This list of features is an overview of my earlier proposed healthcare plan. It reconciles a federal sense of what is important with an actuarial and medical sense of what is. The details would dynamically emerge from a federal legislature, and actuarial as well as medical wikitables. The tables would be kept apolitical much as is the U.S. Supreme Court; their modification, restricted but not necessarily to one country. For most details regarding implementation, please read that early post, Healthcare: A Nationwide System (www.outonatwig.net).

1.      Just as there are treatments and cures beyond medical understanding, there are those beyond affordability. In this plan, coverage for each treatment varies between all and nothing, but always in a manner that mediates optimally between our deepest values and the realities of the particular illness, its diagnosis, and its treatment. It is not rationed, because anyone can buy as much health as can be bought, but it will bring a greater well being per buck than any alternative and to that end must remain both supplemental and supplemented.

2.    For each form of care a dynamic percentage of the going cost would be evaluated and become the mainstay of a basic, federal plan. The percentages for supplemental plans from other agencies (federal or state), from employers and from the individuals themselves would each be derived from and coordinated with that of the basic plan. Greater percentages would funnel money towards care offering the most promise in terms of both need and effectiveness. Care at any percent (even 0%) could be expanded upon at the individual’s expense.

3.     This calculus would be centered, not on characteristics of the patient, but rather on the condition and the promise offered by a diagnosis and treatment. Hence it would be independent of a person’s prior existing conditions or propensities whether medical, behavioral or financial. Payment percentages would be the same in treating a disfigurement, whether congenital, pathological or accidental; lung cancer, whether from smoking or from secondhand smoke; and hypothermia, whether the patient slept in a cardboard box, or a mansion.

4.    The dynamic base percentages would change with medical innovation, assessments of medical realities, average costs of each form of care, and standards of importance. In that way they would spur or even redirect medical research, while bringing attitudes of importance out into the open. They would further trace remaining funds for the basic federal plan’s fiscal year, and thus impose their own fiscal responsibility. Since all supplementary insurers inherit their percentage profiles from the federal base, they would also vary.

5.     Those governing would periodically reassess and possibly reset available funding and said standards of importance along with the values of two percentages: one above which coverage would be lifted to 100%; and the other below which, cut to nothing. Beyond treatments at 100%, the impoverished would rely on the generosity of providers addressing a load now lightened by a totally different form of federal and state support. They may feel left out because the lack of funding is such a blatantly obvious measure; but when medical science fails to connect the dots, we are all unwittingly left out with no measure of blame to attach. Those overcome by frustration in being helpless before the vagaries of illness turn to cries of malpractice or greed but too few roll up their sleeves to take on the nitty-gritty of public or personal health.

A state could introduce its own augmentation for the needy such as barter-service, clearing markets for extended coverage (not for provider compensation) or a special supplemental plan. The latter would bring care to the impoverished just as a Medicare supplemental plan would bring care to those over 65, but in both cases, costs could not be ignored: a boon to the General Accounting Office.

6.    Beyond the governing body, the basic percentages would rely on input from multiple sources (accounting, actuarial and medical) and be in continuous flux.  Actuarial and medical information would be input from perhaps global sources to a wiki section. In the many small adjustments there would be an overall stability of support but in amounts that were only relatively fixed. For instance, a breakthrough treatment would immediately become more financially available even though the breakthrough were in cost, as in over-the-counter.

7.     Medical innovations (or revelations) would update the expectation factors, and by this approach be amplified and placed before us. The coverage for tests would increase with their reliability at diagnosing and the importance of such diagnoses; that for treatments would, with their likelihood of:

·        Benefiting biological function.

·        Alleviating pain or discomfort.

·        Prolonging life.

·        Supporting prevention.

·        Reducing contagion: Currently there is a contagious disease whose spread is often within a hospital's walls. No one wants to pay for the expense of testing those being hospitalized. This plan may well pick up that expense in its entirety.

·        Bringing skill through practice, and understanding through experience in dealing with a particular ailment.

8.    By this plan one could choose physicians, diagnostic and treating facilities; and except for matters impacting contagion, whether or not to take a recommended test or treatment.

9.    The current paper trail costs billions, but it is simply about confirming that care had been provided, determining payment responsibility, and assessing pre-existing conditions. By this coordination, physician, hospitals and secondary insurers would be freed of most of this. Although pre-existing conditions would not affect coverage, medical history and other factors need to be known by physicians to decide the appropriateness of care; by those evaluating various forms of care to bring accuracy to this approach; and by forensic accountants to detect fraud.

In another post, A Tale of Three Databases, I describe a data complex that could contain such private information while guarding patient anonymity. Upon the application of care, it would reveal the patient charge, debit all underwriters, and by all of this position itself to detect fraud.

10.                        In seeking to supplement coverage, individuals or employers would place requests as portions of that year’s remaining per capita annual health care basic allotment. For say each week, enormous bundles of these offering contracts could be sliced up and traded on a futures market. Here there is an inherent conflict between pre-existing conditions and the finding of available sellers (underwriters). If these bundles are not sufficiently encompassing, then a partitioning of bundles by age may be needed, lifting slightly the pre-existing condition blindfold of federal and state policies. Such a step should not be taken lightly.

1.      Establishment of the wiki-database.

2.    The setting of funding, together with an introductory period during which the federal government would go solo.

3.     The coming on board of state, business and personal supplemental plans.  

 For more details regarding implementation, please read my earlier post (now due for an update), Healthcare: A Nationwide System.