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Reintroducing one doctor’s healthcare reform solution. Can sanity prevail?


My Verdugo Hills doctor, Paul Toffel, is giving one last push to his healthcare reform proposal on the eve of the bipartisan White House summit.

Whether it's workable politically or practically is open to debate, but it's certainly bipartisan, and by Toffel's numbers, there'd be no new taxes and no additional national debt. Since I first wrote about it last August, Toffel, a clinical professor at USC's Keck School of Medicine, says each of his five points have been part of the debate at one time or another.

Take a look at the Toffel Fix and tell us what you think:

1. Change the current 50-state patchwork of private insurance programs to a national clearinghouse of choices to increase competition and provide portability for working Americans.

2. Return health insurance companies to the pre-1984 federal regulations that required 85% of collected premiums to go to healthcare.

3. Require all working citizens to purchase insurance to broaden the base and flatten the playing field, allowing elimination of pre-existing clauses.

4. Enact meaningful federal tort reform, as already exists in eight states with huge success in decreasing medical costs.

5. Mandate the 159 urban medical schools, who receive federal grants, to first serve the hard-core indigent and illegal immigrants in their shadows before engaging in empires of private practice (See the USC/LA County Hospital model).

-- Steve Lopez



Comments () | Archives (15)


and the next 6:

1. eliminate employer-provided healthcare except as an "add on" and treat the entire nation as one actuarial pool with variable individual plans at variable price points

2. regulate hospitals and medical practices with MUCH steeper penalties for negligence, malpractice, contamination, etc. - you cannot destroy the ONLY option available to people (litigation) while letting doctors and hospitals literally get away with murder and maiming and the spread of disease. All that would do is socialize the costs of mistakes across patient populations instead of across those causing them.

3. implement loan forgiveness programs for all doctors who work for Medicare and Medicaid practices

4. use the same 85/15 percentages for hospital and medical practice administration - why penalize only insurers when the amount of waste and inefficiency at hospitals and medical offices is STAGGERING.

5. incentivize preventative care at an insurance level, a medical intervention level and an individual level through a program of tiered co-pays, tiered physician compensation and streamlined procedure approvals for those who have done all they could to prevent the "catastrophic" care they may eventually need.

6. require clear, publicly-available rate sheets for all treatments and procedures, along with transparency in things like "number of patient deaths caused by infections from the hospital" etc. We cannot "shop" for medical care because we are never allowed to know what anything will cost, or what our options are. This will also help stem the "procedure stacking" reimbursement practice which costs us far more than unfair victim compensation.

as a physician in private practice, i agree with these points. i would also ban recission after 6 months.

A big fat NO to number 5 ILLEGAL'S are not our problem and at the very least should come dead last they are (ILLEGAL) look it up for definition it's not a good thing when we have plenty of natural born US citizens dieing everyday who could use the care a lot more and at the very least first,We should give the illegals the same consideration that their country would give to us if we were in there country.I think that you can imagine that outcome!

These are all excellent points. I think there also needs to be transparency/competion among the providers that are driving the costs of healthCARE. This "debate" has turned into health insurance reform (which is absolutely necessary) but it is 100% predicated on healthCARE reform. You cannot have a healthcare finance conversation without addressing the costs of the care. There is a high level of manipulation of some providers who "know how to bill" an insurance company and/or medicare based on diagnostic and procedure codes. And there's surprisingly little publis discussion of how much the out-of- control prescription costs and over-prescribing play into this. When done to for the true benefit of the patient, I certainly get it, but there is a tremendous amount done for the benefit of the provider (personally experienced this). When everyone follows the hippocratic oath, there is pure, published transparency and "ownership" at all levels only then will consumers truly understand the "cost" of healthcare in the way the "consumerism movement" hopes, not unlike employers finally pushing for healthy lifestyles, habits and rewarding evidence of such in the workplace. That said, there is a huge contingent that feels entitled to insurance. I believe everyone is entitled to care. Finance that care however you need to (current options: negotiating fees, savings, credit card, insurance, seeing if you qualify for medicaid/medical). Bottomline, we all need to take responsibility, make hard choices and hold ourselves, our lawmakers, healthcare providers and chosen insurance companies responsible. Short of that, be prepared to pay more money either to insurance companies, the providers and/or the government AND give up your freedoms because nothing will be any less money collectively (for most people)than it is now.

It is sad, though, that during the height of a medical situation, we may be forced to shop our options and figure out, to some degree on our own, what is medically necessary, a "good buy" etc. I don't care to have the government involved in my health decisions but I think a lot of people do want/need this. And as a community, we need to formally address how to care for those unable (not unwilling) to care for themselves. I applaud this doctor for thinking through these excellent points and you for publishing, but I think there are more elements that need to be a part of "reform".

suggestion No. 5 contravenes current health care reform bills which specifically EXCLUDE illegal aliens (the official term) from any taxpayer funded health insurance programs. If a medical school receives federal funding, it would fall under this category. Private and public hospitals are already mandated to provide treatment (unreimbursed) to 'indigents and illegal immigrants'. It would be ludicrous to require this of medical schools and they would be overwhelmed by the demands.

