Sunday, April 24, 2016

My Vague Ideas about Healthcare

Principles this is based upon:
1. Subsidies increase prices
2. Providers respond to government payments by shifting services to those that pay more
3. More ideas tried by more entities creates more opportunities for success
4. Government is essential, but should do only what cannot be accomplished by private parties and should accomplish it at the lowest level, with the minimum amount of coercion
5. Plans never accomplish just what they set out to do
6. Any plan will be manipulated by the powerful to their own ends and to the detriment of the public, hence, less power and money reduces incentives for corruption

Things to eliminate:
1. Obamacare and associated taxes
2. Medicare and associated taxes
3. Medicaid - funding shifted to states as block grants for indigent health care - no strings except it must be for indigent health care
4. HHS except as research and advisory role
5. Drug war - at least 25% of savings shifted to states for mental health and addiction treatment
6. All fed restrictions on cross state health insurance

Things to implement:
1. States control what they want to do on health care.  VT is trying single payer, MA mandatory insurance, others may decide to provide free basic health care with catastrophic insurance coverage, others may put the onus on employers.  Who knows, let's take the fetters off and see what works.
2. Streamline FDA drug approval and allow patients and doctors access to experimental treatments, particularly for debilitating or fatal diseases
3. Reduce restrictions on who can provide medical treatment, allowing common sense efforts by states to increase access to more affordable avenues for care such as nurses, alternate practitioners, medical assistance etc.  Ideally one's doctor would provide guidance, but wouldn't necessarily have to be involved in treatment.  This one's a bit fuzzy, but the idea is that medical licensing has become more about protecting the current players from competition and less about protecting patients.
4. Separate health care from health insurance.  Things that everybody needs or should want, are not what insurance is for.  Insurance is about shared risk.  Insurance is for cancer, accidents, etc.  Both need attention, but conflating them has only fucked things up.  States need plans for insurance, and plans for health care, and they are different things.

Bottom line is that the ONE BIG FEDERAL PLAN idea is simply stupid.  It's too big, too subject to abuse, too expensive and stifles any attempts at real innovation.  Cut the restrictions, eliminate federal incentives that drive up costs, and let people get to work finding solutions.  Government involvement equals political involvement.  The higher the government level, the more politics.  Corporations love BIG federal plans because they only have to corrupt one level of government.

Will this solve everything?  Of course not.  Is every idea in here the best idea, probably not.  But putting things in the hands of the President, Congress and Federal bureaucracies only makes a big problem worse.  

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