Thursday, March 29, 2012

Engineering Health Care: And a Bird!

What the Supreme Court arguments show is that Washington is NOT Cambridge and neither is New York. In Cambridge one can go back and forth from the Academy to the home in the suburbs and rarely see reality. In Washington it is a continuous political battle. In New York, for better or worse, it is just money, nothing person, and you win or lose, at least until Washington stuck its head in. You see New York is still driven by Dutch individuality and capitalism, Cambridge by Puritan aloofness and exceptionalism, and Washington by the slime of politics.

Now the NY Times has a piece on one of the MIT Profs who spent his career pushing for a dream, a theoretical dream for health care. Now dreaming up a scheme with models is a far cry from designing a system and assuring it works. It is ivory tower economics versus engineering. This is why we are in such a mess, economists and the ivory tower. Their "ideas" just fails to meet reality.

As I have argued, universal coverage is essential, but the devil is in the details. We have models which work, auto insurance and even home insurance. The characteristics are simple:

1. Universal, yes one just can't seem to get around it. There should be an uninsured pool just in case.

2. Individually procured, NOT through an employer or third party.

3. Minimal required coverage primarily for catastrophes, and of a form where an individual can then add on.

4. Rates determined solely by variation of life style choices, you smoke you pay, you are fat you pay, but no variance for those with hereditary and the like diseases.

5. Skin in the game, you can have even oil change covered but it costs, otherwise you pay out of pocket.

6. Regulation, yes regulation, of the insurers.

7. Government support if incomes are too low. Cannot seem to get around this.

Now I had done a detailed financial model showing how this would efficiently work. I also argued along the line of changes in the means and methods of health care. As did hundreds or thousands of others. Yet the Times believes that there was a single voice. Pity they so all too often neglect the facts.