn's picture

(Audible gasp!)...you mean he was lying when he said he would cut the deficit in half by the end of his first term?!?!

Zap Powerz's picture

Obama did cut the deficit in half.  He also ended all the wars.  He made sure unemployment never increased above 8% and he single handedly saved the US economy from certain collapse. 

I mean, thats that they tell me on the TEE VEEEEEE.

nmewn's picture

Yes, "he's, sort of a god."...to the state controlled media.

(Rolls eyes)...lol.

FL_Conservative's picture

Exactly!  If you want healthcare, PAY FOR IT YOURSELF!!

DosZap's picture

Exactly!  If you want healthcare, PAY FOR IT YOURSELF!!

 

 

IF you can afford it. Checked the premiums for basic care?.$10k deductible,and you stil pay over $600.00+ per month.

Try checking rates for ONLY Catastrophic Coverage(the biggies),you will drop your teeth.

Millions cannot, so are they just supposed to die?.

smlbizman's picture

dos, i dont think he meant under this system....look at the top for his meaning

DosZap's picture

10/4,thanks for the correction!

Zap Powerz's picture

"Millions cannot, so are they just supposed to die?"

What makes you think that their inability to pay for health insurance will automatically cause their death?

DosZap's picture

What makes you think that their inability to pay for health insurance will automatically cause their death?

 

Because MANY treatable diseases with cures, would not be an option for them,who pays then?.Like the one I gave an example of.

No one, they are a statistic.

Zap Powerz's picture

I have more faith in human nature I guess. I just dont see people rolling over and dying without health insurance.  Humans didnt rise to the top of the food chain because they are dumb.  They'll figure it out.

Remember, brother zap, that necessity is the motherhood of invention.

Pure Evil's picture

Billions currently live without health insurance and.....news flash.....are currently not flopping over and dying.

Health care is an expensive scam.

More people are killed per year from doctor/hospital/medication mistakes than the currently believed leading cause of death which is reported as cardiovascular disease.

akak's picture

Quite possibly the same kind of servile, spineless, implicitly pro-authority mindset that makes so many believe the banksters' self-serving lies that the collapse of the current financial and monetary status-quo would automatically mean the end of civilization, if not the end of the world.

sethstorm's picture

Their death won't be immediate but it will certainly be a result of the inability to pay - due to the inability to get the proper care.

DeathBreath's picture

we are all going to die.

try reading the article. the point is that if consumers had to bear more of the responsibility for payment, the costs would be lower

DosZap's picture

try reading the article. the point is that if consumers had to bear more of the responsibility for payment, the costs would be lower

 

I agree 100%, but in order for the costs to get in line, there must be TORT reform, and get the frigging ambulance chasers out of the picture, except for major grievances, and negligence.

Umh's picture

I'm not defending ambulance chasers here, but they are a very small part of health cost. When you come straight to the point moral hazard is the biggest problem with the health care system in the US. That and people who would rather have a low routine vist bill and get it taken out of their paycheck every week along with processing cost....

Henry Chinaski's picture

You are talking about health insurance.  Medical care is provided by doctors. You can have all of the affordable coverage in the world, but it won't save you if there aren't enough doctors.  

Ignatius's picture

Charles talks about simple solutions and there are many.

The problem: the American Medical Mafia.

kaiserhoff's picture

Exactly.  He is also advocated free markets and and open experimentation.  Maybe after the collapse, Charles.  Hold those thoughts.

Never One Roach's picture

There will always be an unlimited demand for 'free stuff.' If everyone had a co-pay of some sort...some stake in the game, they may not abuse it as much.

EscapingProgress's picture

Healthcare is simple. Eat right, excercise, and have a lot of sex.

Sickcare and injurycare are where things get complicated.

MedicalQuack's picture

It is so complex, and they don't see things like this where United Healthcare figured out how to sell medical record data and basically is right up there to compete with the FDA Sentinel program that does the same thing, except now it's going to cost a lot more.

http://ducknetweb.blogspot.com/2013/02/time-has-come-to-license-and-tax-...

And on the other side, lets cut doctors pay a little more...

http://ducknetweb.blogspot.com/2012/12/unitedhealthcare-looks-at-doctors...

I forgot to add this on the doctors pay...the American Academy of Family Practice Physicians confronts United where due to complext contracts they contrive, doctors are getting paid less by Untied in several part of the county...ruthless are they not..

http://ducknetweb.blogspot.com/2012/12/the-aafp-confronts-united-healthc...

