Tuesday, July 25, 2017
A REAL Federal Healthcare Bill
I don't usually write posts this close together, but the whole healthcare flap pretty well requires it. Look, I've worked in the healthcare biz, have been a public healthcare recipient, and have friends in curious corners of the biz -- such as professional medical billers, coders, and clerks: the people who really deal with the nuts and bolts of healthcare funding. I'm convinced that these are the folks that the federal govt. should be talking to. But to start:
If Congress simply repealed the ACA/Obamacare bill, federal public healthcare would simply go back to what it was before. That included Medicare, Medicaid, the Veterans' Administration and, if you please, a division of the Bureau of Indian Affairs. The latter two consist of supplying hospitals, clinics, doctors, nurses and treatment to those two groups of citizens -- for free, or close to it. The previous two consist of funneling tax money through the state govts. into health-insurance companies, with certain written limitations. We've all seen repeated scandals about the insufficiency and lousy quality of the VA system, and nobody has asked the Indian tribes what they think, but they've been using the money they're earning through their casinos to fund hospitals of their own. As for Medicaid, it's full of so many traps and pitfalls that social workers warn their clients against it. Medicare is, and was, just plain insufficient; its coverage falls far short, and its paperwork is horrendous -- as any medical clerk can tell you. And all four of them wasted money at an unbelievable rate. Those are the shortcomings that the ACA was supposed to deal with -- and didn't.
I recall that while the ACA was being debated, there were protesters marching around waving signs that said "JUST FIX MEDICARE", and looking back, that made far more sense than anything the fed. govt. has proposed since. Here's how I think the fix could be done.
First, Congress should go, hat in hand, and humbly beg the Government Accountancy Office for another copy of that report it sent to Congress years ago, which was ignored: the report on redundancy, waste, and downright corruption in the federal bureaucracy -- which listed some 1500 govt. departments/offices/bureaus/etc. which should be completely abolished in order to streamline govt. services, save money, and reduce chances of corruption. This time don't ignore that list, but take the GAO's advice and abolish all those departments, every last one of them. Take the money that frees up, and dedicate it to funding the improved federal healthcare system.
Then, having shown sufficient respect to the GAO, set it to the task of putting together a healthcare bill that will work. Tell it to pay due attention to communications from citizens who know something about the problem. Yes, set it parameters:
1) An absolute minimum of regulations, especially the sort that create paperwork -- which requires clerks/coders/billers/etc. to deal with the paperwork, which creates excessive bureaucracy and costs.
2) Abolish the ACA and Medicaid outright, but expand Medicare to cover everything that both of those did -- and more: pre-existing conditions, experimental treatments, and all.
3) Make Medicare pay directly to the healthcare providers, not go through insurance companies. Medicare is supposed to be the poor folks' insurance, not provide a cash-cow for insurance companies. Add penalties for any healthcare provider who thinks they're too good to accept direct Medicare payments. And insist on no co-pays.
4) Launch a thorough investigation into the pharmaceutical industry, the FDA, and collusion between them to keep prices of medicine high and discredit non-synthetic -- and cheap -- treatments which are more effective. Apply punishment where it's due.
Then stand back and let the GAO do its work, at which it has shown itself to be quite competent. Once the GAO comes up with a workable bill, written as much as possible in plain English rather than Legalese or Bureaucratese, pass it with NO amendments. Don't let anyone hide any cute little bits of pork in the bill. If repairs are needed later, pass amending bills separately -- and only after fully transparent argument and discussion in Congress.
Now that would produce a really efficient and workable federal healthcare bill, one that would allow people with enough $$ of their own to get their own private health insurance but would provide a basic healthcare safety-net for the rest of us. It would also give Congress the time and space to concern itself with other serious matters of government.