Medical? Or Medicare? Are you using California's sytems as an example? They do everything else weirdly, why not Medicare...
Overhaul is the name of the game. Obviously with the expansion of Medicare comes a fearless audit of the whole system. I understand the VA system is something of a model system. Why not start there?
I said Medicare as you had asked what I thought of expanding is asn has been floated. Medical would be far worse.
The VA is not much of an example as it is not required to live within it's means AND deliver top flight care. And while it has made strides bringing itself up to date, it has work to do.
If you want a high level game plan...
1. Eliminate fraud (to a reasonable extent) in the MEDI's by addressing their systemic flaws.
2. Address defensive medicine. This covers a lot of areas and will not easily be done as its become systemic in how doctors are educated. Effective tort reform is a start but not a finish. That will eliminate the need for docs to follow protocols spelled out by malpractice insurance company lawyers. There wil be massive resistance from the providers of medical testing who have come to enjoy all those needless tests or rather the revenue they generate. Since the docs get kickbacks from them them wont love the idea either. And as I pointed out, med schools shifted education opn diagnosing from the doc putting 2 and 2 together on observable date he sees to protocols of tests that are intended to confirm. I remember my old family doc who would take a look at you and prescribe your cure, 99% of the times without need of specialists or further testing. AND in one office visit. Now it takes my wife's FP guy 2-4 visits and as often as not kicking it to a specialist.
3. Address Rx. To be honest I do not have a plan for this. We have to protect the researchers rights for taking the risk to develop new meds (thats an expensive process) but at the same time find a way to manage the costs. I have some background in pharma but not enough to know the crux of the problem. I am not for going soft on validation of new drugs but there has to be a better way.
Take care of these things and you will be well down the path.
Fotr those who think paperwork is the problem, what you do not know is that most insureres adopted the Medicare model in the 80s. This also allowed providers to game the system as they continue to do with Medicare today but that was fixed in private insurance years ago. There is no reason you could not do this again AFTER you fix MeEdicare/Medicaid. The information is 99% the same and already defined in EDI standards and others developed by the private insurance concerns.
One other thing I would like to see and is part, in concept, of the insurance mart portion of the current legislation is to steer away from the current notion of group coverage. The ins cos set policy costs based on history and acturarial research for the pool of clients in a given grtoup. Then they balance this risk (that a group might in any given year have a far worse actual) by doing thi separately group to group. And further by antoher process that further spreads this across companies.
Sorry for the long setup.
I'd like to see a "group" that is not a group under the current definition that could still gain the benefit of that group concept that "just anybody" could buy coverage through. This is sort of available today but the economies are not the same and ther eis no real reason they cannot be. This is a nice stepping off point to transition away from employer based insurance.
The plusses: employers would love to get out of this; by not having to switch when you change jobs no more pre-existing problem; its a little scary for ins cos but they'll soon see the advantage.
The minuses: its a little uncomfortable to ins cos but in the end it erwally doesn't hurt them and it opens up unlimited potential to grow their client base that is always a plus to that kind of business.
Thats enough for now, everything else is small potatoes.
