Wouldn’t The Healthcare/insurance issue be better dealt with in layers, like an onion?
Sunday, 25. April 2010
Peeling off layers, like an onion, is an alternative to a Holistic All-At-One-Time Megasolution. Layering the problem down is sometimes called Disjointed Incrementalism. You do something. See what happens. See what’s left of the problem. Then do something else tailored to what’s left of the problem. When the impact of that occurs, you assess where the problem is at that point — i.e. what’s left of it. Then you hand-tailor a new hack at the problem based on how it is at that point.
The progress in incremental — it happens in pieces, or chunks.
The progress is disjointed — because the plan is “open” like in a chessgame, or a tennis match. You have to see what the effect of your last move is before you design your next move. This is called interaction with reality. It’s less hubristic than a huge plan with thousands of moving parts that you somehow imagine will “work” just because you the wonderful you say it will work.
So what’s the first layer?
It could be vouchers to subsidize some of the uninsured. These would be financial instruments that only the adressee could spend, and that could only be spent on one of the approved 85 health insurance plans offerred by companies that the government has examined and knows to be non-rip-off organizations. These 85 firms are closely monitored for their financial soundess and the integrity of their conduct and the quality of their management and governance.
Vouchers could peel back about 40% of the uninsured problem. The other 60% would not be able to get health insurance even if they had 10 handfulls of vouchers and were standing on Insurance Crossroads of the World. Why? Because they are uninsurable. Too sick. No fixed address. Extreme bad habits. Not able to be identified. Mendacious and unable to assist in their own healthcare. Just your hopeless basketcase type people. There’s at least 25 million of them loose in USA. It would be absurd to expect a voucher program to fix their problems, so let’s not.
Let’s be satified with peeling off 20 million people from the problem. These are the ones that are not too sick, that do have addresses, that don’t lie, and who are only a little dysfunctional, most of it just poverty, not twistedness.
OK — we’ve got 25 million people left — how about maybe Federal Primary Care Clinics — real close to hospital emergency room entrances. When these basketcase people show up, they can be quickly diverted away from the $1000 emergecy room visit, and to a 24/7 Primary Care Pauper’s Clinic that can provide quick medical intervention, and a prescription, and some pills, for about $75 per visit (that’s a 92.5% savings compared to what we do now).
Let’s say that takes the problem down by another 20%. So now it’s 20 million basketcases.
Why don’t I just give you levels 3, 4, 5 and 6 right now? Because I don’t know them. See that’s the whole idea of an open plan — of disjointed incrementalism — like in a chessgame or tennis match — you don’t know how the whole game will unfold when you make the first move. You have to interact with the changing problem — the remnant going forward. So, the fact that I can’t lay it out for you now, does not mean that the layered approach is not viable.
It is plainly the best approach for this type of problem.
Obama has chosen the Holistic approach (like Hillary did).
That’s a huge mistake.
His scheme will be rejected.
When they come back next year to try again, maybe they could try something different, like smart people do instead of trying the same thing that did not work over and over and over — like we have to fight 10 more Vietnam wars before we realize that our approach does not work.