And now that that they are in there, let's head over to Medicare and tell them to aggressively start managing Medicare and Medicaid patients and they have the software and analytics to sell them..

http://ducknetweb.blogspot.com/2013/01/united-healthcare-wants-to-expand...

Stuck on Zero's picture

A good place to start is to break up the American Medical Association (AMA) into competing groups. Let there be holistic practitioners, hi-tech practitioners, family practice, etc. etc.  The government gave this group of criminal misfits a monopoly over medical care and now Doctors are the richest group of people in the U.S. and their service stinks.

 

nmewn's picture

I gave you an up for the body of what you said...not necessarily for playing the class warfare card toward the end.

Personally, I like the idea of the best being the most highly compensated and most sought after. Whether we're talking doctors, plumbers, electricians, painters, architects or even lawyers...lol.

It makes the lessers aspire to be their best and I can tell you from personal experience, there is nothing like a damned good lawyer ;-)

Stuck on Zero's picture

Best?  The best way to judge the "best" is with free markets.  What we have today is crony capitalism and the AMA is the very essence of such.  Remember this:

Q: "What do you call the person who finished last in his class from the worst medical school in the country"

A: Doctor.

 

nmewn's picture

lol...+1

And sure, it's that way for a lot of professions. Just cause "you got the plaque" on the wall doesn't make you the best.

That is decided by the market, the full waiting room to get to the best...not just seen and prescribed a pill. I think we're saying the same thing just looking at it from different angles.

Many "free market type" doctors are bailing out...taking early retirement or the younger ones not accepting anymore "government patients" for precisely this reason...their labor has value and they know what it is. Every professional does, even when they don't admit it among their peers...they know who the best is among themselves.

All that will be left in this "new improved system" is the bottom teir...the bottom of the class in the worst schools as you say, who can't demand the price for their service. The good ones have held on for as long as they're going to out of their own compassion...but that don't pay the rent.

Nothing in this life is free.

sethstorm's picture

Many "free market type" doctors are bailing out...taking early retirement or the younger ones not accepting anymore "government patients" for precisely this reason.

Those people are part of the problem.   Trying to inject politics into medical care through sabotage does nothing but make things worse off for everyone.

StychoKiller's picture

So, not being willing to work as a Govt wage-slave is now sabotage?  Check yer premises.

StychoKiller's picture

Graduating from Med school is only step one, then there's internship and residency, which weed out a lot of incompetents.

plane jain's picture

Read the latest Time magazine cover story if you haven't yet.  

Medicare is super efficient.  Medicaid is hosed up by the individual states.  Allow people as young as 55 to opt in to Medicare @ a reasonable premium. Federalize Medicaid so that it is consistent across the states and let the same team that manages Medicare run it. Let Medicare negotiate pricing for drugs and durable medical equipment.

And, what should be an easy one, tell so called non-profit hospitals that they can not charge more than a maximum of 150% of the allowed Medicare charges and keep their non-profit status.  If they give up their tax advantage then they can charge whatever they can get.  

adr's picture

The number of hospitals not accepting medicare is growing by the day. Why? because medicare won't pay $1500 for a band aid.

plane jain's picture

True about Medicare not paying $1500 for a band aid.  They think that incidentals like gauze pads, tape, and sensors should be included in the facility charge.  But actually it is doctors that don't want to take Medicare, not hospitals.

“I was driving through central Florida a year or two ago,” says Medicare’s Blum. “And it seemed like every billboard I saw advertised some hospital with these big shiny buildings or showed some new wing of a hospital being constructed … So when you tell me that the hospitals say they are losing money on Medicare and shifting costs from Medicare patients to other patients, my reaction is that Central Florida is overflowing with Medicare patients and all those hospitals are expanding and advertising for Medicare patients. So you can’t tell me they’re losing money … Hospitals don’t lose money when they serve Medicare patients.”

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2M3bIfvnD

knukles's picture

Time magazine?
A silly dumbed down Yankee version of The Economist, for numbskulls.
Be lucky they don't change the format wherein all articles are limited to 40 character "Tweets"

JR's picture

What tremendous information. Apparently that’s coming straight from the White House, filtered through the corporate media.

As to “everyone wants unlimited care and unlimited choice,” Charles, I like your article but I disagree with that. They don’t. They want the price down. They want common sense health care for a reasonable price. What they don’t want is to pay for other people getting thier health care free.

