SENATE BILL: Reforming Atlasian Public Health Act of 2014 (Debating)

[bore]

Maybe I'm reading this wrong, but it seems to me that to say the Singapore government spends a lot less on healthcare is a bit misleading. If Medisave is compulsory, it's a tax in all but name.

[Simfan34]

Yes, but the point is to promote personal responsibility.

[bore]

Yes, but the point is to promote personal responsibility.

But if it's a percentage of your income which you have to pay regardless of your lifestyle, it does nothing of the sort.

[Simfan34]

The idea is that if you are pputting in money into an account with your name on it that you can check and feel is really yours, one will choose to avoid wasteful spending as opposed to being the beneficiary of "free money" from the government that isn't really free.

[TNF]

The idea is that if you are pputting in money into an account with your name on it that you can check and feel is really yours, one will choose to avoid wasteful spending as opposed to being the beneficiary of "free money" from the government that isn't really free.

Why shouldn't people be entitled to "free money" for medical care? Arguing otherwise is pretty ing insane, if you ask me. I'm at a loss as to how anyone can defend profiteering off of sick people. Let's just stop with this inventing middle-men bullsh**t and eliminate the problem: profit in health care. Tax the sh**t out of the rich and give everyone free care at the point of use. This isn't hard.

[bore]

The idea is that if you are pputting in money into an account with your name on it that you can check and feel is really yours, one will choose to avoid wasteful spending as opposed to being the beneficiary of "free money" from the government that isn't really free.

See, I'm inclined to think that a doctor is far better placed to decide what is and what isn't wasteful care. This system would likely lead to the poor scrimping on operations or scans because they worry they can't afford it, even if they need it, and the rich getting every operation and scan even if they don't need it.

I'm not sure what the health system is like in other countries, but in britain you get the treatment a doctor thinks you need and that's it, you, being unqualified, don't make that decision, and that's how it should be.

[Fmr. Pres. Duke]

I don't think anyone should advocate massive profits in the healthcare industry. There are some things that I believe should not be for profit, like education and healthcare.

But the system I am talking about is one that is heavily regulated where, yes, private insurance as a supplement exists, but the federal government will set the policies and the prices to ensure there is no price gauging or profiteering off the backs of sick people and the poor will not pay a thing to have access to healthcare.

Of course, taxing the rich is not the answer. Yes, they must pay more because I believe in a progressive tax, but I will never enact a tax that takes 90% of someone's income because they are rich despite knowing some in this senate would want that. Anyone who knows anything about laffer's curve knows that isn't good policy.

[Southern Senator North Carolina Yankee]

People to need to understand that healthcare inflation is caused by three things.

1. Increased Usage - The alternative of denying coverage is not really desirable. In the modern era, people should want to be healthier and we should design a system that makes that possible. One thing we can do is to reduce unnecessary usage by encouraging more responsbile behavior by putting a current term costs with those current actions. With the plan that shua and I are working on, you could give a financial incentive if you utilize prevenative care (which is still going to be provided free), or perhaps join a wellness program similar to what Riley's original bill contained. This will reduce the costs long term and you cannot do it as well with a free at the point of use system.

2. Tuition Inflation - Means that doctors have to earn more to pay off the loans that got them through John Hopkins and Harvard Medical School, so it gets passed from the education sector to the healthcare sector. And we should refrain from bashing doctors, for wanting to earn a decent living for doing brain or heart surgery. To do otherwise would cuase a severe skill reduction, we have seen what has happened from short changing teachers, you end up with the lower academic performers in the profession with the top performers beocming doctors, engineers, lawyers or going to make a killing on wall street.

3. Liability Insurance Inflation - Another pass through from the rising cost of insurance to protect against malpractice suits. Another risk from short changing the doctors is the likelihood that less skilled doctors will make more mistakes of course, which are a cost in and of themselves. There is also of course the cost of unnecessary procedures being done simiply to protect against such lawsuits (which can be tacked back on to number one). It is difficult fordoctors to give people only what they think they need when they have to constantly guard against the lawsuit to follow and at the very least pay for the insurance against such.

[Southern Senator North Carolina Yankee]

I very strongly support the formation of Singapore-style Medisave accounts. I very strongly support Singapore-style anything, but their healthcare model in particular is a model to be followed. Central Provident Fund and all. Indeed, I'd support repealing healthcare taxes and having it be completely paid out of Medisave funds, with means-tested subsidisation when necessary funded through transfers and direct subsidies from the general fund to the ANHC.

Can you explain this I am confused. If you repeal the healthcare taxes, how do you pay for the subsidization? If you take it out of the general fund that would require something rather substantial to be cut in the rest of the budget, no?

[Deus Naturae]

To add to what Yankee said, another problem with med schools is that the accreditation system restricts the supply of physicians (and thus drives up costs) considerably. My understanding of the process is that in order to get licensed, you need to intend an accredited med school. The Federal board that does the accrediting is basically run by the AMA, so there are some obvious perverse incentives there.

And to add on to what he said about high liability costs, that's a problem not only for medical practitioners but also for medical device manufacturers. The massive penalties associated with product liability lawsuits (and under the current legal structure, manufacturers are the only ones liable for device failures/accidents) act as a massive disincentive towards developing new medical technologies, and necessarily increase the costs of existing devices.

