It strikes me that the health care debate is focused on entirely the wrong thing. Let's start with the goal: The best possible health care for everyone at an affordable price . What would achieve that? Here's some ideas in no particular order:
Drug innovation: It is only fair that inventors get compensated for their work to bring new ideas. In today's world, inventors aren't just individuals toiling away in solitude. Invention is often the collaboration of hundreds working together. In many cases this is a research lab: it might be a company, a university, a government institution or a combination of all of that. In all cases the scientists, engineers, and support need to get paid. Usually (mostly?) this is from the results of the innovation being sold to those who benefit. No difference for drugs. The innovation is protected through patents.
But here's the problem. In the current patent scheme in the US, a new chemical idea (a compound) must be protected from the time the inventor determines it might produce a drug, not when it actually is one. Once the patent is issued, it is valid for 17 years and the clock starts ticking. The rub is that it may take 10 or more years for the drug to pass the appropriate testing, clinical trials, and safety checks before it can be released to market. The inventory then has only a few years to make all the money back. What does this mean? higher costs in the short run.
So what if the patent protection were fixed (say 12 years from FDA approval?). I can see these benefits:
1) predictable time frame to recoup the investment in developing and testing the drug.
2) no incentive to rush clinical trials or any other part of the research needed for safety.
3) longer period to amortize the cost, which could result in lower cost even before the drug becomes generic.
Some simple rules could be put in place to prevent the discoverers from sitting on a compound too long, but the natural incentive of anyone I've ever worked with in pharma industry is to save lives. If the idea works, the researches want it out there.
Legal Reforms. Much has been said about the high cost of malpractice insurance and disincentives that it creates for doctors, especially in oby/gyn. How about limitations on liability that are clear and well understood by all? When you get on an airplane the contract for loss of life or limb is clear. Why not when you go to a doctor? How about this: if malpractice does happen the limitation is:
1) what you paid, plus court costs, plus
2) the cost of all future treatment resulting from the malpractice
3) if you can't work, reimbursement of you current wage for the rest of your natural working life (until the current Social Security standard retirement age).
4) plus punitive damages in case of negligence - some multiple - let's say 5 time the amount of (1) plus (2) above.
Incentives for improved process. What is the worst thing about health care for many people? Having to wait around is certainly up there. How do we fix that? Free markets by nature create efficiency. How about posting prices for everything up front. Ever ask a doctor about the fees? The doctor might not know! Now, if you get a better deal, you get something in return - perhaps points that you can redeem for lower cost insurance - i.e. you still get covered, you don't have to do anything, but if you can you benefit directly! what if everyone did that?
Care for those who cannot pay. Well the first thing would be a simple means test, but basically if the vast majority are covered it becomes easier to afford overheads to cover the rest. How to do this without people taking advantage? Well first, if you can't pay you wait if your condition is same as others. If it is really bad, OK maybe you go first - but if someday you are able to pay, you pay back that first. Charities cover people all the time at no cost to the taxpayer. . .I'm sure people have good ideas. If you want want to be a do-gooder softie at the rest of us taxpayers? Well let's say there are 15M in the US who really don't have insurance - this is based on data that of the 45M uninsured in the US, 15M don't want it (because they can afford it) and 15M are already eligible for Medicare so let's assume they get that. Just give the rest one time $2000 each of insurance for a year. That's $30B a year. Put a program in place to wean them off that over time. . .that's a lot less than $1.4T and doesn't change anything for anyone else.
How hard would it be to legislate this? Less than 100 pages? Would people understand it? Worth a try right?
How about the analogy: We offer food stamps to those who need them without changing how other people buy food.
If that's not good enough, well just look up alternative GOP proposals that have been out there over a year now. That's what the GOP means by start over. Obama should listen like he said he would.
