This post aims to suggest a complete overhaul of two aspects of Irish society for the possible benefit of anyone who needs a body, which is currently everyone except a few people working on the Calico project at Google.
The general idea is to propose the creation of a virtuous circle that creates a positive feedback loop for all participants within the system.
First the economics of health care.
When people are young and healthy they are cheap to insure, do not need hospital care and pay far more every year through insurance premiums, and added health taxes, than they need. This surplus washes through the system and allows health executives and quangos lead an enjoyable life. Nurses and doctors do get some benefits, like pay and timetables, and some patients benefit, occassionally.
When people are sick or old, they are expensive to insure, so nobody wants to insure them. What would be the point of insuring someone if you actually had to pay out? When these higher risk people become patients, they generally spend a load of time sleeping on a trolley in a waiting room, and they burn through quite a bit of the money collected in their name, mostly through taxes or idiots wearing hats and selling stickers at Christmas.
This leaves a lot less surplus to top up those executive pension funds, think tank conflabs, international conference travel expense accounts, and advertising campaigns. Nurses and doctors do get some benefit from this, mostly pens from pharmaceutical companies, presentations from investment firms about topping up their their AVCs, and the occasional clipboard from an equipment supplier. Some patients do benefit, but accidently.
So the economics of medicine are that; it is expensive for healthy people with no return, more expensive for sick people with little return, and fabulous if you have a cushy number on a health board.
Note: If you don't understand insurance, or hold the common and completely wrong view that paying more insurance when younger is necessary because you will use more when older, go and learn what insurance is before continuing.
How to fix this?
Firstly, the economics of health cannot be changed. There is no magic wand. So, what needs to be creatively thought about is a funding process that gives back more than a trolley in a waiting room, minimises corruption, and becomes a virtuous circle that positively benefits all those within the system, thus giving them reason to partake in it.
Note: The creation of any virtuous circle requires burning out all malignancies!
Bear this in mind when the inner voice starts telling you "It's not possible". That inner voice is a reflection of your conditioning!
The proposed system
Many people consider the GAA a crown jewel within Irish society, so why not polish it up, and use it for something more than a load of round-robin, back-door, Pat Spillane bashed, play-off games in mid-summer, that result in 1000s of lads sitting around doing nothing for weeks on end because 15 players on a county team need to be wrapped in cotton wool.
I might add that in my opinion the intercounty championship is dull and boring, and the real action is at club level.
So, I suggest the adoption of a system somewhat like this:
- All county boards and newly created 'county health boards' come together with the local GAA, soccer, rugby and whatever else people pay money to go and watch, and create a viable business model that sends a percentage of the revenue generated into the county health budget.
- Each of these sports, or events, would be properly
calendared so that a year round series of high quality events was available for the county to get out, enjoy and to keep revenue pouring into the particular sport, and the county health fund. Once again, don't listen to that inner voice of conditioned helplessness saying it could never happen
- Each county would have to become self-sufficient in providing it's own health care. Of course counties may merge and other counties may form co-operatives to purchase equipment in bulk. The minor details of this people can add to in a million and seven different ways. That is the purpose of making it as local and decentralised as possible.
- Create lasting value in the provision of these local events by making sure leagues, championships or whatever else, are run in a professional and competent manner that gets big crowds in the gates or watching on TV.
- It is imperitive that the county health boards cede from the centralised bureacracy that a body like the HSE has become. This requires rejecting outside interference in local management, and complete rejection of an overlord authority. Particularly anything calling itself a Minister for Health!
The application of 26 different counties, using 26 different methodologies, in an attempt to solve their own diverse health care issues would lead to some outstanding innovation and allow a much wider range of possible solutions to be tried. It would not take long for the successful ideas to win out and gain acceptance in other counties, except Cork. Everyone knows Cork really wants to be Texas!
- The main focus of the monies collected through a system like this would be to cover the costs of capital expenditure in the form of hospitals, care centres, rehab centres, medical equipment, the people outside the insurance sweetspot, the handicapped, and in general the worst off within society.
- The creation of a competitive insurance market for those in the "insurance sweetspot" would keep premiums down on those who generally do not need it.
This insurance market would cover the cost of paying the salaries of those working in the healthcare business; doctors, nurses, phyios, etc. as it would pay them for services rendered.
The separation of funding for facility costs from service costs would allow the competitive pricing of one without the drag of the other, and the reduction of costs to the average person in turn frees up more capital to be put towards useful purposes within society.
In short, I propose that those who can get insurance, buy insurance on the free market, thus covering their own bills. This system is all based around the goal of providing quality health care.
The public health / private health care issue is a false dilemma caused by government interference. The private individual pays for all that, and it costs everyone money.
In this system it is up to the county health board to decide how to use the money generated by the system, and utilise that as a public health issue. Each county would then have to come up with innovative ways of dealing with the \"Medical card\" issue. Essentially those who can't or won't insure themselves and rely on charity. The medical card is charity, no matter how it is dressed up
Just as aside about 'rights', particularly regarding anything that prepends 'free' to it.
