** This post originally appeared on TuDiabetes.org on August 14, 2009. Re-reading it and applying some of the things that I’ve learned in the last three years really hasn’t changed my opinion much
I believe that the health insurance issues are just a symptom and while I want the following to happen, I can almost guarantee that none of it ever will. If it is not currently unconstitutional, these items will totally destroy the current power-base held by our elected officials and long-term bureaucrats. Thus, the never happen part. They are listed in no particular order of relative importance
And before we get started, I want to state up front that momma always said I wasn’t the brightest crayon in the box and momma’s always right.
Let’s get started…
1. Tort reform – Eliminate huge punitive awards. This will lessen the costs of malpractice insurance and lessen the usage of “defensive medicine”. One of the reasons there are less doctors today is that malpractice insurance consumes a huge amount of a doctor’s revenue; they can earn a better living doing something else. “Defensive medicine” refers to the practice of a doctor running every test under the sun to protect them in case of a malpractice suit. Malpractice awards include all medical costs and other actual costs, such as loss of income. Perhaps the max punitive award should be some fixed percentage of that. In egregious cases, the courts should be able to recommend loss of license to practice or, in the case of a company, banning from that market.
2. Public Medical Malpractice database – It is currently nearly impossible to for an individual to discover the medical history of his doctor and/or hospital. This needs to be eliminated so patients can make informed decisions on their healthcare providers and to ensure that doctors are properly disciplined for continued issues. It is currently possible that a doctor can loose his license in one state, yet move to another state and start practicing again. Again, this will lessen the number malpractice incidents. The AMA wants tort reform; this is what is needed to justify that.
3. Congressional Reform – This one has a couple of parts
a. All donations (hard/soft money) go in to the coffers of the Federal Election Commission (FEC). This will eliminate lobbyists from being able to “buy” a vote. If you want a vote, you’re gonna have to convince them, not buy them. Monies will be apportioned to all candidates similarly to how seats are apportioned in the House
b. All candidates for federal office MUST use FEC funds and may not privately fund their election. This will have the effect of no longer allowing federal elected offices to be “won” by the person with the most money. Candidates will have to do something more than just buy all the “face-time” they can get, ie talk to their constituents
4. Eliminate the IRS and payroll taxes and replace them with a National Sales Tax – Most people view the payroll taxes taken now as the “government’s money” and not theirs since they never ever see it. A National Sales Tax will bring to everyone’s attention how much we are taxed and increase accountability by having the money taken from us right in front of our eyes. This will help eliminate waste and pork and will eventually shrink the size of government. Medical expenses, food, basic clothing (i.e. not the $6k dinner gown) will NOT be taxed. Period. Therefore, the folks who have to spend a good deal of their income on the basics will not be punished by taxation just for living and the “this will unfairly burden the poor” argument is eliminated. But cigarettes should be taxed and honestly, if they are really that dangerous, they should be banned IMO. If you want to know how much the health of it’s citizens means to government, look at how much tax revenue is generated from tobacco.
5. Legislative reform – Only ONE issue may be addressed in a single bill. The Defense Budget can contain everything related to national defense however may not contain funding for non-related issues, such as the infamous “bridge to nowhere”.
6. Unfunded Mandates – The Federal Government may not require the individual States to comply with mandates unless they provide funding for those mandates. Similarly, they may not withhold funding to states that do not comply with federal mandates.
7. Pharma – The government must be allowed to negotiate the lowest price with pharma manufacturers. This price negotiated will be the highest price that the product maybe sold for in the United States. Currently, other nations will tell a company that you can only sell this medication here for x-amount. If that price cuts into margins too much, the company attempts to recoup those losses with higher prices elsewhere. Often the US will basically subsidize many other nations’ medications. Gov’t negotiated pricing should also include information on actual costs to manufacture so markups can be reasonable. Oh, and no more commercials. It will become a felony for any licensed professional not to disclose any monies that exchanges hands (hard/soft) and this information will be in a publically available database. This includes the funding of studies.
8. Wall Street Commodities Trading – I believe that speculators on oil drove the huge surge in energy costs seen in 2008, which in-turn drove consumer prices up, which in turn contributed to people defaulting on those mortgages. If you want to buy a 60-day future, you are going to have to hold it the entire 60-days before you can sell it. Let’s see how that calms things down.
9.Insurance – Admit that insurance companies exist to make money not pay for treatments. A single payer system, perhaps similar to the one in France where costs are regulated, not the providers you can choose, may be much more acceptable in the US than some of the other types of programs. Certain industries are so critical to our society that they need regulation. Energy was deregulated and we ended up with California having a huge energy crisis a few years back. Deregulation of the banking/insurance industry in the mid-90′s contributed heavily to the recent financial fiascos on Wall Street. Being able to afford the healthcare you need falls into that category and it is obvious that the current system does not fulfill these needs. I would want the government to negotiate the prices for drugs, tests, treatments, etc. But allow the patient to select their doctor and the treatments that are appropriate for them and not interfere in those decisions. Basically use the power of the availability of a market of 300 million people. All this paid for out of that National Sales Tax
10. FDA – Speed up approval processes. Use the information that other countries have used if they have approved/denied/considering it. Don’t spend years to re-invent the wheel. The FDA Commissioner may no longer over-ride the ruling of the commission that does the approval/denial study. It will become a felony for any licensed professional not to disclose any monies that exchanges hands (hard/soft). All FDA approved clinical studies will be in the public domain and available for review in a public database