[bore]

Surely the answer to having too few doctors is to accredit more schools, not to throw the baby out with the bathwater?

I can guarantee that if we allow anything to go in the training of doctors in a few years there will be countless scandals involving poorly trained doctors killing their patients.

[Southern Senator North Carolina Yankee]

Surely the answer to having too few doctors is to accredit more schools, not to throw the baby out with the bathwater?

I can guarantee that if we allow anything to go in the training of doctors in a few years there will be countless scandals involving poorly trained doctors killing their patients.

Certainly there is some middle ground between too few and too many, one that preserves that academic rigor, yet meets our needs.


I think we are moving too far afield though and will need several bills to deal with some of these other aspects, important though they may be.

[bore]

Surely the answer to having too few doctors is to accredit more schools, not to throw the baby out with the bathwater?

I can guarantee that if we allow anything to go in the training of doctors in a few years there will be countless scandals involving poorly trained doctors killing their patients.

Certainly there is some middle ground between too few and too many, one that preserves that academic rigor, yet meets our needs.


I think we are moving too far afield though and will need several bills to deal with some of these other aspects, important though they may be.

Yeah, there will be a middle ground.

I might introduce a bill to deal with accredition, so we can deal with that seperately...

[Southern Senator North Carolina Yankee]

Be prepared to have it hit the floor soon if you do. Clogging rule and all that.

[Sec. of State Superique]

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I'm sorry for arriving so late on one of the debates that I really enjoy and I apologize for my inactivity during this month. I was pretty overloaded with homework, my exams and the Brazilian equivalent of the SAT.

Anyway, I was taking a look at what you've proposed Yankee and I might say that I pretty enjoyed the idea. Despite not being a fond of subsidies for healthcare private plans, I always believe that the best way to improve a system is allowing the citizenry to opt on a varied types of levels. From the insurance to the providers, being allowed to chose is important and crucial, although the later is much more important than the first. Summing things up, I would like to say that I'm favorable to the changes that you are proposing for our healthcare system.

However, while reading your bill, I might say that Section I - #3 gave me the impression that Regional Governments are permitted not to allow any private insurer whatsoever in their state, am I wrong?

If I'm not, I would like to say that this would be perfect and I think that we should keep it. One of the things that I've been thinking for a long time about Atlasian Healthcare is that maybe we should pass some of the responsibilities of handling Healthcare to the Regional Level. More than just allowing them to opt or not opt to have private insurers in their market, I think that we should allow our Regions to become laboratories of Healthcare Innovation with each Region trying to find its own way of providing Healthcare. I don't know what you Senators think of this, but I'm just throwing this idea in the debate.

[Southern Senator North Carolina Yankee]

For one thing as I have stated, the competition to ANHC will not just be private insurers and those private insurers will look much different. I was figuring that with our likely co-operative developement Act going to pass, that you might them and other non-profit health insurers come online that would provide an alternative as well giving three types of options potentially.

And yes, if a region wanted to, they decide against allowing any to compete against ANHC, giving them the equivalent of the Vermont exemption from Obamacare (meaning single-payer).

Superique, I can use your assistnace on some of the other elements as well. You are familiar with your own contries' various programs  that are built around saving's components I assume and you already have clearly read the framework that shua and I have put together so far, how would recommend crafting the savings component?

[Southern Senator North Carolina Yankee]

Does anyone know anything about this "paying based on outcomes" as opposed to by the number or procedures. I recall hearing about in various discussions but I have forgotten the details. Isn't that what they do at the Mayo clinic?

From what I can remember it sounded like a good way to boost quality, cut costs and reduce those unnecessary procedures we discussed, whereas most measures do one at the expense of the other like tort reform requires balancing the need to guard against mal practice whilst trying to reduce unnecessary procedures and costs and a lot of cost cutting can also come at the expense of quality and so for.

So how does this process work, can it be done on a large scale or should it be done experimentally first?

[Southern Senator North Carolina Yankee]

If we cannot achieve tangible progress in the thread, we can at least keep discussing these other related factors and thus seeding bills in the process that can be offerred whilst I work out issues behind the scenes.


So about the billing by result instead of procedure?

[Lumine]

If we cannot achieve tangible progress in the thread, we can at least keep discussing these other related factors and thus seeding bills in the process that can be offerred whilst I work out issues behind the scenes.


So about the billing by result instead of procedure?

I've been researching the "paying based on outcomes" as you describe it, and so far my reaction is rather mixed after seeing some of the downsides (which involve both results and implementation). If we assume our current Health Care system has not butteflied this, there should be a growing number of clinics in the United States using the system, with the Mayo Clinic being the prime example. It's supposed to increase quality (a Mayo Clinic Doctor said: "you get what you pay for") and provide a far better service, but the initial experiments in the United States never accounted for the cost, which apparently shot through the roof.

