# My Healthcare Reform Proposal **URL:** \ **Category:** Great Debates\ **Created:** [August 8, 2009, 4:11pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745 "2009-08-08T16:11:32Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [August 8, 2009, 4:11pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/1 "2009-08-08T16:11:32Z")
Here is a basis for discussion for healthcare insurance reform: 1. Eliminate the tort system for malpractice and replace it with binding arbitration. 2. Make everyone part of the same risk-pool so you could switch insurers and individuals would get same rate as business. Let people switch insurers during yearly open-enrollment period. 3. Have an alternative govt-run insurance option similar to medicaire, but allow private insurance to compete. 4. Remove restrictions on govt negotiating with drug companies on presciption prices. 5. Remove tax exemption on health insurance benefits. 6. Give a voucher to each family to buy insurance of their choice, with voucher being the cost of the govt plan. There seems to be know way around having some sort of mandatory insurance requirement, otherwise young healthy people would take the chance of having no insurance and then join when they got older or sick. What do you think? ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [August 8, 2009, 4:18pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/2 "2009-08-08T16:18:24Z")
What do I think, I think YOU SUCK. I was JUST finishing My Simple Solution To Health Care in America and was about to post it. Now I have I wait. ---
**Author:** ![Grumman](https://avatars.discourse-cdn.com/v4/letter/g/43a26b/32.png) [@Grumman](https://boards.straightdope.com/u/Grumman)\ **Post date:** [August 8, 2009, 4:31pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/3 "2009-08-08T16:31:55Z")
> [@DanBlather](#): > > There seems to be know way around having some sort of mandatory insurance requirement, otherwise young healthy people would take the chance of having no insurance and then join when they got older or sick. This is a self-inflicted problem, caused by the use of insurance (the provision of stability, which benefits all customers) as a means of wealth redistribution (deliberately overcharging some customers to subsidise others). Stop trying to use insurance to do this (even if you use welfare to acheive the same goal), and the problem disappears. ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [August 8, 2009, 4:40pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/4 "2009-08-08T16:40:02Z")
> [@Grumman](#): > > This is a self-inflicted problem, caused by the use of insurance (the provision of stability, which benefits all customers) as a means of wealth redistribution (deliberately overcharging some customers to subsidise others). Stop trying to use insurance to do this (even if you use welfare to acheive the same goal), and the problem disappears. So if your were 65 years old with a heart condition your suggestion is that your health insurance premium may be $25,000 a year or so and we would provide welfare to people who could not afford it? Or are you saying everyone of the same age-range would pay the same premium? ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [August 8, 2009, 4:49pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/5 "2009-08-08T16:49:43Z")
> [@DanBlather](#): > > 1. Eliminate the tort system for malpractice and replace it with binding arbitration. > > 2. Make everyone part of the same risk-pool so you could switch insurers and individuals would get same rate as business. Let people switch insurers during yearly open-enrollment period. > > 3. Have an alternative govt-run insurance option similar to medicaire, but allow private insurance to compete. > > 4. Remove restrictions on govt negotiating with drug companies on presciption prices. > > 5. Remove tax exemption on health insurance benefits. > > 6. Give a voucher to each family to buy insurance of their choice, with voucher being the cost of the govt plan. > > There seems to be know way around having some sort of mandatory insurance requirement, otherwise young healthy people would take the chance of having no insurance and then join when they got older or sick. > > What do you think? I think point 1 is grossly unfair, 2 and 3 cancel each other out, and i’m not quite sure what 6 entails. 4 and 5 are fine. If everyone’s in the same risk pool, then the actuarial premiums you have to set are for the entire pool of people, no? How does that comport with different people selecting different insurers? Binding arbitration blows and is so grossly biased (both procedurally and substantively) against the party injured that you may have well proposed to eliminate the notion of professional malpractice (which I suspect is your goal). It also privatizes law, causes no precedent to be set (coincidentally the precedent that arbitrators now use come from the public law fora) which would have the end result of an incredibly foggy standard for “professionalism” in the medical field, and guts the right to appeal bad decisions (from both sides). Here’s a better idea: collectivize the risk pool for medical error - one insurer. ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [August 8, 2009, 4:57pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/6 "2009-08-08T16:57:10Z")
