I have written about the Public Option which probably will never be implemented. That leaves two options; the first being the Regional Cooperatives and the other Single Payer mandatory insurance. If what follows is incoherent, that is because the whole $##&^^ process is at present.
The Regional Cooperative Plan creates an area or "regional agency" to which all health care providers must belong. The German model which Uwe Reinhardt promotes=see my post of a year ago
http://dpotpourri.blogspot.com/2008/08/reinhardt-and-german-health-care.html is the best example of that concept.
The Regional unit negotiates a reimbursement schedule with the areas providers as a group, IE: the area physicians association, the area hospitals etc. It is a take it or not participate situation.
There are separate means for covering the employed, those who have lost their job and those who have never been employed. Individuals whose income is above a certain level must purchase private insurance. The Cooperative pays the provider according the negotiate rates. Private insurers reimburse for their policy holders. again at a negotiated but higher rate.
Funding for "workers: is from deduction from their pay that amounts to with some slight variations by cooperative of approximately 14% of their wages; half of which is contributed by the employer. That would make the actual cost about 7%. The never employed are funded by a tax derived special fund. Another fund is in place for those who are temporarily unemployed.
In the German plan the primary physician does not treat patients in the hospital. Likewise except for certain specialties the hospital physician doesn't see the patient after discharge. This practice makes the patient a "case" not a person.
There will be variations of this plan from region to region.
The other alternative is the universal federal run health care system ,or single payer. Medicare is used as the example. It is said to be cost effective, but that is at the expense of mandated reimbursements to providers that have in effect decreased in "purchasing value dollars" over the years. The savings achieved by the plan bu this advantage has been lost in a greater degree by not preventing abuses in the system.
The net result is that in the past few years many physicians are opting out of Medicare and offering various forms of what is called "concierge practices". Although they do not participate in any insurance plans this seems to be a popular and profitable enterprise at the same time offering a return to the Saturday Evening Post "Family Doctor". The patients who can afford the service are ecstatic.
During the Presidential election campaign McCain said about 'Universal Health Care" : 'We will replace the inefficiency, irrationality, and uncontrolled costs of the current system with the inefficiency, irrationality, and uncontrolled costs of a government monopoly. We’ll have all the problems, and more, of private health care — rigid rules, long waits, and lack of choices, and risk degrading its great strengths and advantages including the innovation and life-saving technology that make American medicine the most advanced in the world."
Unfortunately despite the plaudits of the social reformers that statement will be 100% accurate.
Next post I will continue on this subject with some personal comments which I hope may produce some rational discussion and/or implementation.
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