Now, the results in Hospitals and Clinics were initially better, but as time went on and the rest of the Hospital catched up with other programs there was virtually no difference. Paying based on outcomes also has to rely on independent organizations to check on the results, organizations that we are going to have to pay for (and I suspect the cost will be  rather high in light of how many Hospitals and Clinics they will have to follow). One of the sources I checked (http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78) also stated that some Hospitals feared to be "shamed" (as such a method was bound to hurt poorer zones and such).

I still have to do more research on this, but so far it seems overtly complicated and expensive to implement (this is still an experiment since there's no Obamacare, so it will definetly require more experimentation if we want to go forward).

[President Tyrion]

I very strongly support Singapore-style anything, but their healthcare model in particular is a model to be followed.

I don't know if you're being a bit hyperbolic, but Singapore is incredibly authoritarian about some things. Are you sure you want that?

[TNF]

I very strongly support Singapore-style anything, but their healthcare model in particular is a model to be followed.

I don't know if you're being a bit hyperbolic, but Singapore is incredibly authoritarian about some things. Are you sure you want that?

Will given Simfan's distaste for democracy, it wouldn't really be surprising.

[Southern Senator North Carolina Yankee]

If we cannot achieve tangible progress in the thread, we can at least keep discussing these other related factors and thus seeding bills in the process that can be offerred whilst I work out issues behind the scenes.


So about the billing by result instead of procedure?

I've been researching the "paying based on outcomes" as you describe it, and so far my reaction is rather mixed after seeing some of the downsides (which involve both results and implementation). If we assume our current Health Care system has not butteflied this, there should be a growing number of clinics in the United States using the system, with the Mayo Clinic being the prime example. It's supposed to increase quality (a Mayo Clinic Doctor said: "you get what you pay for") and provide a far better service, but the initial experiments in the United States never accounted for the cost, which apparently shot through the roof.

Now, the results in Hospitals and Clinics were initially better, but as time went on and the rest of the Hospital catched up with other programs there was virtually no difference. Paying based on outcomes also has to rely on independent organizations to check on the results, organizations that we are going to have to pay for (and I suspect the cost will be  rather high in light of how many Hospitals and Clinics they will have to follow). One of the sources I checked (http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78) also stated that some Hospitals feared to be "shamed" (as such a method was bound to hurt poorer zones and such).

I still have to do more research on this, but so far it seems overtly complicated and expensive to implement (this is still an experiment since there's no Obamacare, so it will definetly require more experimentation if we want to go forward).

Why did the costs go up? What were the quality downsides that you referenced

Also what forms of experimentation woudl you be willing to support?

[Potus]

The unnecessary procedures that you're talking about are, in large part, caused by two things. The first is defensive medicine that is incentivized by the way medical liability works. The second is the lack of care coordination.

We address the first one with limits on damages, and maybe some sort of government guaranteed liability insurance for medical providers. Reforming the way we go about medical liability will release the amount of unnecessary procedures and bankruptcies among medical providers. This cuts back those useless procedures.

The second one is a bit tricky but I proposed it earlier. Create a tax variable for institutions that coordinate care and promote efficiency. The Health Efficiency Tax Deduction would either decrease or increase your tax liability depending on whether the cost of providing care increased or decreased during the previous year. This creates a strong incentive to coordinate care and reduce costs.



Also, any discussion on cost containment should also include discussion of intellectual property. We need to embark on a liberalization of our copyright laws in order to foster competition and innovation. By opening up the intellectual property market and allowing small businesses and individuals to capitalize on their ideas and knowledge, we can push medical technology and pharmaceuticals to new heights with competition. Many times, people say care continues to increase in cost because of medical tech's march forward. It is not a good solution to slow that march, but rather increase it. By devaluing the current technology that is very effective, we raise the bar for care across the board and expand access to today's technology.

[Southern Senator North Carolina Yankee]

Also, any discussion on cost containment should also include discussion of intellectual property. We need to embark on a liberalization of our copyright laws in order to foster competition and innovation. By opening up the intellectual property market and allowing small businesses and individuals to capitalize on their ideas and knowledge, we can push medical technology and pharmaceuticals to new heights with competition. Many times, people say care continues to increase in cost because of medical tech's march forward. It is not a good solution to slow that march, but rather increase it. By devaluing the current technology that is very effective, we raise the bar for care across the board and expand access to today's technology.

I would recommend pursuing that Intellectual property issue through a seperate bill, like Bore did on the doctor shortage. Chances of it passing are higher and it will decrease the size of this, which is already seeking to be large.

[Southern Senator North Carolina Yankee]

We address the first one with limits on damages, and maybe some sort of government guaranteed liability insurance for medical providers. Reforming the way we go about medical liability will release the amount of unnecessary procedures and bankruptcies among medical providers. This cuts back those useless procedures.

Like Deus said, the medical device providers need to be considered as well. How would such a gov't guarrantee liability insurance be structured?

The second one is a bit tricky but I proposed it earlier. Create a tax variable for institutions that coordinate care and promote efficiency. The Health Efficiency Tax Deduction would either decrease or increase your tax liability depending on whether the cost of providing care increased or decreased during the previous year. This creates a strong incentive to coordinate care and reduce costs.

How would it be to structured to not go too far. If cost cutting is poorly done or done in a way that puts the short term over the longer term, we could end up worse off overall.