NC Universal Health Care
A Raleigh emergency room physician wrote a column in the News and Observer today that covers a topic I’ve been planning to write about as well: Health care reform. Here’s my version, outlined in a series of principles and action steps.
Principle: Basic health care is a basic right for every human being.
Action: The General Assembly should pass an amendment to the NC Constitution that puts health care on par with public education as a right for all North Carolina citizens.Principle: Our national government is broken and incapable of taking the bold, imaginative steps required:
Action: North Carolina should lead the nation in a new approach to providing health care services to all.Principle: Scale is essential for
costrisk-sharing.
Action: North Carolina should contract with a SINGLE PAYOR to administer healthcare payments to every citizen. No one would be allowed to opt-out of the program.Principle: Profiteering is antithetical to a basic health care system.
Action: The state should issue a Request for Proposals from insurers to manage the system, and award that contract starting in 2010. For-profit companies would not be eligible. Executive compensation in the payor organization would be governed by contract.
Principle: Employers should have no role in the provision of health services.
Action: Implement a new payroll tax to fund North Carolina’s Universal (NCU) Health Care Program.From the N&O column:
Before you reject this, think about it for a second. For most people, such a tax need not result in any loss in take-home pay. A payroll deduction eliminates the need for employers to withhold salary dollars to pay insurance premiums -- money that should (by law if necessary) immediately flow through to workers to offset any new levy. For people who earn too little, refundable tax credits would reduce the burden. For higher earners, the payroll tax could be phased out above a certain level (as with Social Security), or these individuals could opt out with proof of private insurance.
Principle: Individual responsibility is important.
Action: Build incentives into the system that discourage reliance on costly services (ER visits) and encourage wellness and prevention.Principle: We must reduce costs associated with end-of-life care.
Action: “Premium” payments for individuals who do not have certified Living Wills would be three times those of individuals who do have Living Wills.Principle: This is America
Action: Private insurers would be free to operate and anyone who wants to pay more for private insurance could do so, though they could not opt out of NCU.Principle: Transitions are messy
Action: Recognize that it will take several years to phase in a dramatic change like this. Anticipate risks by initiating pilot programs in selected counties.
What am I missing?
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A closing tag on your < strong > or < b >
:)
Yes, I'm a smartass. It's what I do best.
The last is probably one of the best and most forgotten. Transitions are messy. Most people have a fear of the unknown and will stick with a crappy program simply because they know how that crappy program works. Pilot programs are an excellent idea.
Robin Hayes lied. Nobody died, but thousands of folks lost their jobs.
Thank you dear.
:)
Any time sweetie
Nice post
Robin Hayes lied. Nobody died, but thousands of folks lost their jobs.
What Are You Missing?
Will it be better than that Tricare crap I have and can I switch?
If you don't say, 'Yes', then well ....
I have a horse ....
would you like to ride it? ;)
Yes and yes
In fact, you'd be required to switch. Tricare would almost certainly go out of business in North Carolina.
You'd have a card that would certify you as a North Carolina citizen, and you could go anywhere you wanted for care, except to those providers who don't participate. Most would, however, because it would dramatically simplify their lives and cut down all the cat-and-mouse BS that goes on right now. Some high-end, exclusive docs might not join.
There would have to be an oversight board, similar to the Board of Governors for UNC perhaps, that sets policy and payments. This is already done in many arenas. For example, the Public Utilities Commission and the Insurance Commissioner operate in roles that could be models for this.
With "Health Care for All"
there is no plan, after we win the fight of getting universal health care as a "right", then we have to fight to see what that means. I would bet that federal programs will not go away (Tricare, medicare), but that we would dissolve s-chip and medicaid into one new state-based health care program.
John Edwards is great!
- Sam Spencer, BlueNC, 7/3/07
TRICARE
I want out.
No dental, no optical, 20% co-pay, limited, limited, limited.
You might as well roll over and die if you don't have the cash to meet your cost share.
My son and I would be better off without it because Medicaid would cover us better.
That sucks! What happens when I have a decent job?
grrr......don't get me started so early in the morning. (oops - it's not morning anymore...)
But I like my Tricare!
Now that I'm 65. It acts as a Medicare supplement. I still have to pay my own dental & optical, but it's cheaper than a Medicare supplement policy.
You're right, of course, when it was all the health care I had, I just had to try not to get sick. And the answer to this question:
is Tricare pays secondary to any employer provided policy, so it picks up your deductibles & co-pays, so that would be a good thing. Tricare really sucks if it's the only insurance you have, and the catch-22 that you're in is even worse. We certainly need something better than the patchwork we have now for health care coverage - just figuring out what's covered could be a full-time job.
From the hodge podge of scenarios I've seen analyzed
a pool with the scale of all North Carolinians . . . and greatly reduced general administrative and marketing costs . . . would be significantly less expensive per person than any systems currently operating. I wish I had saved all the bookmarks for the studies I've seen . . .
: (
Yes - Tricare is Always Secondary
What used to piss me off royally is my STB ex had better coverage than I did because of his Medicare -
and he was NEVER a vet. The ******* never even voted in his entire freakin' life.
Try being a retired disabled vet with a young child and shitty coverage like I have with Tricare.
It's BRUTAL.
It sucks.
n/t
Chapel Hillians can meet to discuss universal health care.
Will have a chance to meet and discuss this at a showing of Sicko. I'm still working out the details, but I'm hoping for a mass gathering of progressives and moderates interested in universal health care to meet at the Varsity theater to watch the movie, then head out afterwards for a drink or dessert to discuss what can be done here in North Carolina. I'm trying to get the groups that I am working with are Health Care for All NC, OC Democratic Party, and One Corps.
