Monday, February 19, 2007

A Proposition for the medical care and insurance crisis in the US

Experimental proposition to be fleshed out:

We should expand the and reshape the two tier form of medical care, coverage and insurance that we currently have in this country into a three tier system that would look something like this:

First tier - strictly market based, completely deregulated tier, especially for the treatment of complex and difficult diseases such as cancer. Allow as much competition as possible by federalizing the regulatory system at this level.

Third tier - a universally covered medical system run by nurse practitioners who have been extensively trained in standard Western triage and diagnosis skills and pain management skills not unlike and perhaps even based in Chinese medicine. This tier should screen and manage all complaints before referral to the second tier. Practitioners at this level would devote substantial amounts of time to each patient and would not earn as much as practitioners at other tiers through the market mechanism, but through a substantial increase in government spending in programs similar to medicare and medicaid, they would still earn good money. In order to accomplish this military spending would have to be cut and lots of money would have to go into recruiting qualified nurses from abroad and subsidizing the training of individuals in the US.

Second tier - the usual medical industry composed of doctors who only see patients from the third tier who have clearly medical pathologies - i.e. bacterial infections, cancers etc but who cannot necessarily afford the more expensive market based systems.

All doctors would participate in all three tiers through some regulation (management of nurses in third tier) but how this would work I'm not entirely sure.

The purpose is to compromise between not impairing what works about the US system - obscure and complicated treatments are readily available for those who can afford them - but fixing what doesn't work - those who can't afford medical treatment tend to suffer disproportionately. The Canadian system errs on that side by allowing everyone the same access but thereby artificially restricts the access of those who can afford better treatment and consequently reduces incentives for improving and experimenting in medical techniques.

This is a very raw idea. This is my proposal, I'm curiously to hear constructive additions and modifications of this proposal. Help me flesh this out.


Su Dongpo

1 comment:

A. Smith said...

You had to take an unnecessary potshot at the military didn't you?

"In order to accomplish this military spending would have to be cut and lots of money would have to go into recruiting qualified nurses from abroad and subsidizing the training of individuals in the US."

The U.S. already spends more on medical services (14% of GDP) than military (4% of GDP). And the proportion on medical services is increasing much quicker. Even if we spent $0 on the military it wouldn't impact medical service spending that much.

I recognize that I'm not putting forward a solution b/c health issues are such a large beast that I do not have a great grasp of a single solution. But the idea that our military is crowding out medical services is an unsubstantiated political stance that takes away from an otherwise interesting idea.