> [@Rumor\_Watkins](#): > > Binding arbitration blows and is so grossly biased (both procedurally and substantively) against the party injured that you may have well proposed to eliminate the notion of professional malpractice (which I suspect is your goal). It also privatizes law, causes no precedent to be set (coincidentally the precedent that arbitrators now use come from the public law fora) which would have the end result of an incredibly foggy standard for “professionalism” in the medical field, and guts the right to appeal bad decisions (from both sides). Here’s a better idea: collectivize the risk pool for medical error - one insurer. I don’t have any “goal” to get rid of professional malpractice, but our current system of awarding huge sums for punitive damages (with lawyers sometimes getting hundreds of thousands of dollars in fees) seems out of hand. Litigation is expensive and I’d rather see the money go to providing health care than to lawyers or insurance companies. ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [August 8, 2009, 5:21pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/7 "2009-08-08T17:21:21Z")
> [@emacknight](#): > > What do I think, I think YOU SUCK. I was JUST finishing My Simple Solution To Health Care in America and was about to post it. Now I have I wait. Was it to make the US part of Canada? 😉 ---
**Author:** ![Grumman](https://avatars.discourse-cdn.com/v4/letter/g/43a26b/32.png) [@Grumman](https://boards.straightdope.com/u/Grumman)\ **Post date:** [August 8, 2009, 5:31pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/8 "2009-08-08T17:31:42Z")
> [@DanBlather](#): > > So if your were 65 years old with a heart condition your suggestion is that your health insurance premium may be $25,000 a year or so and we would provide welfare to people who could not afford it? For the sake of argument, yes. If you’re going to make subsidising people’s healthcare mandatory, I would prefer that you don’t take this as an excuse to make buying the insurer’s services mandatory too. By separating the two you force the insurer to provide a service that benifits its customers, or perish as people cut out the middle-man. ---
**Author:** ![sleeping](https://avatars.discourse-cdn.com/v4/letter/s/839c29/32.png) [@sleeping](https://boards.straightdope.com/u/sleeping)\ **Post date:** [August 8, 2009, 5:39pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/9 "2009-08-08T17:39:41Z")
> [@DanBlather](#): > > I don’t have any “goal” to get rid of professional malpractice, but our current system of awarding huge sums for punitive damages (with lawyers sometimes getting hundreds of thousands of dollars in fees) seems out of hand. Litigation is expensive and I’d rather see the money go to providing health care than to lawyers or insurance companies. True, but arbitration is the wrong way to go about this. Instead, you would need someone to set a standard of care that applies to all plans and physicians, so that the courts don’t have to make these decisions on a case-by-case basis. And that someone can only be the government. Also, I don’t think malpractice litigation amounts to a very large portion of healthcare expenditures. Substantial to necessitate reform maybe, but not the primary factor in healthcare spending increases. ---
**Author:** ![tumbleddown](https://avatars.discourse-cdn.com/v4/letter/t/e9bcb4/32.png) [@tumbleddown](https://boards.straightdope.com/u/tumbleddown)\ **Post date:** [August 8, 2009, 7:23pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/10 "2009-08-08T19:23:25Z")
Malpractice lawsuits account for roughly 1% of U.S. healthcare costs, on par with UHC providing Canada. [Cite](http://www.tampabay.com/news/article1021977.ece) ---
**Author:** ![sleeping](https://avatars.discourse-cdn.com/v4/letter/s/839c29/32.png) [@sleeping](https://boards.straightdope.com/u/sleeping)\ **Post date:** [August 8, 2009, 8:04pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/11 "2009-08-08T20:04:10Z")
Thanks, **tumbleddown**. Here’s a more in-depth study, delineating the costs of the number of malpractice claims, average award amounts, legal costs, underwriting costs, and, somewhat more nebulously, defensive medicine: > [@](#): > > [“Health Spending In The United States And The Rest Of The Industrialized World” > Anderson et al. > Health Affairs, 24, no. 4 (2005): 903-914](http://content.healthaffairs.org/cgi/content/full/24/4/903) > > **Are claim payments higher in the United States?