It reminds me of a joke:

A Russian arrives in New York City as a new immigrant to the United States. He stops the first person he sees walking down the street and says, “Thank you, Mr. American, for letting me come into this country, giving me housing, food stamps, free medical care and free education!” The passerby says: “You are mistaken. I am Mexican.” The man goes on and encounters another passerby. “Thank you for having such a beautiful country here in America.” The person says, “I’m not American. I’m an Israeli.” The new arrival walks farther, and the next person he sees he stops, shakes his hand and says, “Thank you for wonderful America!” That person puts up his hand and says, “I am from the Middle East. I am not American.” He finally sees a nice lady and asks, “Are you an American?” She says, “No, I am from Africa.” Puzzled, he asks her, “Where are all the Americans?” The African lady checks her watch and says, “Probably at work.”

And now the “Gang of Eight,” McCain, Schumer, Rubio, Menendez, Durbin, Jeff Flake, Lindsey Graham and Michael Bennett are working to drastically change forever the demographics of America with an immigration policy to please Obama that will push the nation ever closer to a third-world status  by giving virtual license to illegal aliens to continue working in the U.S. while being processed for permanent residency.

It only differs from what Obama envisions by failing, at this point, to allow homosexuals to sponsor their immigrant partners for citizenship.

Antifaschistische's picture

How about letting people choose.

Why can't four seasoned military combat nurses come back to the US and open their own "urgent care" practice?   Why does a PhD with a few experiences on a fetal pig have to put a few stitches in my cut hand?

Why can't a few nurses from the local hospital start their own clinic for kids with coughs and runny noses?

Why can't I get my own 800 mg Advil tablets without forcing me to go see a doctor.  This is total blackmail.

Why can't an orthopedic surgeon who performs 20 surgeries a week on dogs with ligament damage....even look at a human x-ray?

Why can't a few local paramedics open up their own burn clinic?

Competition in the medical field is outlawed...thanks to the incestuous relationship between the AMA, Washington and the Legal Profession.  Competition....is outlawed...you want to know why it cost so much for medical services...this is the one, and only reason. 

adr's picture

But what if somebody gets hurt by one of those vets that looks at an X-ray? The jew lawyer will have a field day.

Don't forget about that problem as well. Layers and doctors are two sides off the same assrape coin.

freecrafted's picture

I would normally agree with you, but I'll give you an interesting story.

Back in the late 70s Carter an appointee that was responsible for the federal budget earmarked towards Medical education. His perfectly smart theory was that if he increased the quantity of people going through medical school he could invite more competition into the marketplace and competition would result in lower prices and costs would fall. Makes sense! What actually happened?

Costs exploded! Why? Because in a marketplace where almost every dollar spent is paid for by a 3rd party(government, insurance company, etc.) you have no concern for the cost of what you get. You'll gladly take the 10 times more expensive option with the marginal improvement in outcomes than take the cheaper option because it's not you that is paying for it. So under an environment where there is limitless demand of healthcare services it should be no surprise that as soon as supply goes up the demand immediately uses up that extra supply. Now you have more utilization and still higher costs yet. I know it's messed up and completely different than any other market in the US.

You can't expect the doctors to fix it because they're not even remotely interested in saving the government or insurance carriers money when they have a patient in front of them demanding the best because they're not paying for it. The only way to solve the problem is for the sick to feel responsible for the money spent on their behalf.

Being sick shouldn't be an excuse for spending other peoples money irresponsibly.

And the only reasonable solution to that is to have higher co-pays and deductibles so that people say "Hmm $10k for to see a specialist for my headaches of which I'll pay a $1k, nah I'll just go see a GP at a fraction of that." Only when that happens in mass will you see this rush for the best quality and most quantity after you get diagnosed subside. And when people start second guessing every extremely expensive option costs will fall.

McMolotov's picture

People can't do any of those things because it would dillute power and spread it among everybody. Can't have that, can we?

The drive toward centralization represents the drive toward total control. It's very easy to see a darker agenda lurking behind what's happened in healthcare over the past century. Once you abdicate responsibility over your own health and well-being to the State or a corporation, you exist solely at the discretion of the State or corporation. When your life is in the hands of a bureaucracy, you can be made to do anything that bureaucracy wishes.

For a short period of time, we lived relatively free from centralized powers dictating how we must live our lives, but that seems to have been an aberration, and now we've basically reverted to the mean. Human beings apparently like being told what to do, and despite our almost universal misgivings about monopolies, people have tolerated (and even encouraged) monopolistic or cartel-like behavior in healthcare.

And it doesn't matter whether it's in the public sector or the private sector. If the past few years have taught us anything, it's that there's very little distinction between government and the largest corporations anymore. In light of that fact, it makes absolutely no sense to believe centralized healthcare is intended to benefit any of us lowly serfs. It's meant to control us and enrich the right people.