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

[Lumine]

Nay.

While I commend TNF on trying to find a solution and taking the time to do this, I don't believe single payer is the solution, nor I believe it would be practical to the Atlasian context in light of the challenges that Fritzcare faces.

[Lumine]

Better idea:

No market mechanisms whatsoever
Care is free at the point of use
Free medicine for all
Public ownership of all medical facilities and Big Pharma
Medical facilities managed by those who work there
Funded entirely out of general revenues

We can certainly discuss the theoretical benefits of such a system, but can we really afford the costs involved in those proposals? And furthermore, what would be the point of pushing for nationalization of the health industry? If anything, past events show that we can't sustain or manage something like that. While I am not involved in the discussion as I should be, I support Shua and Yankee's efforts and the framework they are designing.

[Lumine]

I think there are three ways to handle Part III.

1 Use Fritzcare in a medicare like form to cover the veterans and those with mental illness, maybe even those with pre-existing conditions.

2. Use the main subsidized pre-medium sysrem for as many of those as possible with some kind of fall back for the rest.


3. Some kind of self-contained VA like system branched off of the Fritzcare public option.


I think three is the most complex, expensive and considering the recent RL information, it might wall them into an inferior model and we don't want that. They should get the best not the worse. So maybe some combination of 1 and 2.

I would personally recommend using the first one. Much as I support introducing more and more free market elements (like the Health Savings accounts), I believe the least we could do for the veterans is to have them covered (mental illness is also a tricky issue). And, from a political point of view, it might give this bill a great chance if keep those benefits. Still, I recall that an earlier TNF bill stated that the health care benefits of the veterans were to be increased, perhaps it was one of the anti-imperialism bills?

[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).

[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).

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?

Mostly because the experimentation so far has focused on quality alone, which meant there was a disregard of the potential costs of the system. Increased experimentation and a focus on cost as well (as some clinics have started to do in the past year) would probably help reduce this, but then again it will take some time before it's efficient enough to be implemented (at least that's what I think). With quality downsides I didn't mean that quality would go down, but the actual increase was not really impressive once the rest of the hospitals and clinics were able to catch up through modernization programs.

I guess we could perfectly set up a few clinics (some private and the rest public via the SoIA, perhaps?) with a determined span of time and the directive to focus on the combination of quality/cost, but that would take some time.

[Lumine]

Aye!