** \*\*Surprisingly, U.S. malpractice payments (including both cases that resulted in a judgment for the plaintiff and cases resulting in a settlement) were lower, on average, than those in Canada and the United Kingdom. \*\*In 2001 the average payment in the United States was $265,103, which was higher than in Australia but 14 percent below Canada and 36 percent below the United Kingdom.22 While U.S. media and public attention have focused on multimillion-dollar awards at the upper end of the range, the average was actually smaller than in Canada and the United Kingdom in 2001. > … > **Possibly the most important and best summary measure of the magnitude of malpractice awards is total payments divided by total population. On this measure, the United States is only slightly higher than the other three countries: $16 per capita in 2001** , compared with $12 in the United Kingdom, $10 in Australia, and $4 in Canada. In all four countries, however, malpractice payments represent less than 0.5 percent of health spending. > > These figures do not include the legal costs of defending malpractice claims. Legal costs are estimated to average $27,000 per claim in the United States, which adds approximately $1.4 billion in costs to the $4.4 billion paid in settlements and judgments.23 The costs of underwriting insurance against malpractice claims are estimated at an additional 12 percent, or $700 million.24 **The cost of defending U.S. malpractice claims, including awards, legal costs, and underwriting costs, was an estimated $6.5 billion in 2001—0.46 percent of total health spending**. > … > The total cost including awards, legal costs, and underwriting costs was $237 million (PPP) in 2001—0.27 percent of total Canadian health spending. > … > Defensive medicine—tests or procedures ordered by physicians to protect against the risk of being sued—could contribute more to health spending than malpractice payments do. Several attempts have been made to quantify the amount spent on defensive medicine, but estimates vary widely. The difficulty lies in determining what services are purely “defensive”—that is, both inappropriate overuse and motivated by fear of litigation. For example, a physician might ask for a second opinion on a difficult diagnosis, mindful of the potential of litigation, but that second opinion could be considered appropriate care. Other services could be considered inappropriate overuse but were motivated by incentives other than the litigation threat, such as payment policy. These gray areas make precise estimates of the cost of defensive medicine extremely difficult. > > One estimate of this cost has come from HHS, which estimates that $70–126 billion (5–9 percent) in health spending per year would be saved if malpractice tort reform, similar to policies in California, were passed at the national level.26 ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [August 8, 2009, 8:22pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/12 "2009-08-08T20:22:52Z")
> [@sleeping](#): > > Thanks, **tumbleddown**. > > Here’s a more in-depth study, delineating the costs of the number of malpractice claims, average award amounts, legal costs, underwriting costs, and, somewhat more nebulously, defensive medicine: Ignorance fought. I did find it odd that the article says costs were only “slightly more” tha in other counties when US costs were 3 times that of Canada. But, it still does not amount to much. Interestingly, pharmaceutical companies pay about[8 times](http://www.sciencedaily.com/releases/2008/01/080105140107.htm)that amount in advertising. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 8, 2009, 10:13pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/13 "2009-08-08T22:13:44Z")
The OP is more or less where the discussion in the US has been going. I’m afraid whatever Max Baucus comes up with will be something “almost like this” but so adulterated by concessions to special interests that it doesn’t really function in a way people like. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 8, 2009, 10:17pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/14 "2009-08-08T22:17:23Z")
> [@Grumman](#): > > This is a self-inflicted problem, caused by the use of insurance (the provision of stability, which benefits all customers) as a means of wealth redistribution (deliberately overcharging some customers to subsidise others). Stop trying to use insurance to do this (even if you use welfare to acheive the same goal), and the problem disappears. I think I agree with what Grumman is saying. Personally, I would unify Medicare & Medicaid, & just make everyone eligible. (This does not mean all medical bills would be tax funded; it would cover basic care, & supplemental insurance would exist as well.) The funding base could be a flat tax instead of premiums. Also, what we really need to do is to train more physicians. We’re not keeping up with demand, & that’s diminishing access to care & driving up prices. That’s possibly a greater inflation driver than health insurance. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 8, 2009, 10:21pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/15 "2009-08-08T22:21:00Z")
