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A Direct-Democracy Healthcare Bill - Dilbert Blog

A Direct-Democracy Healthcare Bill

I don’t know much about Congress, and all its arcane rules, but I think the process for creating a healthcare bill goes something like this:

  1. Congress asks lobbyists to write a bill that is good for the healthcare industry and bad for the American public.
  2. The bill fails because Congress is neither credible nor functional. But the public doesn’t care too much about the failed bill because it wasn’t for their benefit anyway.
  3. Repeat.

With our current system (a Republic), that’s as good as we can do in 2017. The politicians need money to stay in office, and this is how they earn it – by selling out their constituencies.

But the days of the Republic are over. Social media is now the dominant force in politics. The people rule, but only when they have focus. Unfortunately, the people don’t have expertise in healthcare, and they don’t have a plan of their own. So they can’t focus on anything useful.

Can that be fixed?

Surely, some private citizen or group of citizens has the necessary expertise to come up with a bipartisan healthcare bill. Maybe it could even be explained in plain language so voters can understand it. And maybe it can be online so critics can weigh in with counterpoints and supporting links, so the plan improves over time.

I’m sure there are conservative think tanks with ideas, and liberal think tanks with ideas. I don’t want to hear any of them. If I can identify the authors with a political side, the plan has no credibility.

What we need is a healthcare plan that has an unknown creator, ala bitcoin. We need both sides of the political debate to see the plan as neither left nor right, but rather something supported by data, and perhaps by the case histories of other countries.

Give me a plan I can understand, that is backed by data, not written by the healthcare industry, and not identifiable as right-leaning or left-leaning, and I’ll help sell it.

Let me give you an example of what some of that might look like. This is just a thought experiment, not a suggestion.

Suppose President Trump declared Detroit (for example) a special Healthcare Economic Zone. The Zone would feature:

1. Free healthcare for everyone in the zone, paid by the healthcare industry itself because…

2. The zone would be a test bed for new technologies and new systems. That means some extra risk for the patients, but not much. 

For example, let’s say IBM wanted to test its Watson computer to diagnose patients. The rules in the zone would say IBM has to provide real doctors to confirm every diagnosis until Watson can outperform humans. So a patient might need to spend twice as long at the doctor’s office, but in return, he gets free healthcare, and potentially better medical treatment than anywhere else in the world.

The zone could have a special FDA fast-track for approving the things that are somewhat obviously safe(ish) but would normally take years to work through the system. Here I am not talking about internal medicine, just external medical devices. For example, if someone invents a handheld CAT scan device, we probably know enough about how to make that safe without a full FDA process. The fast-track stuff would be limited to the easy decisions. The questionable stuff would still take the long, safe route.

Now, what happens in Detroit if everyone has free healthcare? I think it would attract businesses that want to save money on providing healthcare to employees. And the medical industry itself would bring lots of jobs into the area. If you give me some robots, and some human employees who don’t need me to pay for their healthcare, I’ll build my medical device factory in Detroit instead of contracting with China.

The things we learn from the special Healthcare Economic Zones would spread to the rest of the country and provide practical models for what works best.

We can have more than one special Healthcare Economic Zone. Each one would teach us something different. For example, one zone might focus on technologies and systems that dramatically lower the cost of medical care. The stuff that works can spread to the rest of the world and lower the cost of healthcare everywhere.

The idea of Healthcare Economic Zones isn’t mine, by the way. I heard it from one of the smartest people on the planet. (He’s the one sitting to the left of the actual smartest person on the planet.) But don’t blame him if I interpreted the idea wrong in this blog post. I probably missed some important points, but I think you get the idea.

Waiting for Congress to fix healthcare seems like a fool’s dream. It is obvious that they don’t have the tools to do that. But nothing is stopping citizens from proposing their own ideas and using social media to pound it through the system. 

My other idea for fixing healthcare is to tie it to term limits. I’d like to see Congress play chicken with itself and pass a bill that says term limits go into effect if they don’t pass a viable healthcare bill by some future date. That would get their attention. It won’t get us a good healthcare bill because lobbyists are writing the bills, and Congress isn’t functional. But at least voters would get revenge on their representatives for betraying them when no bill is passed. That’s not nothing.

You might enjoy reading my book because Detroit.

I’m also on…

Twitter (includes Periscope): @scottadamssays​

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