If you think anything is your right; 'free' health care, 'free' education, freedom, 'free' speech you are automatically making it the responsibility of someone else to provide you with that right. Should you wish to sit back and enjoy your 'rights', you will lose them if you don't take personal responsibilty for them!
The creation of health care market exchanges
Markets are vitally important, and facilitate the provision of everything you have in life. Even a \"meat market\" disco-bar probably provided the world with you, after a deal was done after a whiskey too many.
But one of the most important market functions is price signal! Without a competitive marketplace on healthcare provision, the price of healthcare cannot be known.
This means that the county health boards need to compete for patients. Meaning all procedures, medicines, consultations and surgeries would have to be priced and traded on an exchange, in much the same way as the building and equipment costs are priced on a market. Not only would this allow patients to choose the best option for them, because premium vs lower end care will always exist, but it would also expedite their decision making process when care is needed, as patients and insurance companies would be able budget appropriately with what funds they have available.
To illustrate the point, imagine the following decision making chart for a Coronary Artery Bypass:
- Clinic A built and funded by the Limerick County Board.
Heart surgery team Clinic A | Experienced team with 300 surgeries | outstanding reputaton | good follow up care unit | cost €75,000
- Clinic B built and funded by the Cork County Board.
Heart surgery team Clinic B | Young team 11 successful surgeries | limited repuation | good follow up care unit | cost €23,000
This competition would also translate into certain boards specialising, thus paying more for certain doctors and nurses, making sure the best in a particular field ended up gravitating towards working with each other. This is good. If you think it is not, then imagine being treated by the medical equivalent of Real Madrid, or being treated by the equivalent of your average club hurling team who happen to have one outstanding player. No matter how good he or she is, someone not so good on that team will probably drop a sponge in you during surgery!
This ying and yang of competition and co-operation requires a little bit of thinking about, but everyone understands it almost instinctively. It comes pretty close to the internal conflict of being a human within all societies; to look after #1, or think of some greater good!
Minimising corruption: The Blockchain
Let me introduce you to the potential star in an endevour like this. A health care crypto-currency. The minimisation of corruption can only be brought about by complete openness, and a crypto-currency allows for complete openness while still allowing privacy to those interacting with it.
By making "SportHealthCoin" [someone else think of a better name] the payment mechanism for everything within this system it would create a demand for that coin.
- Insurance companies would need to hold, hedge and trade it to pay for bills.
- People would need it to interact with their local events
- Those working in the health system could be paid in it.
- Heathcare exchanges would be priced in it.
- The health county boards would pay for equipment in it.
So long as the whole system used it to settle accounts, and the flow of value through it was large enough, and it was easily tradeable against other cryptocurrencies, FIAT currencies, commodities and had a futures and options market, the price of the crypto-currency would stabilise. That is one of the functions of capital markets.
One of the additional benefits of a crypto-currency backing the health system is that mining pools could be formed. Everyone within the system would be able to partake in the generation of the coin that the system needs. Boards, clubs, individuals, hospitals, players, patients and anyone else would be able to use the process of mining and validating transactions on the system to generate their own income.
The creation of public wallets, such as the fund for cancer equipment, the fund for down syndrome care, the fund for whatever, would allow the money sent to those wallets to be accounted for in a completely transparent fashion.
Now imagine the added demand and price stability brought to this cryptocurrency if energy costs were also priced in it; petrol, electricity, gas, water!
This would mean that the power needed to run the network would be backing the currency, as well as the health care system, and a large chunk of the sports entertaiment available.
People understand the general idea of a currency backed by something tangible. The gold standard or the petrodollar, both of which generally result in certain oil or gas rich countries needing to be liberated.
Why is this this backing important?
Because power, and health are always necessary. You can't live without either for too long, so by backing a currency with tangible assets that cannot be \"invaded or confiscated\" you sow the seeds of a virtuous circle, and reduce the governments ability to expropriate these assets for their \"favours and handouts for votes\" system.
The final piece of the jigsaw would be a completely open and tradeable energy unit exchange, allowing everyone to upload and download power onto the national grid as needed, and by backing this with the cryptocurrency would allow power generators to essentially make their own money. That should also open up the flood gates of creativity and see 1000s of new and individual ideas attempted at cracking the power dilemma which may be looming in the future, if you believe in peak oil and or limited resources. This of course would need a whole separate post of it's own and does not fall within the scope of this article.
This is a general outline for a system that aims to generate revenue in as many imaginative and useful ways as possible, to eliminate as much corruption as possible, and to allow as wide a range of possible solutions to health care provision problems.
There is always enough money, it is simply a question of creating flows of value. The idea is to create a system generating value so great that it can support the underlying costs.
After that, it is up to the actors in the game to start upping their skills!
The likelihood of something like this ever happening
Maybe when the health situation reaches two patients per trolley!
The idea is to enable swarm intelligence and decentralise decision making to overcome the problems facing society, and to enable maximum personal freedom and particpation, while guaranteeing the creation of "public good" infrastructure. If you cannot get your head around those ideas I recommend these three articles: