Seed-Ratio Based Healthcare Funding

Postby strange_person » Wed Jun 10, 2009 2:04 pm

Here is the concept:
There is a national healthcare fund.
Every citizen has an account. Anyone can contribute to the fund, either in cash or from their pre-tax income. Total contributions by any given citizen are public knowledge.
When you go to the hospital, or other medical care, the provider sends you an itemized bill. If you pay within, say, 30 days, that's that; if you don't, or don't pay it all, the remainder is charged (in a non-itemized form) to your national healthcare fund account. Total withdrawals by any given citizen are also public knowledge, although the exact details of who the money went to are available only to the citizen whose name is on the account and that person's authorized representatives.

The national healthcare fund always pays the bills it receives, no matter how much you've charged and how little you've paid in.

However, the ratio has legal weight: when allocating scarce medical resources, it is illegal to discriminate on any basis other than
1) medical necessity (for example, triage)
2) the ratio of a patient's total payments to the healthcare fund to their total withdrawals from said fund.

For example, if two people are waiting in line for a kidney transplant, one of whom has $3million in previous expenses and $4million in previous contributions and the other has $1000 in previous expenses and $1500 in previous contributions, and they're about equally compatible with the next available kidney, the poor one (ratio 1.5) is prioritized over the rich one (ratio 1.33) unless moneybags is willing to drop another half-mil in the pot to even the odds.

Since people have an opportunity to pay directly, it's not socialism and there's still a niche for private insurance companies, which makes it at least somewhat politically feasible. The way the math with ratios works out, there's no moral hazard; all the patients still want to keep their expenses low, and pay in as much as they can afford, and the medical professionals have to compete on price, service, and quality of care rather than behind-the-scenes deals with HMOs and drug companies.

What am I missing? How would this break down?
Hello!

Praise be to Athè, and Hob, Her living vessel.
2<3
For I have crescent pies to bake
And smiles to throw before I wake
User avatar
strange_person
2000 Post Medal Of Wow!

  Offline
 
Posts: 2274
Joined: Sat Jan 19, 2008 8:09 pm

Re: Seed-Ratio Based Healthcare Funding

Postby Coda » Wed Jun 10, 2009 3:20 pm

The problem I see arising there is that the lower-income patients are statistically MORE likely to need medical care -- and therefore higher expenses historically, which makes it difficult for them to have the better ratio.
User avatar
Coda
Magickal Melon 666

  Offline
 
Posts: 762
Joined: Sun Apr 05, 2009 12:19 pm
Location: Holy crap, Coda set an avatar

Re: Seed-Ratio Based Healthcare Funding

Postby Tychomonger » Wed Jun 10, 2009 6:52 pm

The reason for that statistic might be that they have worse health care.
Hello!
Aealacreatrananda wrote:When I envision a far far future.... I don't fuck around.

People assume that time is a strict progression of cause to effect, but actually from a non-linear, non-subjective viewpoint, it's more like a big ball of wibbly-wobbly, timey-wimey... stuff.
--The Doctor
User avatar
Tychomonger
Watermelon Graduate

  Offline
 
Posts: 866
Joined: Sat Jan 19, 2008 7:13 pm
Location: Beside myself

Re: Seed-Ratio Based Healthcare Funding

Postby strange_person » Wed Jun 10, 2009 7:01 pm

How much of a problem would it be to have a bad ratio, in this system?
Hello!

Praise be to Athè, and Hob, Her living vessel.
2<3
For I have crescent pies to bake
And smiles to throw before I wake
User avatar
strange_person
2000 Post Medal Of Wow!

  Offline
 
Posts: 2274
Joined: Sat Jan 19, 2008 8:09 pm

Re: Seed-Ratio Based Healthcare Funding

Postby Tychomonger » Wed Jun 10, 2009 7:07 pm

Take black people for example. They have a significantly higher rate of heart problems, if I remember correctly. They also have a lower income. So they will have more need for the very scarce resource of heart transplants, but less income with which to spend on increasing their seed ratio.
Hello!
Aealacreatrananda wrote:When I envision a far far future.... I don't fuck around.

People assume that time is a strict progression of cause to effect, but actually from a non-linear, non-subjective viewpoint, it's more like a big ball of wibbly-wobbly, timey-wimey... stuff.
--The Doctor
User avatar
Tychomonger
Watermelon Graduate

  Offline
 
Posts: 866
Joined: Sat Jan 19, 2008 7:13 pm
Location: Beside myself

Re: Seed-Ratio Based Healthcare Funding

Postby Jennifer Diane Reitz » Wed Jun 10, 2009 8:01 pm

How about this:

Absolutely free (paid by national taxes, like any government service) universal health care for all citizens, period.

If you really want to save money, then have each visit rated by the doctor at the time as being necessary or unnecessary. If a patient keeps coming in trying to get antibiotics for a viral disease like the flu, or they are a hypochondriac, they have to pay for each visit out of their personal pocket. They get charged by the government. But if the visit is determined to be necessary, a legitimate need, then there is no cost to the patient. That would cut abuse of the system instantly.

How could this be possible?

Currently, taxes take out more than half of every ordinary person's income in the US. What I mean by this is, that if you make less than a quarter of a million a year, you probably are paying out about half to 60% of that income you make to state and nation.

Of course, if you make above that, you probably are not paying much, perhaps not paying anything at all. But, there are very few such massively wealthy people compared to the vast ocean of poor and middle class people, so there is tons, just tons of money coming in to the government. Far more than enough to give everyone utterly free health care for life.

So why is national health care so opposed, and why does it have problems in nations that already have national health care (i.e. the entire whole of all other First World nations on the planet?)... the answer is the usual - corruption.

Medical corporations in the US don't want national health care because it would mean vastly less profit - in other words they are fucking greedy beyond all comprehension. 'Medical ethics' in the US amounts to whether or not the corporation that the doctor belongs to gets paid.

The government doesn't want national health care because of two reasons; the corporations that fund the elections of congress will be mad, and that means no money, which means no re-election, which means NO. And of course, overall, if money is used to actually take care of people, there will be much less for other needs, such as lining pockets, paying for wars of aggression, and... more lining of pockets.

But the US is already in financial trouble!!! Oh Noes!

Yes, it is. But this was not caused by taking care of people. Far from it. It was caused by utter greed, total corruption, and more greed and corruption. Then some more greed. And some more corruption. Over a fairly long time, actually.

There is no legitimate (not greed and corruption based) reason to deny Americans total national health care, just like any civilized nation.

But Canada has crappy health care and the US has great health care all because we don't have national care!!! Oh Noes!

That is a lie.

The US has really amazing health care -for the incredibly rich. No question. If you have millions and millions, this is the place to be.

But you, and everyone you know, will not have that care. You will never see it. You will go broke and end up on the street living under a bridge if you ever need it. Like 65% of all homeless people. That, by the way, is how families most often end up homeless. Trying to pay for that fantastic level of health care that only rich people can afford. Amazingly, not everyone has decent health insurance... or even any health insurance, especially after they have lost their job, as roughly 30% of Americans have (if you figure unemployment the old way, where you also measure those who no longer qualify for benefits, and are just plain unemployed. We don't count them anymore, so the figures look better than they really are.)

But I heard that you have to wait forever in England even to see a doctor at all!!! Oh Noes!!!

Sometimes you wait, sometimes you don't. That's all just a matter of management.

Ever tried to get into an emergency room in the US when you don't have the right insurance papers, card, or even any insurance at all?

You will wait far longer, and you may end up being told to leave - to go to the other hospital that takes poor people. If you die on the way, well, at least you didn't cause the investors to lose profit. This is common. As many of you know, I do not doubt.

But the guy on the TV news said... Oh Noes!!!!

Yes, he did. Of course he did. The news, all the news, every bit of news on the television, or in almost all magazines, is owned by one or more of only five corporations. All of these corporations also own vast holdings in the American medical industry, from clinics and hospitals to pharmaceutical corporations to medical chain outlets. Why would they ever say anything that would threaten their own profits? They don't care about you. They don't have the slightest interest.

The truly wealthy live on another, parallel earth. They are separated from your earth not by dimensional walls, but by gated communities, private mansions, and lear jet travel. You don't exist for them, except as a rabble, a faceless mass of peasants, of consumers, that they manage much like a farmer manages chickens, for gain. You have no souls, you are not really people to them. You are 'eaters', and there are already too many of you.

It can't be like that! Prove it! Prove it all in detail! The rich care about us! Compassionate Neoconservatism!

Go outside once in a while, numbnuts. Read something.

Or just wait. Until the time you need medical care.

Then you can apologize to me in your heart. From the alley. Or under the bridge.

See you there.

So what can we do then?

It all involves an effort nobody is willing to make, and risk nobody is willing to take. Not even me. So, nothing. We're screwed.

Try to be happy for the people in the other countries.

Who can (usually) get medical care whenever they need it, every time they need it.

Unlike you. Or me.
Jennifer Diane Reitz
'Giniko-chan'
Image
User avatar
Jennifer Diane Reitz
Creatrix

  Offline
 
Posts: 1217
Joined: Sat Jan 19, 2008 10:25 am
Location: Olympia, Washington

Re: Seed-Ratio Based Healthcare Funding

Postby Coda » Wed Jun 10, 2009 8:12 pm

The biggest problem that you're going to see with such a simple plan is the arguments and controversy and LAWSUITS over what constitutes "legitimate" and "necessary." You're going to find corrupt doctors who will call treatments "necessary" just so they can get more of this free money -- and where does the money come from to audit this? To combat this?

Don't get me wrong -- I'm all for universal health care. I just think that this particular setup is way too easy to exploit.
User avatar
Coda
Magickal Melon 666

  Offline
 
Posts: 762
Joined: Sun Apr 05, 2009 12:19 pm
Location: Holy crap, Coda set an avatar

Re: Seed-Ratio Based Healthcare Funding

Postby RaharuAharu » Thu Jun 11, 2009 1:29 am

Coda wrote:The biggest problem that you're going to see with such a simple plan is the arguments and controversy and LAWSUITS over what constitutes "legitimate" and "necessary." You're going to find corrupt doctors who will call treatments "necessary" just so they can get more of this free money -- and where does the money come from to audit this? To combat this?

Don't get me wrong -- I'm all for universal health care. I just think that this particular setup is way too easy to exploit.



How about a system of Peer and Civilian reviews as a method of checks and balances?
I think it would be fairly inexpensive to set such a system up.
Hello! *~( ! !)>
Alien Parachronism
Image
User avatar
RaharuAharu
1000 Post Forum Master!

  Offline
 
Posts: 1099
Joined: Sun Jan 20, 2008 2:09 am

Re: Seed-Ratio Based Healthcare Funding

Postby Coda » Thu Jun 11, 2009 6:35 am

It's not a bad idea. In THAT case, there are two points that would need to be taken into consideration when designing the system:

First, peers are rarely impartial -- many a jury has been swayed by a particularly emotional appeal, and I don't see it being any better when dealing with issues of life and death. This isn't irreconciliable, but it's a factor that must be taken into account when designing the system. Perhaps the review board only gets to review the patients' medical records, with no identifying information attached -- no name, no gender or age (unless it's relevant to the condition or procedure), no race.

But that brings up a second worry: bureaucracy. We have to make sure the system is flexible enough to treat patients in a reasonable amount of time. It has to be straightforward enough that there doesn't become a backlog of paperwork necessary to process the backlog of transplant patients.
User avatar
Coda
Magickal Melon 666

  Offline
 
Posts: 762
Joined: Sun Apr 05, 2009 12:19 pm
Location: Holy crap, Coda set an avatar

Re: Seed-Ratio Based Healthcare Funding

Postby RaharuAharu » Thu Jun 11, 2009 9:59 am

Coda wrote:It's not a bad idea. In THAT case, there are two points that would need to be taken into consideration when designing the system:

First, peers are rarely impartial -- many a jury has been swayed by a particularly emotional appeal, and I don't see it being any better when dealing with issues of life and death. This isn't irreconciliable, but it's a factor that must be taken into account when designing the system. Perhaps the review board only gets to review the patients' medical records, with no identifying information attached -- no name, no gender or age (unless it's relevant to the condition or procedure), no race.

But that brings up a second worry: bureaucracy. We have to make sure the system is flexible enough to treat patients in a reasonable amount of time. It has to be straightforward enough that there doesn't become a backlog of paperwork necessary to process the backlog of transplant patients.


I think your right, and thankfully neither problem is insurmountable.

It may help if the Peer(Doctors) and the Civilians are not from the same area as the hospital in question, or in the case of the Doctors, simple not from the same hospital.

As for the Bureaucracy, there is a Chance the Obama's new reforms for updating medical records could help greatly with that, and if not, it is really just a matter of enough time and effort put in to designing an efficient system and then running it with enough time and effort.
Hello! *~( ! !)>
Alien Parachronism
Image
User avatar
RaharuAharu
1000 Post Forum Master!

  Offline
 
Posts: 1099
Joined: Sun Jan 20, 2008 2:09 am

Re: Seed-Ratio Based Healthcare Funding

Postby strange_person » Thu Jun 11, 2009 10:45 am

Jennifer Diane Reitz wrote:How about this:

Absolutely free (paid by national taxes, like any government service) universal health care for all citizens, period.
My proposed system includes this, yes.

It has the additional advantage of accounting for where the money comes from, in a manner that requires absolutely no lawyers and next-to-no administration. Money comes in, money goes out, the amount of money is added up and the numbers are published. In principle the whole system could be managed by a single minimum-wage data entry clerk. Doctors and hospital administrators don't need to think about where the money's coming from; they just treat whoever's in front of them, with contribution ratio relevant only as a last-ditch tiebreaker in triage.

There is still a niche, in this system, for private health-insurance companies; they can help people pay for large, unexpected expenses on the initial itemized bill, to stop a sudden drop in ratio. That's what insurance should really be about, anyway: distributing risk across a broader demographic. Not providing leverage for discounts on routine care. Insurance companies and 'health-maintenance' organizations will have no rational basis on which to complain, so perhaps their mewling appeals to greed and neo-feudalism will be sufficiently absurd that the politicians they attempt to lobby will finally recognize that America does not, in fact, have the best healthcare system in the world.

The remainder of your points, while true, and distantly relevant, are strawmen in this context.
Hello!

Praise be to Athè, and Hob, Her living vessel.
2<3
For I have crescent pies to bake
And smiles to throw before I wake
User avatar
strange_person
2000 Post Medal Of Wow!

  Offline
 
Posts: 2274
Joined: Sat Jan 19, 2008 8:09 pm

Re: Seed-Ratio Based Healthcare Funding

Postby Skatche » Thu Jun 11, 2009 3:05 pm

Coda wrote:The biggest problem that you're going to see with such a simple plan is the arguments and controversy and LAWSUITS over what constitutes "legitimate" and "necessary." You're going to find corrupt doctors who will call treatments "necessary" just so they can get more of this free money -- and where does the money come from to audit this? To combat this?

Don't get me wrong -- I'm all for universal health care. I just think that this particular setup is way too easy to exploit.


Actually, I never really hear about this sort of thing in Canada. I'm not familiar with the details, but I can guess at the reasons:
(1) nonessential medical procedures (orthodontia and that sort of thing) are simply not covered;
(2) when you're making as much money as a doctor generally does, at a certain point you actually would rather do less work, because you can afford to; and,
(3) humans are actually pretty decent on the whole. Besides, if you're smart enough to become a doctor, and really want to rape society for all it's worth, you'll probably end up on Wall Street or as a CEO instead.
Skatche
Kumquat Class Sensei

  Offline
 
Posts: 268
Joined: Wed Jan 23, 2008 1:55 pm

Re: Seed-Ratio Based Healthcare Funding

Postby Wic » Fri Jun 12, 2009 5:02 am

People are not that kind. They are not going to pay anything voluntarily, even if they had the money. Why? Because they know the money is going to go to bums and other poor people they'd rather not to see.

It'd better just to tax it progressively. Then the rich would support the poor, even against their will.

But I guess taxing is that dreaded socialism.
It's that my homunculus inside my head doesn't even try to understand the outside world. He thinks it's a video game and smashes the buttons at random to find the key where you shoot the lasers.
User avatar
Wic
Apple Class

  Offline
 
Posts: 392
Joined: Wed Jan 23, 2008 1:04 pm

Re: Seed-Ratio Based Healthcare Funding

Postby strange_person » Fri Jun 12, 2009 12:18 pm

The incentives in this system do not rely on kindness to any degree, although it is still encouraged if present. Rich people, as you say, will not voluntarily pay to support the bums; they will, however, pay to make themselves look good, or to cut ahead in line.

1) Contribution ratios are public knowledge. If you're rich and have a ratio below 1, the tabloids will start comparing you to Leona Helmsley.

2) Contribution ratios are a factor in who gets treated first. It's the equivalent of bribing the maitre'd to get yourself a better table, except instead of a dinner date it's your life on the line, and instead of a guy in a tuxedo with a waxy moustache the money goes to cute, helpless orphans.

3) If it's a tax, there will be political conflicts about exactly how much the tax should be, and even after it's established, an ongoing conflict between government auditors and 'creative' accountants. All that conflict eats up resources that could otherwise be used to provide actual, necessary care. With a system of voluntary contributions, the conflict is a bidding war to see who can donate the most and consume the least.
Hello!

Praise be to Athè, and Hob, Her living vessel.
2<3
For I have crescent pies to bake
And smiles to throw before I wake
User avatar
strange_person
2000 Post Medal Of Wow!

  Offline
 
Posts: 2274
Joined: Sat Jan 19, 2008 8:09 pm

Re: Seed-Ratio Based Healthcare Funding

Postby Wic » Sun Jun 14, 2009 10:23 am

Donating to poor might be kewl now, but is it after ten years? I wouldn't trust on fashion.

Besides, don't we have kazillion of these kind of systems? Like Red Cross?
It's that my homunculus inside my head doesn't even try to understand the outside world. He thinks it's a video game and smashes the buttons at random to find the key where you shoot the lasers.
User avatar
Wic
Apple Class

  Offline
 
Posts: 392
Joined: Wed Jan 23, 2008 1:04 pm


Return to The Political Arena

Who is online

Users browsing this forum: No registered users and 1 guest

cron