So, again, which would you prefer and why?
I'd thrown it open for discussion, but would be happy to address it.
Some basic systems analysis.
System
Define the system if we consider any element of healthcare which is as general as you can get:
- individual providers (doctors, hospitals, midlevels, nurses, and assistants)
- organization or system providers - health insurance entities, drug companies, medical device manufacturers, etc.
- administration both private and public, state and federal
- anyone else that could be a cost to the system that provides healthcare or derives profit from the system.
Goals (general, may or may not be attainable)
1. Reduce costs to the system and to the users
2. Make the system efficient and effective in providing care
3. HC coverage for the maximum amount of Americans
4. Allow for a reasonable profit or increases (salaries, etc.) to the system components (defined above)
5. Address shortages in areas of need - rural, primary and specialists physicians, hospitals, etc.
6. Educate providers and users
7. Enforcement of laws, e.g. fraud
Objectives
So you construct a system that works towards each of those goals by setting Objectives. This can only be done on a federal level and the system must cover both public and private entities.
For example, medical criteria for an admission to a hospital or skilled nursing facility reduces costs, makes the system more efficient, forces providers to become efficient and deliver care at the appropriate level.
Another, an electronic medical record and digital images allow easy access to providers, and its standardization and compatibility facilitates efficiency, may reduce costs, timeliness and appropriate care.
Bundled payments for admission diagnoses with limitations on length of stay gives elements that reimburse on a standard, thereby reducing costs and making the system efficient.
A single payer system also meets many of the goals above.
Regulation of drug prices and negotiating of prices controls costs. Generic prices are set at affordable (to patients) levels. Allow importation of drugs from other countries, but they must be of the same quality.
Fraud eats up 15% of health care dollars, so the DOJ needs to control to recover billions, which is also facilitated by the electronic medical record.
Costs differ between states (salaries, property for hospitals, etc). So flexibility must be built in. Allow states to be flexible in constructing a system that addresses their needs.
Those are starters and meant as examples. You should also define barriers to these objectives and devise a system that is fair to all. For instance, you need to adjust for risk and unexpected catastrophic costs to the system. I can think of more but will stop here.