> [@DanBlather](#): > > I don’t have any “goal” to get rid of professional malpractice, but our current system of awarding huge sums for punitive damages (with lawyers sometimes getting hundreds of thousands of dollars in fees) seems out of hand. Litigation is expensive and I’d rather see the money go to providing health care than to lawyers or insurance companies. It was my understanding that the most egregious malpractice awards were in obstetrics; I see this as jurists/juries not understanding the science well enough to decide fairly. We need better general education on the inherent & inevitable risks of childbearing. ---
**Author:** ![The\_Tao\_s\_Revenge](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@The\_Tao\_s\_Revenge](https://boards.straightdope.com/u/The_Tao_s_Revenge)\ **Post date:** [August 8, 2009, 10:30pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/16 "2009-08-08T22:30:27Z")
> [@DanBlather](#): > > 1. Give a voucher to each family to buy insurance of their choice, with voucher being the cost of the govt plan. What about individuals without a spouse or kids? ---
**Author:** ![NinetyWt](https://avatars.discourse-cdn.com/v4/letter/n/cc9497/32.png) [@NinetyWt](https://boards.straightdope.com/u/NinetyWt)\ **Post date:** [August 8, 2009, 10:56pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/17 "2009-08-08T22:56:48Z")
> [@foolsguinea](#): > > Also, what we really need to do is to train more physicians. We’re not keeping up with demand, & that’s diminishing access to care & driving up prices. That’s possibly a greater inflation driver than health insurance. I like this. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [August 8, 2009, 11:45pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/18 "2009-08-08T23:45:25Z")
> [@DanBlather](#): > > I don’t have any “goal” to get rid of professional malpractice, but our current system of awarding huge sums for punitive damages (with lawyers sometimes getting hundreds of thousands of dollars in fees) seems out of hand. Litigation is expensive and I’d rather see the money go to providing health care than to lawyers or insurance companies. I don’t want to keep dragging up med mal reform every time there’s a healthcare debate, but… there are almost no punitive damage awards in medical malpractice cases. full stop. i think people dislike medmal for this reason: people are jealous of the award amounts while oblivious to the pain and suffering that comes along with those awards. it makes it very easy for insurance companies and doctors groups to lobby that “something” needs to be done about it, when it is demonstrably shown, time and time again, that the rates and amounts of awards aren’t that ridiculous. most of the reason that awards are high is because the cost of the injured party’s future medical care is correspondingly high… > [@NinetyWt](#): > > I like this. 100% agreed. I would love if our federal government build 25 new med schools, provided free tuition for all enrolees and extract a commitment to work for a set salary at government-owned (not necessarily federal - alot of counties own hospitals) healthcare facilities for 8-10 years or so. and while i’m at it, i would ban the practice of doctors having any ownership stake in any medical diagnostic or care facility. it’s a big, fat, disgusting conflict of interest that needs to be stamped out. ---
**Author:** ![NinetyWt](https://avatars.discourse-cdn.com/v4/letter/n/cc9497/32.png) [@NinetyWt](https://boards.straightdope.com/u/NinetyWt)\ **Post date:** [August 9, 2009, 1:27am UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/19 "2009-08-09T01:27:08Z")
> [@Rumor\_Watkins](#): > > i think people dislike medmal for this reason: people are jealous of the award amounts while oblivious to the pain and suffering that comes along with those awards. I dislike medmal because my doctor’s premiums are high. > [@](#): > > I would love if our federal government build 25 new med schools, provided free tuition for all enrolees and extract a commitment to work for a set salary at government-owned (not necessarily federal - alot of counties own hospitals) healthcare facilities for 8-10 years or so. Sounds good. ISTR there is a program like that for teachers - our Delta has benefitted from that program. > [@](#): > > i would ban the practice of doctors having any ownership stake in any medical diagnostic or care facility. it’s a big, fat, disgusting conflict of interest that needs to be stamped out. Other than a doctor’s office, you mean? ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 10, 2009, 8:01pm UTC](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745/20 "2009-08-10T20:01:38Z")
> [@Rumor\_Watkins](#): > > i would ban the practice of doctors having any ownership stake in any medical diagnostic or care facility. it’s a big, fat, disgusting conflict of interest that needs to be stamped out. Er, wha? What’s wrong with doctors owning the care facilities? Or do you mean ones other than where they work? [Next page](https://boards.straightdope.com/t/my-healthcare-reform-proposal/505745.md?page=2)