Please vote up "The Sperry Plan" (an evolvable "single payer plan) question at: http://change.gov/page/content/openforquestions_20081217_private_url
THE SPERRY PLAN
PART OF THE ANSWER TO THE HEALTH CARE PROBLEM
(The below plan was presented to David Cutler as an evolutionary plan not a revolutionary plan. It should cover MEDICAID and should be open to anyone who doesn’t have insurance on a means basis the way the “single payer” plan is in Japan. It should also be an option for MEDICARE and anyone else. It is believed the bonuses for better care and service will provide a service that will be the most attractive to all as they see it work and as it brings its costs down.)
To obtain optimum health care for less we must change the way we buy health care. It is easy to do. All that is necessary is to stop letting the special interests control the market through fear mongering. We are the source of the money and we can decide how we want to give it over to the health care providers and insurance companies. As we decide we wish to change the way we buy health care, the health care providers will have to adapt the way they sell or get out of the health care business.
The Meat:The Sperry Plan has contract bonuses based on morbidity report line items and service satisfaction reports such that the bidder for a contract would see the bonus as the expected profit if a projected performance is met.
Endemic health problems for a bid area could be approached by providing increased bonuses on that morbidity report line item. An example of a morbidity line item and its related bonus might be .01% for meeting a minimum acceptable rate of live births.02% for achieving a national average rate of live births .02% for achieving a locally set goal of live births .02% for exceeding the locally set goal by 20%Etc.The above is picked out of the air. It would be expected that contract administrators would be able to set the bonus items somewhat scientifically on a goal achieving target basis which should be somewhat based on community input. Such items should bring more focus on the less costly preventive medicine methods of health maintenance and benefit us all with a longer life expectancy and lower cost health maintenance.
Others have been thinking along the lines of some of The Sperry Plan details.
Peter Diamond: Institute Professor, Massachusetts Institute of Technology wrote an op-ed for the New York Times in 1992 entitled “Fanny Medic”. His basic premise, we should buy health care based on where we live, is on the right track but the Sperry Plan had it first. Lemuel was promoting the better and more complete Sperry Plan in the Los Angeles area in 1991 as a potential ballot initiative but was unable to have or raise finances sufficient to get it off the ground.
The Sperry Plan buys health instead of sickness. Contracts for health maintenance would be issued by location with the consumer choosing his home zip code, his work zip code, his school zip code, or a neighboring zip code for the location of his health care.
The consumer would be able to choose his physician and hospital with in his selected area. Emergency care would be at the nearest available site with fixed day rate transfers between the provider of the care and the patients health maintenance contractor. (This charge would be similar to the fixed charges by military medical facilities for emergency care to those who would not otherwise be qualified for care at military facilities.) A patient who becomes dissatisfied with his contract area’s care should be able to change his area at will.
There would be no co-payments.
A physician’s assistant corps would be developed by methods similar to the training of Navy corpsman. The physician’s assistant corps could be reserve military and would be assigned to health maintenance contractors on request with the contractor picking up the costs of pay and benefits for the members of the physician’s assistant corps assigned to them.
The physician’s assistant corps is the backbone of the preventive medicine item of no co-pay. Physician’s assistant corps volunteers should be able to receive full scholarships to medical, nursing or medical technical school if they are mentally and physically qualified, including the pay and benefits of military academy cadets and if a slot is available. They would be required to continue to serve the corps as assigned for a minimum of say 2 years for each year of training as a means of payback.
The Sperry Plan has a contract bonus based on morbidity report line items and service satisfaction reports such that the bidder for a contract would see the bonus as the expected profit if a projected performance is met.
Endemic health problems for a bid area could be approached by providing increased bonuses on that morbidity report line item. An example of a morbidity line item and its related bonus might be .01% for meeting a minimum acceptable rate of live births.02% for achieving a national average rate of live births .02% for achieving a locally set goal of live births .02% for exceeding the locally set goal by 20%Etc.The above is picked out of the air. It would be expected that contract administrators would be able to set the bonus items somewhat scientifically on a goal achieving target basis which should be somewhat based on community input. Such items should bring more focus on the less costly preventive medicine methods of health maintenance and benefit us all with a longer life expectancy.
A percentage of the bonuses would be required to be shared with all employees on a pro-rata basis to help improve “bed side manner”.
