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HEALTH CARE OBSERVATIONS AND SOLUTIONS
  1. Key Observations
  • Fifteen percent of Americans (47 million) have no health insurance
    • This is our most important economic inequity and is morally unacceptable
  • Cost of health care is soaring
    • The pace is unsustainable and economically unacceptable
    • The primary cause is our multi-payer private health insurance system, which results in higher administrative, drug, and care costs
    • Secondary causes include disorganized care delivery systems, ‘uninsured’ costs, malpractice, inadequate clinical scientific evidence and standards for informed consent, fraud, and life style
      • Some impair quality of care as well
  1. Key Solutions
  • Single-payer government health insurance program (Medicare for all)
    • Universal coverage (addresses moral issue)
    • Lower administrative, drug, and care costs (addresses economic issue)
    • Better outcome and access for acute care
    • No rationing of proven therapies
    • Only affects who pays for health care, not how it is provided or by whom
      • Only affects choice of carrier for primary health insurance
      • Maintains choice for provider, treatment, and secondary health insurance
  • Legislation addressing other causes of escalating costs and inconsistent quality
    • Organized systems of health care delivery
    • Malpractice (tort) reform
    • Funding for clinical outcome research and anti-fraud programs
    • Standards for informed consent and gift disclosure
    • Life style

The United States must return fairness and reasonableness to health care policy now. The current system is immoral and economically unsustainable. That about 47 million Americans have no health insurance is the most glaring inequity in our social framework. That the cost of care is skyrocketing with no end in sight is an existential threat to our economic strength. That quality of care is suboptimal due to disorganized delivery of care is unacceptable. That choice of provider and treatment is impaired due to private insurance profit-motivated decisions is indecent. As such, health care reform should be a ‘must do’ priority for Democratic, Republican, and Independent policy makers, whether they base their decisions more on moral or on economic bases.

I believe the principles used to guide reform choices should be based on objectives of pursuing morally- and economically-optimal policy rather than that which is politically expedient. Opting for one reform option over another should be based on an assessment of which is most likely to achieve universal coverage (U), cost effectiveness (C), high quality (Q), and provider choice (C).

With these targets in mind, there are three main reform choices:

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  1. Single-payer government-sponsored health insurance system (Medicare for all)
    • Moral and economic quality: optimal
    • Political challenge: highest
  2. Multi-payer public-private (hybrid) system with government- and employer-sponsored health insurance competition, and continuation of Medicare and Medicaid
    • Moral and economic quality: intermediate
    • Political challenge: high
  3. Multi-payer private system with employer-sponsored health insurance system without public competition, and continuation of Medicare and Medicaid
    • Moral and economic quality: lowest
    • Political challenge: lowest

The first option, Medicare for all, is the most moral- and economically-sound choice because it is the one most likely to achieve the health care goals.

The entire population (all) would be covered with government-sponsored health insurance. Thus, the goal of universal coverage would be achieved.

Drastic reductions in administrative costs (due to higher efficiency), drug costs (due to improved bargaining power with pharmaceutical companies), and caring for the ‘uninsured’ costs, would occur. As employers would no longer provide primary health insurance, profit margins would increase enabling higher wages, with both outcomes resulting in higher tax revenue.

Revenue should also be increased by equilibrating the current regressive health insurance tax exemption (capping at the Medicare for all premium level and elimination for high-income earners). Reform of malpractice tort law (‘defensive medicine’), care delivery systems (disorganized inefficient systems), reimbursement (incentives), informed consent standards (unnecessary procedures), and anti-fraud programs should also be accomplished to reduce cost. Thus, the goal of cost effectiveness would be achieved.

Transitioning to organized care delivery systems, improved ethical standards of ‘informed choice’, and performance incentives would help achieve the goal of improved quality of care.

Americans would maintain rights to choose providers and to purchase supplemental insurance. In fact, choice would improve because all doctors and hospitals would be ‘participating providers’. Thus, the goal of provider choice would be achieved.

REMEMBER: WITH MEDICARE FOR ALL, EVERYONE WOULD HAVE PRIMARY HEALTH INSURANCE VIA MEDICARE. THERE WOULD BE NO LOSS OF CHOICE FOR MEDICAL PROVIDER, HOSPITAL, TREATMENT, OR SECONDARY HEALTH INSURANCE CARRIER.

The multi-payer hybrid health insurance compromises (being considered in Congress) have potential for decreasing costs in comparison with the current multi-payer private insurance system because the public entities will have lower administrative costs. This may also incentivize private entities to decrease these costs to remain competitive. However, neither multi-payer system reaps all of the substantial economic rewards of a single-payer system.

Medicare for all is therefore a win-win solution for all parties except insurance companies. Insurance companies would surely oppose such reform but that is not a reason to preclude doing what is right. Of course, during a transition to Medicare for All, insurance company employees should be provided assistance in transferring employment to Medicare, temporary unemployment insurance, and retraining. Insurance companies should be allowed to bid for contracts to administer Medicare insurance.

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