OK a lot of back and forth on what is wrong and some very generic solutions like single payer BUT what does that really mean for the US. Its hard to go from one extreme to another over night but lets presume we can.
Here is what I would do if I was the Supreme Leader:
- Structure/Admin: Create a federally owned insurance company. Maybe merge the biggest two or three companies and get the likes of Bezos and Buffet to restructure them and build the IT.
- Funding: The US is a awash with health care dollars its just needs channeling into one administrator. All medicare, medicaid, company premiums and individual premiums matching the 2017 amounts should be paid into the central administrator. We can work on contributions in future years but as a starting point just redirect the existing funds.
- Healthcare Costs: Two federally appointed committees for medical procedures and pharmaceutical/Ancillary pricing. Set the amount doctors and hospitals can receive for services with adjustments for regional costs.
- Point of Service: Income based co-pays to ensure the system is not abused. Something like $10/$20/$30 for a doctors appointment, $25/$50/$100 for ER based on income. Unemployed and very poor would be exempt.
- Cost Control: Setting the procedure and drug costs will keep things in check. To push long term costs down incentivize universities to create more nursing and medical courses. Give grants to people enrolled in these areas as well. More nurses, doctors and medical professional will help keep long term costs down.
There you go problem solved
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I feel a single payer does need copays to help curb abuse and raise some revenue based on income at POS. The NHS has always been terribly burdened by people that misuse doctors and ER services.
Agree with the majority of what you say. I've previously mentioned excesses to help curb abuse and raise income. The issue is selling this in the UK as it's become such as political football that the second top up fee's get mentioned you get a flurry of abuse from the opposite political party screaming that the in power party is ending the "free at the point of use" mirage. Of course this mantra is complete nonsense already considering every single time I visit the doctor, dentist, optician or hospital I end up with a bill. At 30 years old I currently spend a £300-500 per year on medication, checkups and procedures etc that if went unspent would have a material detriment to my health.
Until the aforementioned viewpoint changes and people wake up to the fact that the NHS charges people every day; I'd propose a tweak to your proposal. A reverse excess. A solution whereby people get a £100 rebate at the end of the year if they did not use the NHS outside of their long term requirements. This would also satisfy the group of people that would say a £50 excess would cause the poorest in society to not go to the hospital if something was wrong. The initial cost would seem to be huge (£66m * £50 = £3.3b); but firstly a large proportion of the population will require healthcare and so will lose their payment and secondly in the scheme of things that amount is peanuts in respect of the overall budget if it results in a change of culture.
Having worked for the NHS, and my wife being a nurse, I can only despair at the sheer red tape and wastage that's crippling it. Sure, blame the Tories all you like, but the NHS management and procurement are an utter disgrace. Money being thrown around willy nilly and suppliers taking the piss. My wife is bombarded with sales reps offering all sorts of crazy incentives (not just free branded pens) to try out different brands of wound care products on her patients.
I'll reduce it to this: How does a packet of Ibuprofen cost 35p at Tesco yet the very same product costs £4 for the NHS to procure???
Times that insane discrepancy by thousands of products that make up the NHS Supply Chain and it makes you really wonder whats going on.
The problem is that there is no incentive for the NHS to procure things competitively. There is no ability to give bonuses to senior managers who effectively modernise and introduce cost saving measures into their hospital. There is no long term carrot offered for bosses to look long term, rather than short term. There is no "profit-share" facility whereby successful hospitals can split the fruits of their labour with their best doctors & nurses and give them bonuses or salary increases. Because of this lack of incentivisation there is no reason to operate in an efficient manner. As a manager why would I spend hours and hours tendering to several different companies for dozens of different purchases, when my current supplier gives me a spa & golf weekend for two at the end of each year? Why would I risk investing in the infrastructure of my hospital for long term benefit, when it's a lot easier to put those funds into the short term easing of pressure employing extra agency staff?
When I joined my company the procurement of several items were left in the hands of our accounts department who had absolutely no incentive in procuring items competitively. They were all salaried members of staff who did not have a stake in the business. One of these items was stationary which our annual spend was £26k. We reduced this overnight by 22.5% by speaking to a few different suppliers. At the end of the task it became apparent that one of the main reasons we were spending £6k too much on stationary per annum was down to one reason: we were buying in very small quantities on a twice weekly basis because our current supplier offered a "free" packet of chocolate biscuits with each delivery. We were literally paying £6,000 per annum for £150 worth of McVitie's digestives...
Naturally both myself and my buyer had an financial incentive to procure this product more competitively; whereas our accounts department saw free biscuits on one hand and diddly squat on the other and went with the biscuits. This mentality is unfortunately endemic in the public service and charitable sector. A lack of incentive for everyone leads to a laissez faire attitude when it comes to efficiency.
This isn't having a go at these sectors, it's human nature. Why do a lot of us go through the grief every single year of comparing car insurance, home insurance, electricity, gas, broadband, TV and every other bill that we want to pay as little as possible? Because our time and effort is rewarded with clear financial gain. Lets be honest with ourselves - if we didn't get these savings in our pockets every year, would we still compare? Of course not.
If the same time and effort were rewarded in the public sector with financial gain as it is with comparing car insurance then everybody would win. The managers would win as they'd be paid more, the patients would win because the hospitals would be more efficient and the best doctors and nurses would win because they'd be paid more than their less able and hardworking colleagues.
Staff incentivisation is the only way to improve our NHS.
