Thursday, August 18, 2011

How to fix America's healthcare system - without nationalizing it.

I'm writing this from my phone to see if the additional annoyance helps me to keep this short. :o)

One of the biggest problems with healthcare in the US is that doctors get paid according to how many procedures and tests they do. This is not the case in countries with national healthcare systems. There, doctors are salaried, like regular workers instead of like lawyers or contractors

I'd argue that this can be done with private insurers, too. Why not pay doctors a set amount for seeing a patient, plus covering 99% of costs arising from additional procedures, plus a bonus for a good outcome?
Good doctors might be willing to switch to such a plan. Indeed, some already have: Kaiser Permanente uses a similar system. Let's try some pilot projects on a more national level. If it works, maybe we can scale it up, requiring insurers and doctors to do it. This would go some way towards cutting down on unnecessary procedures.

I envision doctors getting bonuses according to outcomes AND patient ratings! Insurance companies would set pay amounts in collective bargaining with doctors on their plans. Cheaper plans would attract fewer doctors, but patients would pay less and be ensured good care, in no small part because they get to rate their doctors' performance and this determines a portion of doctors' pay!

A couple more steps would be needed, too. Legislation to protect doctors and hospitals from unreasonable lawsuits would be good. Another step would be to move people off plans provided by employers. This would keep people covered between jobs, encourage them to shop around for the best rates, and make sure they know what it all costs, getting consumers more control over cost-cutting decisions.

These three things combined would help a lot. Other countries pay a fraction of what the US does for healthcare, but for equal and sometimes even better outcomes. Something's gotta change, because that's just not right.

I'm pondering education, too, but this seems tougher. Any good ideas?


Charles Kirchofer said...

Worked like a charm! Concise and to-the-point! I think I'll have to start doing that with all of them. Compare this post to the one after it! What a doozie!

Charles Kirchofer said...

Ah, and a further comment: just imagine easy access to patient ratings of doctors, much in the way that has revolutionized shopping. More power to patients to choose good care and control costs themselves, fewer incentives for doctors to jack up prices (which admittedly often happens because they're afraid of getting sued, which is why I included the part about tort reform).