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I'm certainly not going to complain that the healthcare bill passed. I have many friends who were denied coverage for minor pre-existing conditions. The bill will correct many of the bullying excesses of the insurance industry.
However, I'm hoping people see it the bill for what it is -- a philosophical transition to the idea of universal healthcare that does not address the big fundamental problems in how healthcare is practiced.
Currently, 16% of our GDP is going to healthcare, and that amount is rising fast. Now that the government will be picking up much of the tab for this, they are in a unique position to make these costs go down while keeping their people healthy. The government gains money when people stay alive, healthy, and productive. So they should protect their investment.
Here's the big problem: The health care industry is composed of various groups, none of which have the goal of keeping people healthy as their core motivation:
- Insurance companies want to minimize how much they pay for patients' care.
- Drug companies want to sell as many expensive drugs as possible. (For them, a cheap cure is a bad thing... an expensive treatment that is not a cure is a good thing.
- Hospitals want to bill for lots of procedures and avoid getting sued.
- Patients want to eat what they want and watch TV, and have everything taken care of when they get sick.
Here are some follow-on things the US govt should do to improve the healthcare system:
- Start a series of prizes for various cures and advances in medicine. Suppose they offer $5 billion for a cure for HIV that costs less than $X per patient, or an intravenous glucose control system for less than $Y etc. At the end the government would own the patents and technology of the winning team. Writing the prize rules will be tricky, but the result is that drug companies and other researchers will look to lower instead of raise costs for healthcare.
- Allow full health insurance portability to encourage people to keep the same insurance plan for life. Right now insurance companies are not motivated to invest in people's long-term health because they frequently switch jobs and thus insurance companies. Any upfront investment for long term benefit, such as genetic testing, doesn't usually pay off for them. By having lifetime plans, insurance companies will be encouraged to invest in their people's health in a proactive fashion. This allows for another of my favorite ideas:
- Patient incentives for preventative care. People who exercise daily and eat healthy diets should get tax breaks. There are a variety of ways of tracking progress (eg lung capacity, hemoglobin levels etc). Incentives would be relative so as to make sure everyone has motivation for improvement.
- End patents on genes. It's stupid that you can patent a gene without knowing what it does.
- End corn subsidies. It's also stupid that we subsidize the production of corn syrup, which will ultimately cost the government billions. We should be taxing unhealthy foods, not subsidizing them.
- Let health plans cover over-the-counter drugs. Sometimes people skip buying an over the counter drug because they can get an (in some cases) identical prescription drug for free (even though it's extremely expensive) because their health plan covers it. The copay system should provide proper incentives for patients to choose the treatments that are cheaper to the overall group.
- Create the equivalent of a "driver's test" for prescription drugs. If you prove decent knowledge of chemistry, statistics, math, and biology, you should be able to prescribe some common drugs for yourself alone. Quantities would be strictly regulated to ensure people aren't acting as dealers or hypochondriacs. There would also be some drugs excluded from this category for being too dangerous, too addictive, or too damaging to the commons (eg antibiotics) This would dramatically reduce doctor visits, as many times people are going in just to get a prescription refilled.
- Dramatically shorten the FDA approval process. Paradoxically, by having the FDA approval process be so long and expensive (up to $1billion and 10 years), drug companies are more likely to try to manipulate the system (eg cheating on trials, marketing the hell out of their products, proposing them for less appropriate uses) because the fate of their company is riding on a han dful of drugs getting approved. If we had a system where drugs tthat would be sold to a more limited audience (say, < 100,000 people a year) were approved faster, then drug companies would be more likely to take risks in exploring new avenues of research.
However, I'm hoping people see it the bill for what it is -- a philosophical transition to the idea of universal healthcare that does not address the big fundamental problems in how healthcare is practiced.
Currently, 16% of our GDP is going to healthcare, and that amount is rising fast. Now that the government will be picking up much of the tab for this, they are in a unique position to make these costs go down while keeping their people healthy. The government gains money when people stay alive, healthy, and productive. So they should protect their investment.
Here's the big problem: The health care industry is composed of various groups, none of which have the goal of keeping people healthy as their core motivation:
- Insurance companies want to minimize how much they pay for patients' care.
- Drug companies want to sell as many expensive drugs as possible. (For them, a cheap cure is a bad thing... an expensive treatment that is not a cure is a good thing.
- Hospitals want to bill for lots of procedures and avoid getting sued.
- Patients want to eat what they want and watch TV, and have everything taken care of when they get sick.
Here are some follow-on things the US govt should do to improve the healthcare system:
- Start a series of prizes for various cures and advances in medicine. Suppose they offer $5 billion for a cure for HIV that costs less than $X per patient, or an intravenous glucose control system for less than $Y etc. At the end the government would own the patents and technology of the winning team. Writing the prize rules will be tricky, but the result is that drug companies and other researchers will look to lower instead of raise costs for healthcare.
- Allow full health insurance portability to encourage people to keep the same insurance plan for life. Right now insurance companies are not motivated to invest in people's long-term health because they frequently switch jobs and thus insurance companies. Any upfront investment for long term benefit, such as genetic testing, doesn't usually pay off for them. By having lifetime plans, insurance companies will be encouraged to invest in their people's health in a proactive fashion. This allows for another of my favorite ideas:
- Patient incentives for preventative care. People who exercise daily and eat healthy diets should get tax breaks. There are a variety of ways of tracking progress (eg lung capacity, hemoglobin levels etc). Incentives would be relative so as to make sure everyone has motivation for improvement.
- End patents on genes. It's stupid that you can patent a gene without knowing what it does.
- End corn subsidies. It's also stupid that we subsidize the production of corn syrup, which will ultimately cost the government billions. We should be taxing unhealthy foods, not subsidizing them.
- Let health plans cover over-the-counter drugs. Sometimes people skip buying an over the counter drug because they can get an (in some cases) identical prescription drug for free (even though it's extremely expensive) because their health plan covers it. The copay system should provide proper incentives for patients to choose the treatments that are cheaper to the overall group.
- Create the equivalent of a "driver's test" for prescription drugs. If you prove decent knowledge of chemistry, statistics, math, and biology, you should be able to prescribe some common drugs for yourself alone. Quantities would be strictly regulated to ensure people aren't acting as dealers or hypochondriacs. There would also be some drugs excluded from this category for being too dangerous, too addictive, or too damaging to the commons (eg antibiotics) This would dramatically reduce doctor visits, as many times people are going in just to get a prescription refilled.
- Dramatically shorten the FDA approval process. Paradoxically, by having the FDA approval process be so long and expensive (up to $1billion and 10 years), drug companies are more likely to try to manipulate the system (eg cheating on trials, marketing the hell out of their products, proposing them for less appropriate uses) because the fate of their company is riding on a han dful of drugs getting approved. If we had a system where drugs tthat would be sold to a more limited audience (say, < 100,000 people a year) were approved faster, then drug companies would be more likely to take risks in exploring new avenues of research.