I was recently quoted in a couple of articles up in the San Francisco paper. I think the articles are a well written analysis of how the health "cartels" are becoming too powerful... To your doctor's excellent ideas, I am adding - REPEAL THE ANTI-TRUST EXEMPTION THAT FOR PROFIT INSURERS NOW OPERATE UNDER. We need pricing transparency and the insurance companies are colluding with hospitals to pay very high prices for medical devices. See these stories:



No individual mandate. It takes away from the freedom of the individual. Forcing people to buy something is not a solution. It is like saying all the homeless are required to buy homes.
Or a better idea, make it illegal for people to get sick or injured. It would reduce the risk of the insurance companies, and only the criminals would get sick. Besides you need have healthy eye sight to drive, so it the same thing right?

seems so easy. and it is.
these 5 points would go a long way towards introducing reform.

i don't know why people have so much difficulty grasping some of these issues:

re: issue #3: you can NOT force an insurance company to ignore pre-existing conditions if you do NOT mandate everyone (healthy and sick) to buy health insurance!!! that's obvious! otherwise, why would I, a healthy young person, spend $300 month to buy insurance? i will wait until i get cancer... then, i'll buy my $300/month health insurance, that i will expect to pay $5000/month for chemo. IT JUST DOESN'T WORK THAT WAY. you have to be a moron if you think that it does. insurance is spreading the risk.... not everyone gets cancer and not everyone has to pay $3000/month for medications. but, if 10 people spread that risk, each person pays $300/month for insurance, and one person gets cancer, all 10 people pay for his treatment. that's how insurance works. think: car insurance!

re: issue #4: you MUST have tort reform. as a doctor, i will always order more tests! why? because it's defensive medicine. because i'm not going to miss that 1 in a 1000 diagnosis. because if i do, that 1 person will sue me. and i'll lose. even if i did everything right. that's why everyone with chest pain gets admitted to the hospital. even if it is borderline or bogus. because no one wants to miss that 1 heart attack, even if it is in a totally healthy 35 year old. it's not worth it. period. i didn't spend 23 years of my life preparing to become a doctor, to spend the rest of it defending law suits. if you don't believe that this is happening, then ask your doctor. this is not the way of my parents' generation - but they weren't forced nor threatened on a daily basis with "i'm going to sue you if you don't order an MRI and something is wrong." seriously. this happens. with regularity. remember, as a doctor, the moment you are named in a lawsuit, you have lost. it costs upwards of $30,000 to get your name removed off the suit... even if it is totally frivolous. and our system allows anyone to sue anyone at any time.

ok, just a few points for thought.
thanks for reading.

Scott, maybe you should learn how to spell ("dieing", "there country") before you write, but to respond to your diatribe, if you ever travelled outside of this country, you might find out that anywhere else in the world, if you are sick you are treated for free. We are the only ones who have an uncivilized and arcahic system that not only doesn't work but has contributed to the destruction of our economy. P.S. if you worked in a hospital you would know that there is such a thing as EMTALA laws that require hospitals to provide care to anyone who needs it, regardless of coverage or lack thereof. Therefore, the only ones getting penalized in this, by not providing coverage for the "illegal aliens" are hospitals who have to eat their losses, and doctors who treat the patients while they are hospitalized, who have to do the same.

Thank you, Michelle, for your comment!

"Change the current 50-state patchwork of private insurance programs to a national clearinghouse of choices to increase competition and provide portability for working Americans. "

One problem with this is that states have different mandates as to what an insurance company is required to pay for. There's a patchwork of private insurance programs because there's a patchwork of state laws governing insurance. State A may require that annual check ups be provided with only a co-pay, State B may not require it, saying that an individual must pay for the annual check up themselves. Which State's requirements will be followed? The least restrictive? The most restrictive?

One reason the GOP is pushing across-state-lines insurance is that Insurance companies will flock to states with the fewest mandates and the least amount of regulation and transparency. The current bill is as long as it is because of hundreds of complexities like this. It's 1900+ pages long for a reason.

In addition, the GOP is making a big deal about Tort reform, when the savings is likely to be just a few percentage points in terms of the overall cost of heath spending. Implement Tort reform, and discover that we've reduced our heath care spending by 1-2%. Then what?

I have spent twenty years in private surgical practice and recently navigated from group health to COBRA to individual portability health coverage. Consider:

1. A Federal Malpractice Cap on pain and suffering to lower the cost of defensive medicine.
2. Provide financial incentives that encourage the use of cost effective Evidence Based Medicine while discouraging the widespread early adoption of unproven expensive therapies.
3. Mandate emergency hospital insurance coverage(EMTALA ER and EMTALA Hospital Coverage) for all full time employees, thus partially funding the unfunded EMTALA mandate.
4. Provide a National Uniform Standard definition of pre-existing conditions and a Federal mechanism for determining who has a pre-existing condition to counter the ongoing spiral that only allows absolutely perfectly healthy people to buy standard health insurance. This should reverse the disturbing trend in which individuals avoid seeking medical care for fear of being labeled with a pre-existing condition. This should also level the playing field so that insurance companies can compete on price and excellence of service rather than on underwriting skills.

You can always tell when someone has a good-legitimate argument...when they attack your grammar and spelling, but not issues...

What I want to know is who will regulate the insurance companies? Are they subject to regulations of the states they are headquartered in, or some federal rulr. As far as the undocumented, no one is illegal and everyone needs health care. If not treated, some illness and diseases are contagious. Ya want somebody getting on a bus with tb?


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