bud’s four-tiered health care system

Just to show that I’m serious in my admiration for people who are able to articulate smart plans from scratch (rather than reacting the way I tend to do), and to further our discussion, I thought I’d give bud’s four-tiered approach to health care coverage, which first appeared as a comment back here. Compare and contrast it with Doug’s informal proposals, and with the single-payer idea I offered as a way of starting this conversation (most formally set out in HR676):

Doug, your point is well taken that funding of our health care
system is extremely complicated. I would suggest for starters a four
tiered system. These tiers would have nothing to do with age (medicare)
or income (medicaid). Instead they would focus on health care urgency
and time.

Tier 1 would be for the funding of major 1-time events. These would
include serious injuries from accidents and crime victims, heart
attacks, strokes and other narrowly defined situations. These could be
100% funded by the federal government. The list of these events would
be short and all hospitals would be required to accept the government
rate for these services.

Tier 2 would be events that are chronic such as cancer treatments,
diabetis and other longer-term illnesses. These events are more
complicated to address and hence there is likely to be some guess work
to define what ailments are included. Hospitals and doctors could
charge whatever they want depending on where they practice. Patients
could choose between the largely government-funded hospitals and those
that are mostly private (perhaps with a voucher approach). This would
allow some market incentives but would still allow everyone access to
decent care.

Tier 3 is for the preventive issues. Everyone could visit a state
clinic for shots, mammograms, colonoscopies and other screening
programs. Individuals would be required to fund a small portion of
visits beyond the basics each year. I don’t think a 100% government
funded program for tier 3 would work because some people would abuse
it. Needy folks might still be unable to afford the basics, even if
highly subsidized, but at least most people would could recieve care
without an emergency room visit.

Tier 4 would be for elective medical treatment. I see no need for
government involvement here. This would include plastic surgery,
vasectomies and liposuction.

I suspect there is a large grey area between tiers 2-4. But tier 1
should be pretty straight-forward. Some sort of blue-ribbon committee,
established by the government in a cabinet-level agency, could be
formed to place medical care into the proper category. The onurous
nature of th insurance companies profit motive would be greatly reduced
by this system.

18 thoughts on “bud’s four-tiered health care system

  1. Lee Muller

    Why should the government be involved in taxing me to help buy any level of medical care for anyone?
    No one has a right to medical care any more than they have a right to an automobile or a house. The only way for the government, which produces nothing, to give something to one person is to take it from those its rightful owners.
    The only way for government to force down the price of drugs and treatments is to force doctors, nurses, scientists and medical device engineers to work below the free market incomes which patients are willing to pay them now.

  2. Gary Karr

    Anyone who loves single-payer should read this article in The New York Times: http://www.nytimes.com/2007/11/30/business/30golden.html
    It ought to give you a dose of reality about the ability of the government to keep health care affordable. A government-run single-payer system will still have to make decisions about how much to pay for certain services. Money, after all, is not infinte. I imagine even Brad believes there is some level of taxation that is too high. (I kid because I care, Brad).
    Anyway, in a single-payer government-run or government-dominated system (like Medicare or this four-tier system) ANY decision government makes will be subject to potential protest from some quarter — doctors, hospitals, oxygen-supply companies (the focus of the NYT story), and of course those evil Big Pharma companies Brad hates so much.
    This is not to say that health care system in general is all hunky-dory. It’s a marketplace with many distortions, as people smarter than me have said, starting with the World War II-era distortion of government wage controls which led employers to start offering health insurance as a way to keep or recruit employees.

  3. H.Robbins

    I would favor a single-payor system for the following reasons:
    1) The US system spends twice as much for ADMINISTRATIVE COSTS as any other country in the world. We could consolidate all of the different programs (medicaid,medicare, etc.) and enjoy the savings from economies of scale.
    2) The definition of “insurance” is the pooling of resources to reduce risk, not the pooling of resources to enhance shareholder value. Our present day insurers have forgotten that.
    3) Employer sponsored health-care stifles entreapeneaurism in that many would choose to work for themselves except for the fact that they or a dependent need the “bennies”. In this respect, employer sponsored health insurance is the slavery of the 21rst century.
    As you can see, my concern is with health insurance-not the health care system. Too many times these are blended into one.
    Do I think health-care is a right? NO
    Is it the right thing to do? You bet!

  4. Wally Altman

    Lee, how do you reconcile “no one has a right to medical care” with unalienable rights including “Life, Liberty and the pursuit of Happiness”?

