Wednesday, October 21, 2009

Science is whatever we want it to be.

OK, after listening to my friend Ira Glass' two part radio program on health care, I think I've got a pretty good handle on things. When I am king, one of the first decrees I shall make is, "Fix health care." Even though the problems are old and convoluted, they'll be easily whisked away in a way that no president can whisk. Not even Obama, that charming motherfucker.

If you haven't listened to the This American Life special on health care, you should. But for now I'll give you the Reader's Digest Condensed version without the evil Christian angle. Here it is in a nutshell: Everyone wants to be wealthy and live forever.

That's it. The crux of all our problems. If we all had our way we'd be immortal versions of Brad Pitt or Angelina Jolie. Now while that would be awesome, like too much of anything there would be problems. Problem number one would be, who'd do math? Problem number two would be, who'd play the sidekick? As you can see, society would quickly break down if this were the case. So it is breaking down now. How can we resist the dream of looking good in an eye patch?

First thing. Everyone wants to be wealthy. Doctors want money from helping people. That's a noble cause, isn't it? But what if they help too much? People want to be wealthy by not having to spend money on being helped, though they want the help to be limitless. Insurance companies want to become wealthy being a middle man between the helpers and the helpees. Now we've got a serious case of helpees. (I just couldn't help typing that even though it has nothing to do with my point.)

So what do we do? Easy. We need to decouple money and health care, and couple money with health. Here's my plan. Every single person will pay a tax that will be the premium for health care insurance. The insurance will be a large oligarchy run coop that will be 100% non profit. Doctors will get paid a modest salary based on their specialty and amount of training and experience. Here's the kicker: they'll be a bonus for having really healthy patients. So for example, if you're a General Practitioner with your patients only coming in for basic checkups and vaccinations and stuff, you'll make more than if you have a lot of repeat business for the same issues. It'll be in your best interest to keep your people as healthy as possible before they come to see you with a problem. So maybe during your check-ups you'll spend a little time going over what a healthy diet is with your patients and how important exercise is, and less time treating type 2 diabetes.

Now don't worry. Doctors won't be penalized for treating their patients with problems. Shit happens and when it does they need to be ready to do what ever it takes. However, if you can treat a condition with a generic drug or a less complicated procedure and get a great result, there's some extra cash in it for you. Do you know that back surgeons currently do a more complicated back operation that involves plates and pins when an older more effective version of the operation exists? Why? Because if they do more they get paid more. Plain and simple.

Of course, if you skimp and refuse to treat issues to try and get some bonus money and the result is a patient's condition worsens or they even die, you'll be tried and convicted of neglect and you could face jail time and at the very least become a janitor at a penitentiary. Not needing big insurance companies I'll have some money left over to do reviews of all doctors to make sure things are being done correctly. Honestly, I'm not that worried about it. Doctors go into health care because they enjoy helping people be healthy. I truly believe that. I think it only goes bad when there's a big drug company waving a lot of cash in front of them so they prescribe the $600 drug instead of the $50 generic drug. Who could resist that temptation when the patient has insurance and will never even see the real price of the drug? When I am king that temptation will be gone.

Now if you want to be a doctor outside the system, that's fine but you will only be able to charge the patient directly for services. This way when a person goes in for a Pitt pectoral implant or a Jolie lip job, they can but will have to pay what ever the market rate is. Hypochondriac and want a CAT scan ever month? Sure, on your dime. I'll make sure my system creates the healthiest population in the world, but if you're looking for something above and beyond, then it's only fitting that you pay for that extra service.

Now there's the issue of the drug companies. Of course I think it's a good idea to incentivize the development of new useful drugs. So does the current U.S. Government and they do it by taking your tax money and giving it to companies to help fund their research. I'll continue this practice, but the double pay day will not be there any more. What business gets subsidized and then gets to charge enormous amounts of money for the product they make? It's one or the other. If you want to develop a drug using private investors' money, charge what ever the market will pay. If you want a hand out from the king, you'll make a reasonable mark up that takes into consideration how much it truly cost the company to develop and manufacture it. Basically I'm saying if the people pay for it, it's theirs already.

I'll also form a non-profit drug company. Sounds crazy? I think nay. I know scientists. They love to do science, and they hate to deal with keeping a company's stock prices high. I bet I could attract a large number of scientists from all over the world who'd jump at the chance to do pure science. They'd also get special bonuses for working on really effective drugs, and I'll also put their pictures on the drug bottles and have their World of Warcraft characters level up a few levels for each break through. Don't tell me I don't know how to motivate nerds.

So that's my plan. I know I left out a bunch of details, and of course horrible things will happen until the bugs get worked out of the plan, but I think it'll all work out in the end.

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