When I studied management I learned about disjointed incrementalism. It works well on really huge problems. The idea is the disassemble the problem one layer at a time, taking off easy layers as they appear. How would this work for a National Healthcare System?
40 million of the problems are all about individuals who just can't afford, food, rent, and also healthcare premiums.
So why not vouchers for them?
You send out 40 million vouchers that cover a reasonable annual premium.
10 million of the people who get the vouchers still can't get insurance. Even with the voucher in their hand, they still can't get lucky and make a deal with a legitimate insurance company. Why? There are about nine obvious reasons, no time to detail each of them here -- bottom line they still can't get insured even with the voucher. OK fine.
So, 30 million problems are solved. That whole layer has been removed from the problem.
Let's look for another easy layer. How about if we gave all honorably discharged vets the right to buy their meds direct from the VA with no other contact or involvement by the VA in their lives. Their doctors can FAX in their prescriptions The VA puts the pills in a bag and sends them out (maybe to the doctor, to be given to the patient, so that way you have a secure chain of custody with less opportunity for cheating and abuse). This basically forces the VA to be as good to USA vets as Canada Pharmacy now is. It actually helps the VA because the bigger the purchase contract, the bigger the discount from big drug companies. It makes USA look good -- like a nation that actually cares about its vets and is willing to do something for them, instead of nothing. Fine.
You just took another 10 million people out of the problem zone. And how easy was this step? It was very easy. How costly was it? It actually made the government money -- so less than no cost -- actual net revenue gained.
Let's look for more easy layers. How about Federal primary care medical service offices. Rent an office, hire six doctors and 8 staffers, buy some prespcription pads, and Shazaam! you are offerring primary care. All the recipients of this care are volunteers. None of them get to sue any of these doctors or staff members. The whole office is protected by the sovereign immunity defense. But very very high quality doctors could be recruited and selected to work in these clinics. The clinics could be overseen by very senior primary care attending administrators, let's say one of these for every 20 primary care clinics, so they can visit about once a month, in a contiguous and compact service area, or at least six times a year.
Would all the people now going to emergency rooms from their primary care switch over and start using the Federal primary care clinics? No! Probably half would. The other half would want to preserve their right to sue, and they've gotten used to the emergency room approach, so they will keep doing that. Fine.
You've just taken another 20 million people out of the problem.
Three layers have been taken off the problem. Is it solved? No. That's why this approach is called %26quot;disjointed%26quot; incrementalism. The whole problem is not solved all at once with one big Hillary-Care system. It's solved by taking off layers. Easy layers. One at a time.
So how big is the remaining problem. Not so big actually. You have your basically uninsurable people. Insurance is a bet. Nobody will sell you car insurance after you've already crashed your car, or fire insurance when you are standing in the smoldering ashes of your house. It's a bet. Not all betters are willing to bet on everything. And for some things no betters are willing to bet. Duh, right?
The rumpen lumpen of the problem also includes the sue-happy persons, and the emergency room denizens -- the sad-eyed persons of the lowlands. It includes uninsured people with terrible, hugely expensive diseases -- ALS patients, brain tumor patients, microcephalics, etc., who can't pay, have no insurance, and are basically your hard luck cases.
What to do? County Hospitals. So, maybe our fourth layer would be some sort of Federal subsidy program to support the truly outstanding County hospitals that are doing a great job cheaply, quickly, efficiently, and very well indeed. Let's put the money to where the excellence is first, that way, we know we are not wasting it.
Any problem left after these four easy layers have been taken off? Plenty, I'm sure. But probably less than 20% of the original problem.
We have worked off 80% of the Healthcare Crisis. So now it's not a crisis anymore. It's an area of need. Something that requires ongoing attention. But not a bonfire, not a brushfire that will eat us up.
The method is called Disjointed Incrementalism.
I say it's better than Hillary-Care (or Obama-Care).
What do you say?To Change the Healthcare System -- Wouldn't Disjointed Incrementalism work better?All vets can get medical care through the VA, but to get a prescription filled, it must be from a VA MD.
You don't understand a lot of the issues surrounding healthcare. There is a shortage of primary care physicians because the reimbursement rates are so low for them.
County hospitals are at the breaking point already.
