single-payer

We are developing a discussion as to how to improve the US Health system. This discussion is motivated by the recognition that the cost Health care is increasing while it is still not structured so that some people are able to get it provided to them in a cost, and results benefit way. (The poorer and un-insured are able to get their treatment through the emergency system but only after their health has degraded and only via facility that was poorly designed and funded to treat normal medical problems)

The "Liveright" plan is a limited, base level, single payer system as follows:

1. Full coverage -- Everyone would be covered from Cradle to Grave, funded from general taxes.
2. Cost/Benefit -- The system would cover 100% of all reasonably "cost effective treatments", e.g. those that we, though our representatives, were willing to pay for. Any treatment would have a Cost/Benefit number associated with it which would represent the "cost of the treatment" divided by the "expected live or life extension" times the percent of live quality improvement",
   
3. Optional treatments -- A treatment that was not Cost/Benefit justified might be partially covered up to the plan certified number. e.g. if the plan covered treatments up to $500/quality-year-extension, then an individual might choose to be treated for some more costly situation. If the cost of the most expensive procedure was estimated at $1000/quality-year-extension, then perhaps the plan would cover 50% of the cost, with the patient covering the other 50%.
4. Optional providers -- The plan would pay for a standard provider for each treatment so that a patient could get treated for an essential service at not additional cost in his locality. -- If the patient wanted to get treated less expensively, by going to a more efficient doctor or location, including a foreign country, then any money he "saved" could be split with 50% of the savings being invested into a personal health savings plan. On the other hand if a patient preferred to be treated in a luxury manor and pay more than the standard, the base cost would be paid for and the excess would be paid for by the patient.

This plan would be paid for by general funds and tend to replace Medicare, Federal tax breaks on employer insurance, Emergency room subsidies, etc.

The Federal Government would be the payer of first resort and any un-paid balance would be passed through to the individuals "gap" insurer or back to the individual.

The plan is meant to provide Universal coverage of the treatments that we, as a society feel are cost effective while also allowing the patient, doctor, insurance companies, etc. to be involved in the cost of these treatments, thus allowing the free enterprise system to be effective in keeping down the costs while paying for the services and permitting the people who feel that they want to get better treatment to augment the system.

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Note: most of the proposals to improve the system are usually a partial mixture of the following:

1. No change -- Things are OK, or at least as good as any other system.
2. Free Enterprise -- Reduce state, and perhaps federal regulation so that people can purchase the care that they want without having the government limiting their choices.
3. Tort limits -- Cap and discourage the amount that can be recovered via tort law, e.g. Malpractice suits, etc. so that the cost to the providers is lower.
4. Single Payer -- provide a low profit, often the Government, who will offer, and perhaps require that all people can get a level of health insurance/care. (Medicare as an example)
   
5. Single Provider -- provide a single health system managed for the benefit of the patients and available to all. This could either be like the Vets hospitals or perhaps like Keiser.

Links:

• Why modest reform is preferable to single-payer health care. Slate: Michael Kinsley
• Single Payer Health Insturance debate WSJ Econoblog: Mark Thoma and Andrew Samwick
• Quality and Satisfacton of health care The Washington Monthly
• Asymmetric Info, Healthcare objectives and plan (March 26, 2006)