Here are some random and stale thoughts I will share (yes I realize I am not answering your question):
1. Doctor's should be paid salaries. (Capitation and fee-for-service just produce too many negative incentives). 2. There really is less and less "insurance" going on each year (to the detriment of the poorest and sickest who do benefit from this sharing of risk). What is called "health insurance" should be called a health prepayment plan with severe price discrimination. This is what "managed care" means in the big picture. In this sense, all health care is managed including Medicaid. 3. There is tremendous equity in the social insurance (sharing of risk between well and less-well as well as rich and poor) of single-payer health care. 4. I had something nice to say about reforms in the Netherlands a few years back but I am too lazy to dig up what. 5. I am not that impressed with the focus of progressive advocates on universal or even increased access to health care. I do believe that this important but (at least where I live) becomes the sole focus of health reform. 6. The fact is that health care delivery is a personal interaction (a principal-agent problem). This has far reaching implications. First, giving someone financial access to a system they are treated poorly in is less of a improvement than people realize (especially because many poor people and people who cannot afford their regular medical care can get free care just as good or better than low-quality care they would get under some state-sponsored universal plan). Second, there is considerable sociological research that shows that marginalized communities get worse care than the general population even when they have access. Third, universal access actually encourages crappy coverage, excluded conditions, out-of-pocket nuisances, etc. (although at this point I suppose it cannot get much worse) rather than redistributing resources is a systemic resources to the medically underserved. 7. Health care delivery in the United States is a very strange and complicated mess. It works to some degree, but there is a reason why so much death, injury, pain, and fear is created BY the health care system. The complicated financial relations, the rationalizing of labor costs and the resulting understaffing, an increasingly confused and distrustful patient, etc. all leads to preventable problems. 8. People are over-prescribed in shocking numbers (thankfully, these a large percentage of these prescriptions go unfilled because most patients know their situation better). I have plenty of second hand stories here, but my favorite comment was by a mental health doctor who said "Thankfully, people with mental illness forget to take their pills" (his health plan would be out of business if "their patients took all the medication prescribed to them). Doctors are indoctrinated in rote formularies and prescriptions are quick way of dealing with patients, patients are inundated with increasingly sophisticated advertising and demand creation, 9. Health care and markets just do not mix. We are REALLY REALLY REALLY REALLY lucky there are millions of caring and generous people that do dedicate their life to the health of others. If these people actually put market incentives first (which is certainly a possible future), things will be bad. 10. Non-physician health care workers are treated very bad. This is not good on many levels. 11. Health care should not be linked to one's job (the Cato Institute and I agree on this one).
Peace,
Jim
At 03:26 PM 3/27/02 -0500, you wrote:
>There seems to be a lack of proposals that provide a
>bridge from incrementalism (tho SCHIP is a pretty
>good-sized increment, I think) to full-blown national
>health insurance. Our resident health expert at
>EPI, now sadly departed for greener pastures,
>was always reluctant to plumb this territory. One
>is to go for state-level systems. There is a project
>on this underway in MD. But what about something
>short of universal but much better than what we
>have now? Have you some ideas in this vein?
>
>max
>
>
> > Unlike Max I think that this can be accomplished with
> > well-reasoned changes
> > in policy on a systemic basis (however, like Max my criterion for
> > evaluating that policy would be incremental--does it make things better?).
> >
> > Peace,
> >
> > Jim
> >
There are people who'd rather have a dollar in their pocket than to have you alive. . . See how the word "care" is confusing here?"
-- Billy Golfus, *MOUTH*, September 1996.