No type of current medical provider would be blocked out of being a contractor or subcontractor. If an insurance company using fee based medicine could achieve profitable results and meet the morbidity and consumer satisfaction standards they could bid on a contract. The patient however, must be exempt from filling out claim forms other than signing a certification that the care was received. It is unlikely that an insurance company could obtain a competive basis bid contract because of their added costs of claim administration and a requirement that they pay all claims.
Anyone who is satisfied with their present medical plan would be able to continue it. Employers who provide health insurance presently would be required to maintain what they have as long as the employer cost isn’t raised and be required to add The Sperry National plan as an option.
Everyone would be required to pay Sperry Plan premiums according to their means, and other available coverage; a minimum premium for National Catastrophic incident coverage and would be transferred to The Sperry Plan on exhaustion of all other insurance benefits. In this manner The Sperry Plan would replace much of MEDICAID. Everyone would be required to be insured or post an adequate bond to assure their ability to pay for their health care out of pocket. In the event they choose to “roll the dice” and not pay for health insurance other than the means tested catastrophic fee collected with the Income Tax (MEDICAID now hidden in your tax bill), they would have to catch up all unpaid premiums from the point of their last coverage until they need insurance covered care. (Similar to what MEDICARE does now for those who elect not to have other than hospital coverage except not as onerous.)
The Sperry Plan would take all pre-existing conditions without an additional charge. Any state desiring to add their welfare recipients or other destitute residents to The Sperry Plan could do so by doing the means testing and could elect to pay the premium for such individuals.Premium collection and issuance of insured cards would be administered by the IRS while the contract auditing and oversight would be by the National Public Health Department. Local area contracts would be administered by contract administrators selected by state publically elected officials and approved by the Surgeon General of the U.S.
Prescription Drugs need to be free. We don’t want anyone to die because they can’t afford or think they have more important choices than their medication. To keep the cost down, military style pharmacies should be at all clinics. How the commercial pharmacies will be compensated for loss of business is a question? Perhaps they could bid as a subcontract for providing pharmaceutical services.
THE SPERRY PLAN is not written in stone. Let's discuss it and revise it to the point that most voters will accept it. It can be revised or repealed even after it is enacted. But let's get off the fence and do it. Just do it.
For editable copies of this blog email me at: lembray@hotmail.com
Plenty of space has been left to insert flags in the pdf file, or if you choose you can recommend changes in the word document and send which ever you use back to me. We’ll discuss the changes and up dates on the various forums for this purpose. Ultimately, I may send 2 or 3 versions to David Cutler and the institute writing the details. (I’m still hoping to be selected to be on the institute.)
Questions that have not been addressed:Tort reform. Evolution of inclusiveness.
HISTORY
In 1963, The Sperry Plan was hatched by a Dr. Webb (If I remember his name accurately) aboard the USS Sperry AS-12 following a Saturday morning sick call just before the watch was set and the liberty crew was off for the week end. It has since tweaked it to avoid the “incentive problems” which, although different, exist both in socialized medicine and fee based medicine.
Some of the corpsmen were complaining because of the “minor things” such as simple colds etc. that members of the crew were bringing to sick call and were saying that there should be a co-payment similar to that which civilian insured had to pay for medical care so the medical department could concentrate on the more serious complaints.
Dr. Webb insisted that the “Navy Medicine” was best and that it should be adapted for a National Health Care system. He said it best met the reasonable goals of medical care by both the right minded health care providers (the ones you would want to take your problem to) and the patient.Goal 1: The right minded physician doesn’t want to worry about the patient’s ability to afford the care and adjust his diagnostic procedures accordingly.
Goal 2: Both the physician and the patient want the best possible outcome and want to have available whatever advanced diagnostic procedures, treatments and equipment is available.Goal 3: Both the patient and the physician don’t want to worry about the money. The patient whether he can afford it or not and the Dr. who wants the best mental attitude in his patient for the optimum outcome and no paperwork or worry by the Dr. in getting paid for his services. The patient particularly doesn’t want to worry that he is getting an unnecessary operation because the Dr. needs the money.
Good as far as it went but it needed tweaking.
Later analysis realized the “economic incentives” were the primary impediment to optimum medicine. In socialized medicine, such as “Navy medicine”, HMO’s and other socialized medical programs there is no financial incentive to the provider for doing their best. (As was exhibited by the complaining of the corpsman on the Sperry) The patient is locked in to the provider to a greater of lesser degree. The provider gets no more or less money based on the quality of service.
Fee based providers actually work harder and longer hours in order to obtain a larger customer base (practice).
HMO’s improve their bottom line by denying the patient some tests or procedures because they may show no pathology—thus often delaying the care of the “cold symptoms” until the problem has gone too far. Also denied are extra days in a hospital bed that may have proved beneficial.Fee based medicine sells you as much as they can get away with, or as much as you or your insurance will pay for. (A problem that has to be dealt with by all single payer plans)
The socialized medicine care giver must derive his motivation to give his best care altruistically. At least there is some motivation to control costs and some motivation to control costs by getting the patient healthier from management.
In Fee based medicine the primary impediment to optimum care is profit motive that goes against the patients’ goal of getting healthier. No fees are paid by or on behalf of healthy people.If there is not enough call for your new drug you advertise to drum up new business. Never mind if you flood the physicians’ offices with hypochondria. Some won’t mind because they get their fee.In 1965, while working a part time night shift in a local Catholic hospital in Waukegan, IL near the Great Lakes Naval Hospital, a conversation between two physicians in the canteen late at night was overheard. They had apparently just finished with an emergency cesarean. One was saying to the other, on that late spring night, that he had seen a boat at a local marine sales that he just had to have, but didn’t have enough for a down payment. “Would you believe it,” he said, “3 hysterectomies walked into my office on Monday.” One must question how many of these were necessary. Certainly the physician believed the hysterectomies were necessary or he wouldn’t have mentioned them. And he didn’t give thought to how it must sound. Still, how much was his judgment colored by his moment of financial need. And would the second, then scowling physician have done them. (More emphasis for the need of the Sperry Plan)
Fee based hospitals mark up things provided to the patient based on item cost. There is no incentive to shop for the cheaper elastic back support because 30% of $70 is more than 30% of $30. And if they can get it cheaper they can still do the markup on the higher cost, as long as they keep some of them, and get away with it. So the elastic back band that you could get off the shelf at a local department store for less than $30 will probably cost you or your insurance company more than $90 if it is provided to you in a hospital emergency room. And with insured Fee based medicine you have to worry about the catastrophic incidence.
If you have an automobile accident with a paralyzing back injury your insurance will be maxed out of benefits. You will have to divest of all your assets and request Medicaid unless you are a multi-millionaire. When looking at “health care” costs, particularly the runaway costs in the U.S. now, one must consider the total national cost and all elements in it rather than our personal individual portion because we are paying our share of the total one way or another. We pay in higher taxes, higher passed on cost of goods and services, or directly in higher medical and medical insurance costs to make up for those who don’t or can’t pay.
So you say, “I don’t like the HMO medicine, so I know I won’t like socialized medicine. How about the point system, single payer, fee controlled national plans such as Japan and Canada.” They have the best part of fee based medicine for the consumer and I won’t have to worry about affordability. I’ll pay according to means. And I won’t have to worry about divesting my assets that I plan to pass on to my children to cover catastrophic health care costs.
And all HMO’s aren’t so bad. Secure Horizons of CA use to provide MEDICARE recipients full coverage including dental for the MEDICARE premium under a contract with MEDICARE that allowed them to avoid the claims form administration except for out of area care for which there was also a co-payment.
Fee based single payer point systems are better than socialized medicine and the multi--payer runaway plan we have now. The Japanese, for example can choose their physician and hospital for care. But their plan is not the best possible. And they still have the co-payment that causes some to wait too long to go the Dr.
The primary problem with the single payer plans is they put the health care providers’ hands in your tax and premium pocket. This is not nearly the problem in Japan that it would be in the US. It doesn’t matter if you are ready to be discharged from the hospital, you’ll be kept as long as the point system allows. And the economic incentives are still not right. If you want better health care for less then the “market” should be structured in that way. The computer I am working on is cheaper and far better than my first computer. That is because the market is competitive in the consumers’ favor.
Purely socialized medicine is deficient because of the quality of bedside manner, long lines and delayed access because of insufficient numbers of care givers and insufficient motivation of care givers to give extra time.
Navy medicine, by not having a co-payment, all small problems that develop into big ones are followed and well documented. The over working of the physician is handled by the corpsman screening and taking care of those they can handle and documenting that “cold” that won’t go away so that when it comes time to look more closely to see if it is really a symptom of a major developing problem there will be no further delay by the physician waiting to see if it would get better on its own.
Lem Braylembray@hotmail.com
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