Shoot me an email if you are interested.
John Edwards is great!
- Sam Spencer, BlueNC, 7/3/07
I'm interested.
Let's do it sooner than later.
A
PS I forgot to add: I know this is your domain and my perspective is pretty limited to being either a patient or an employer. Just trying to keep the ball moving.
My goal...
is for everyone to be posting a diary about universal health care. Then we'll know we have the momentum.
As for "A Night out with Sicko" or "A Night on the Town with Sicko", we are shooting for next weekend. It is all pretty last minute. Right now my major stumbling block is getting in touch with the owner of the Varsity/Chelsea to discuss it.
John Edwards is great!
- Sam Spencer, BlueNC, 7/3/07
i am also interested
Just tell me when and I will show up. I haven't seen the film yet and was waiting for a good time to go. In the mean time I will be doing the animated film circuit with my little boy.
My complaints about health care are few - i have good coverage, like my doctor, the kid is healthy. Still, my husband pays for this from his small business, and it does not come cheap. I know there are plenty of people out there going without, and I take the idea of the common good very seriously.
I have also lived in places with national health care and seen the difference it makes.
I'll be posting about the event here, Facebook, Change.org
twitter, MySpace, DailyKos, etc.
John Edwards is great!
- Sam Spencer, BlueNC, 7/3/07
seeded this on Newsvine: Carolinas and Calendar groups
Linky:
Some other ones
Principle: Auditing fee-for-service charges increases paperwork. Consider the 250-page Medicare statement for three weeks in a hospital--every aspirin ($10), every X-ray, every bedpan itemized and justified.
Action: Negotiate annual payments with providers on a provider-by-provider basis. Renegotiate each year based on provider service provided, quality of service, and patient satisfaction.
Principle: Scale is not essential for cost-sharing; scale is essential for risk sharing. Big pools are the least-cost way of reducing risk for everyone. Cherry-picking reduces risks only for those who are not cherries. Treatments that require small scale of operation are often more efficient and effective than those that require large scales of operation. For example, why shouldn't there be a hospital and working CAT-scan machinery in every county? Why must folks in rural counties have to travel to Winston-Salem, Chapel Hill, Durham, or Raleigh to get certain types of care?
Action: Include out-of-pocket costs to patients (such as travel and lodging) and not just to the institutions in assessing the economic feasibility of treatments.
Principle: Medical students should not have to bear the entire cost of their medical education.
Action: Reimburse medical personnel with outstanding student loans to pay off their student loans. Reimburse medical personnel whose loans from providers has become golden handcuffs on their ability to form an independent practice. Subsidize medical education for students who remain in North Carolina in return for a promise to work five years in underserved counties of North Carolina.
50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts
Excellent additions
I should have said "risk sharing" . . . that's what I meant. Thanks for the correction.
Absolutely agree with the other two principles too. Driving paperwork out of the system is a top priority for driving cost out of the system.
the small things
That struck me about Sicko was how universal healthcare actually puts the patient forward again rather than the cost. With universal healthcare, HEALTH becomes the focus. In Sicko, Moore interviews a doctor who discusses how he gets bonuses for all the patients who quit smoking, lower their blood pressure, and so on. The doc gets a bonus for improving health, not for decreasing costs (of course, the long term effect the doc's actions have is a lowering of healthcare costs through prevention).
The other simple point Moore makes is that we have many "socialized" programs already, like the police, the public libraries, and the military. For some reason we trust our first responders to be in "socialized" programs, but God forbid our healthcare be the same way.
I think those against universal healthcare (other than those working for the insurance companies) are just scared of a change. We need to let them know that it is not only a choice, but it is the better choice.
For the Majority - yes
But not for the bottom line on the profit margin. Why do you think they fight? With PACs and pens and little red hens....
Can't wait to see it this week.
Another big development is the change in business attitudes. CEO's used to see health benefits as a way to differentiate their companies from competitors. Now it's all just a big cost with almost now upside.
I understand the history of how businesses got into the role of doing insurance in the first place, but it never made any sense to me. It's one of those things that started and continued with no rhyme or reason. I think business is ready to get out of the insurance role . . . and CEOs are increasingly the ones pushing for an alternative approach.
Next all we need is a big insurer to step up and say "You bet. We know there's a better way and we're here to help." A lot of people are cynical that would ever happen, but I'm more of an optimist because, frankly, the writing is on the wall. It's just not very legible yet.
More on health care
and why businesses want and need to get out of the equation - from an insider.
Daily Kos
Risk Pool and Cherry Picking
Insurance is based on large numbers heterogeneous people with variations in life styles and afflictions. Medicare, sucessful despite right wing whining, that all people over 65 are in the risk pool and have been contributing taxes toward it-think premiums.
The insurance people, curses on them and theirs, work to break up the risk pool, making smaller pools, and choosing the healthier ones, cherry picking, selling these well folks lower premium, higher deductibles -- and when they get dread disease, insurers pitch their carcasses out. Needless to say, the insurers leave the poor, chronically ill and end of life patient to the taxpayers' tender mercies.
There must be ONE risk pool with everyone in it!
And, if you allow pilots, the insurance vermin will sneak back into every crevice. Forget incremental change, it
does not work and conveys ambivalence (and such stupidity) that our enemies rejoice. Do the change over in six months! Enough fear and loathing.