  5. Karen McLeod

    One reason for universal health care is that you don’t want to develop an underclass of people who can become a pool for various and sundry contagions (TB, syphilis, whooping cough to name a few). When you have people who do not receive appropriate medical care you tend to develop such a ‘class.’ If these people don’t actually have any given disease, they are usually to weakened by other problems to have much resistance to anything.
    We are already paying for others’ health care, in the form of subsidizing public hospitals. That’s the expensive way to do it. If we stop that, we literally run the risk of having to step over dead bodies on the way to work or school. More disease and contagion anyone?
    I can think of few things that can make a person more desperate than having to watch a loved one suffer without having any way to relieve that suffering. And desperate people do desperate things.

  6. Lee Muller

    Our fundamental rights to life, liberty and the pursuit of happiness would be grossly breached by a socialist medical system which takes away freedom of choice, punishes those who work and save to provide for their families, to hand out vote-buying mediocre care to the lazy and frightened masses which politicians would control.
    If you give up your right to use your money, to choose your medical care, for yourself, and your family, you have lost your freedom and dignity.
    Enslaving productive taxpayers is no less immoral than enslaving workers on plantations. It elevates the status of the deadbeat as having a superior right to the labor of others.
    Socialized medicine isn’t about providing better medical care – it’s about socialist control of people.

  7. slugger

    Why did the issue of healthcare for everybody all of a sudden raise its ugly head?
    Politicians want to get elected. Who vote in mass? What party can carry the needed votes? Ask Hillary. She knows. The main part of her platform is that she knows more about the healthcare problems than any other candidate and she has the solutions by providing healthcare to everybody.
    When the masses get to the polls to vote for Hillary and socialized medicine it will be taking the money from the working class people to give to the non-workers. Before her 8 years are up as a two term president, there will be only two classes of people in the USA. The rich and the poor because the middle class has to pay for everything and they will be only getting a day older and deeper in debt.
    Oh. I know that you think that the rich pay as much taxes as everyone else but there are more in the middle class. Hillary will find a way to see that everyone in the USA that makes over a certain percent of income or profits in a year, will turn the rest over to the government. Maybe industry has seen this coming and that is why they have moved to other countries?
    Maybe it is better after all for the future of our country to have a lying republican instead of a socialist democrat?

  8. Karen McLeod

    I’ll give you odds that even in a “socialized” medical system you’d have some doctors who would choose to charge more, and some people who would go to them. What we need to do is ensure that all who need it get competent, ongoing care. Currently we are paying through the nose for episodic “emergency” care, which is more expensive because it lets little problems go until they become big problems, and does not provide preventitive care at all, or ongoing care to keep chronic disease from worsening. In the long run this would cost us less, because it would enable people to be healthy and productive longer, and it would reduce the number of children coming into adulthood with medical and physical baggage.

  9. Brad Warthen

    slugger, let me ‘splain something to you about the actual world of politics:
    Non-workers don’t vote. The idea that they do is a libertarian fantasy that is necessary to prop up the whole philosophy.

  10. slugger

    Brad your comment Non-workers don’t vote.may very well be true in Columbia but where I come from. I know that you are pulling my leg. Hillary is a dangerous political animal. She has all kinds of plans for us.

  11. Lee Muller

    The only non-workers who don’t vote are those with criminal records, and the ones that are too lazy to vote (thank God).
    If only those who paid more in taxes than they received in government handouts, payroll and retirement could vote, Garbage Government would be tossed out in the next election.

  12. Karen McLeod

    Thank you, Brad! Not only do non workers not vote, the working poor usually don’t vote either, and in any case, unless you have more money than most of us in the lower middle class, your vote is about as much influence as you get. Unless you can support a lobbyist or (speak softly here) the politician, him or herself, you have very little direct influence. You’re just sitting out there, waiting to be influence by whatever misinformation and scare commercials those with influence can dream up.

  13. Karen McLeod

    Lee and Slugger, There are still more of us that of them–are you suggesting, after 8 years of robbing from the poor and giving to the rich–that they are voting when those of us who work and have leisure to think and consider (and hunt down policy statements on the web) don’t?

  14. slugger

    Non workers do not vote. You got to be kidding me. When you go to voting polls and see the voters being brought to the polls by the numbers in cars, vans and busses to vote, who do you think are providing the rides to the polls? Wake up.

  15. Lee Muller

    Ms. McLeod,
    You don’t sound like you are one of “us” High-Productivity Citizens.
    As for “robbing from the poor and giving to the rich”, could you be more specific? Are you referring to GOP repeal of Clinton’s tax on the middle class? The tax cut which ended the Third Clinton Recession?
    It’s confusing, because the Democrats talk about taxing the rich, but they just passed a 50% income tax increase on the lowest income bracket workers, set to take effect in 2009, after the elections. Last week, millionaire Senators were calling anyone who made over $50,000, “the rich”.


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