Saturday, January 16, 2010

A sacerdotal suggestion on single payer health care (LD 1365)

Here are some words of wisdom I've read or heard over the years:

"Everything I need to know I learned in kindergarten, like 'look both ways before you cross the street.'"

"If you want to be a trapeze acrobat in the circus, the first thing you need to remember is to not let your one hand release the trapeze you're already swinging on until you have your other hand firmly gripping the one coming at you, or you're gonna learn more about gravity than you wanted to know."

I love the imagery of both. 

I worked in a world where these words made perfect sense - the complex command and control systems that go aboard Naval combatants like those built at BIW over the decades, and in particular, the AEGIS Weapon System known to many of you in the area.

And it strikes me that the principles in all of these cases are incredibly relevant to the consideration of single payer health care as previously addressed in this post about legislation submitted by our caring public servants in the Maine legislature.

The world of complex shipboard systems involves a combination of complex subsystems, and a cardinal rule was that you never advanced the state of things by throwing out the old approach and replacing it with something new and untried and untested.  You simply couldn't take that risk.

Instead, you evolved things in a very controlled way, ensuring that if the new concept wasn't successful, you could return to the prior configuration and restore things to the way they were.  One of the ways we described this concept was "build a little, test a lot."

In other words, build your new capability or system, and test it very carefully to make sure it didn't completely screw up everything already in place.  If you've fooled around much with your personal computer(s), you probably understand the principle.

We usually keep our computers for several years, or maybe even longer.  Over those years, we may upgrade installed software (Windows, or Office, for example) or hardware (hard drive, etc) to newer and more capable versions.  Most of the time this works pretty well, but when it doesn't, it's nice to have the "restore" function to be able to reset to the working condition before the attempted upgrade.  Wouldn't it be great if this was the way everything worked?

Thinking about LD 1365, the proposal to convert the state to single payer health care in one swell foop, I realized that it flies in the face of the principles mentioned above, and in the process, ignores the "wisdom of the ages."

The proposed legislation, to be blunt, is the equivalent of crossing the street with a blindfold on in a rush to grasp the phantasm on the other side.

This is how the state "upgraded" the DHHS computer system a few years back, and created total chaos.  It overran the budget for the upgrade; it completely screwed up the payment system;  and it "lost," as I recall, tens of millions of dollars, if not more.

Taking this all in, Other Side has a recommendation.  In keeping with the evolution, or incremental progress idea, as embodied in "build a little, test a lot," we suggest that rather than throwing out the health care system currently in place and replacing it with something new and completely unproven, that a "pilot program" be implemented to validate the single payer concept.

In order to make sure that the pilot program is well defined and well controlled, the new system should be tried out on Maine State employees, including legislators and their various support organizations.  A period of 3 years or so should provide considerable insight into how workable the proposal is, and more importantly, robust cost data.  If a wider test is considered important, the pilot program could be expanded to cover municipal employees, including all those in the public education system.

Meanwhile, the rest of us could retain our current coverages, and serve as objective observers and reporters for how satisfied government employees are with the proposed single payer system.

Whatta ya think, Charlie?  This has gotta sound reasonable, right?  If you need help drafting the amendment to make this a reality, let me know.

If the phone don't ring, I'll know it's you.

As for our faithful readers, hell, if nothing else, for the time you wasted reading this today, at least you learned a new word!

If you looked it up, that is.   Charlie, of course, didn't have to.

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