Monday, February 23, 2009

Best Healthcare Plan I've seen

This is the plan, as created by Ezekiel Emanuel and Victor Fuchs.

It's called the Guaranteed Healthcare Access Plan, and it is single payor, but to my knowledge is vastly different than other plans in existence.

It will guarantee coverage to EVERY american citizen. Here's a snippet from Emanuel's book.

Benefits and Coverage

1. Guaranteed Coverage
Each American household will receive a healthcare certificate for coverage through a qualified health plan or insurance company. The certificate will NOT be a "cash card" to buy healthcare services; rather, it is an insurance voucher entitling the individual or family to enrollment in a healthplan of their choice.

2. Standard Benefits
Standard Benefits will be generous, modeled on services currently recieved by members of Congress. Benefits include office and home visits, hospitalization, preventive screening tests, prescription drugs, some dental care, inpatient and outpatient mental-health care, and physical and occupational therapy. Patients can choose their own physicians and hospitals.

3. Freedom of Choice
With the healthcare certificate, Americans will be able to choose from among several health plans. Plans will be required to accept any enrollee without exclusions for preexisting conditions and with guaranteed renewability each year.

4. Freedome to Purchase Additional Services
Americans can use their money to buy additional services and amenities, including a wider selection of physicians, additional mental-health benefits, coverage of complementary medicines, and "concierge medicine." Such purchases will be made with after tax dollars.

5. Elimination of Employer-Based Insurance
The current 200 billion dollar tax exemption for employer-based health insurance will be eliminated. Employers will stop offering health insurance, and worker's wages will rise accordingly.

6. Phasing Out of Medicare, Medicaid, and SCHIP
No one recieving benefits from Medicare, Medicaid, SCHIP, or other government programs will be forced out, but there will be no new enrollees. Current enrollees will have the option of joining the Guaranteed Healthcare Access Plan. Over a period of about fifteen years, these programs will be phased out.

7. Independent Oversight
Modeled on the Federal Reserve System, a National Health Board and twelve Regional Health Boards will be created to oversee the healthcare system. Supported by dedicated funding, the Boards will be independent of annual congressional appropriations, and insulated from political and special interest lobbying.

8. Patient Safety and Dispute Resolution
Each of the twelve Regional Health Boards will create a Center for Patient Safety and Dispute Resolution to receive and evaluate claims of injury by patients, compensate patients injured by medical error, and discipline or disqualify from practice those physicians found to be repeatedly injuring patients. Funded by a dedicated revenue, these regional Centers will develop, and finance the implementation of interventions proven to enhance patient safety.

9. Cost and Quality Control
Funded through a dedicated tax, an Institute for Technology and Outcomes Assessment will assess the effectiveness and cost of new drugs, medical devices, diagnostic tests, and other interventions. It will also assess and publish the clinical outcomes of patients in different health plans.

10. Dedicated Funding
Initially, the healthcare certificates will be funded by a dedicated VAT of 10% on purchases of goods and services. Revenue from the tax can not be diverted to other uses such as the military or Social Security. No other tax revenue will be used to pay for the Guaranteed Healthcare Access Plan. Congress has the power to increase the VAT rate."



FutureDoc said...

So all of this great stuff will only cost us an additional 10% sales tax on anything and everything?

cynic said...

Ahh hell, whats another $ 20,000 my kids don't need to go to college.

Anonymous said...

Don't worry cynic: a college education is as much a right as free healthcare! you're kids will get a mediocre, liberal arts education and a shiny new healthcare card in their wallets!

single payer systems will only lead to crappy healthcare for all, long lines for the CT scanner, and lower wages for providers.

If you notice that whenever the powers-that-be talk healthcare reform they never mention what will happen to our paychecks...

Before you blast me for "only caring about myself and not giving a rat's @$$ about my patients" my children need a place to sleep tonight and some food to eat. after I pay my student loans that is just about all I can afford...

Anonymous said...

if this healthcare reform passes into a socialized universal healthcare like Obama wants he better socialize medical school, and offer every medical student, resident, fellow, and physician out there a complete repayment of all of their school loans (undergrad, grad, etc). The may help to make up for the huge decrease in money we will be making after the reform. He will have to be sure that some incentive still exist for intelligent able bodied men and women to want to work there ass off and surrender much of their young life for their future as physicians. Otherwise we will have an even greater physician shortage than what is currently projected and the quality of physicians will go down immensely.

as the veteran physician said at my white coat ceremony. "it is obvious we do not go into this profession for money as we are all bright people who could make a fortune much quicker in the world of business and retire early. It is not to say that being a physician does not have its financial pay offs after the many years of hard work. However, that financial pay off is very long down the road. A physician must want to help others above anything else."
I agree with his words, but as he said we could make more money elsewhere currently, if the reform occurs this will be even more true. That will lead many from medicine as paying back school loans and the interest that accumulates over the long years of school, residency, etc. makes a physician barely able to put a roof over his head.

Anonymous said...

"... and workers wages will rise accordingly."? I don't think so.

MLP said...

I am afraid a single payer system such as this will only make everyone's care mediocre. We cannot have excellent services for all individuals in this country. We ration healthcare b/c there is NOT enough to go around at the level we are used to. If we open it up to everyone we simply will ration the care by time i.e. long waiting list to see our PCP's and even longer for specialists. I am very concerned that there will not be an incentive for physicians to go to all the schooling, residencies, and fellowships if they are not compensated at an appropriate level and with universal health care a deduction in pay is almost certain, is it not?

Toni Brayer MD said...

I like the ideas in the post and I am getting sick of the scare tactics of "universal socialized medicine" whenever creative solutions are offered.

Universal coverage does not point to mediocre care. In fact, other Countries achieve coverage and have better outcomes so that argument is just plain wrong.

My concern is that this gets everyone coverage but doesn't address anything else in our broken system. We don't have enough primary care. We have perverse incentives to do more and more,even without science to measure outcomes. We cannot give "free" care without some way to control costs. We have incredible waste that is not addressed.

I would like to see some financial modeling. I'd gladly pay 10% sales tax to get universal coverage and good medical care. It would be far cheaper than the insurance I now pay for. Without other reform, however, I don't see how this is possible,

physasst said...

Agreed, one of my focus areas in health policy is access to care, and primarily, access to primary care. However, to do this, we need to not only overhaul current CMS reimbursements, but we need to think outside of the box, and perhaps utilize midlevels, at least in primary care, to a degree that has not been done before.

Nurse Practitioners Save Lives said...

I would like to see the term "health care provider" so that it includes NPs and PAs as primary providers. We are already filling the role.