1) If a medical procedure, service or medication existed in any documented fashion 50 years prior to January 1st of the current year, they are covered by the national, taxpayer supported, single payer system. Period. No committee debates about what should be covered, and to what degree, etc. If the wealthiest person in the United States could buy the medical procedure 50 years ago, it's covered, but modern substitutions are not. For example, the system would pay for the cost of a leg cast in the fashion that existed 50 years ago, but if that method is no longer in use, the system does not pay for the modern waterproof, exothermic, quick-setting version that is in common use today. Not even at a partial degree. If your doctor doesn't have the old method, or refuses to use it because it's antiquated, there is no payment at all from the national system
So no digital x-rays, no MRIs, no treatments for HIV/AIDs, no rubella or mumps vaccines-- actually quite a number of vaccines wouldn't be covered-- no arthroscopic surgery, no lithium battery powered pacemakers, no life-saving heart attack drugs like tPA, no minimally invasive robotic surgery, virtually no fertility treatments, no statins...
Not yet, anyway; at least not on the dole. Again, all of the systems that we presently have would still exist, the 50 year baseline rule is just a backstop for those who "fall through the cracks" or otherwise choose to gamble with doing without medical insurance for a time, and lose that bet.
Sounds like a dystopian hell hole of a medical system, based on blind dogma instead of science.
Sounds like you don't have any idea what I was talking about.
Here's an idea: If the public is going to pay for public health care (which we already do) then the focus on actually providing cost effective health care, instead of focusing on creating a completely arbitrary standard (must be 50 years old!).
I just can't wrap my brain around the fact that cost and effectiveness should have no role in public health care. I would put those measures at the very top.
If you actually understood what I had just done with my rules, you'd realize that is exactly what I just did. The US medical system used to be the highest quality care available in the world (we can leave aside the argument about whether it still is for now), but it remains the most expensive. It is expensive, because quality is expensive. The 50 year baseline rule (it could be 40 or 30, whatever. Just has to be several years longer than the longest possible patent term, to give the generic market an opportunity to mature the market for that service/product and establish an accurate labor time and/or common cost) exists to establish that as the minimum standard of care, and gives doctors & other service providers the option to provide for the minimum quality care, or not. I suspect that most would simply refuse to do so, and would generally provide the best care they could in most cases. So I am attempting to maximize two desirable variables here at the same time; cost effectiveness and quality. The key to doing this right is allowing for variation, and letting the public gravitate towards the best for them. Over time & across the country, the medical industry would shift towards maximizing
value, which is literally the combination of optimizing both cost & quality.
Also, there wouldn't need to be a payment structure. This could all be paid for by documenting these minimum standard treatments, and then settling up with the government on tax returns. Said in a more familiar way, payments for the minimum standards of care could be claimed on a doctor's, nurse-prac's or hospital's tax returns as a refundable tax credit. The only snag is that such claimable care could only be claimed by a registered medical professional, and the documentation requirements might be a burden unto themselves. Fortunately, we already track most medical professionals, so no problems there, unless someone wanted to claim a homebirth to pay their (not licensed) midwife.