Health Care

Health care is a fundamental human right and the payment for it a Natural Monopoly. Therefore the Globality will manage health care, including dental, hearing, vision, mental health care including addiction treatment, and maternity care including free access to birth control, for all The People.

There is no point in arguing the “fundamental human right” aspect of this as it has already been decided: Show up at any hospital emergency room in any city in the world with a serious injury, and you will be treated regardless of health insurance or even citizenship. The issues with addiction and mental illness are even more clear cut: Besides the “humane treatment is a requirement” justification, it makes better financial sense to treat people before they commit crimes or become wholly dependent on The People. Otherwise we not only incur the cost of treating the original condition, but also the additional cost of institutionalization. This being the case, all that’s really left is to figure out the most efficient way to provide for these things.

The concept of Natural Monopoly also applies anywhere The People have decided that a product or service is a fundamental human right, such as health care, pensions, and income protection. It cannot be expected that competition from capitalist forces will form naturally in these areas and so it must be managed by The People. Competition is nevertheless still necessary, and so current practices of establishing large government bureaucracies to perform the work or attempt to calculate and then dictate payment rates (a la the US Medicare reimbursement system) should not be acceptable. Instead, social engineering techniques must be used to design systems that provides the efficiency gained from competition while still guaranteeing a standard level of service. For example, administration of benefits can be sent out for competitive bidding on a Locality level, and contracts for medical services can be bid on in areas where competition can naturally be found. The resulting reimbursement rates would be the same for those services used in areas where competition available.

Yes, this means that in areas with a sufficient number of doctors an individual may have to see different doctors for different types of services or pay a differential if they prefer to see some particular doctor. For example, if one network/group of doctors determines that they can do annual physicals more cheaply than the competition, that group’s bid will define the reimbursement rate for that service, with the individual given the choice of using a doctor in that network with only the normal (nominal) co-pay or paying the difference between the standard reimbursement rate and the rate being charged by their doctor of choice. This will of course require complete portability of medical records, but that is a necessary feature of any advanced health care system and so is not an unreasonable requirement. Management and disclosure of services and reimbursement rates must be done publicly to support competition as much as possible. If an individual knows the medical code for a treatment they need, perhaps determined by reviewing their own medical records, they should be able to use The System to find the practitioners near them that offer this service and the cost they’d pay to use each of them. The System will also be used to review the service received to ensure quality and consistency between vendors (including the ability to calculate and publish treatment success rates) and for fraud detection: Individuals must be able to review their medical records and services that have been billed in their name and flag them for outside review, for which they might receive a bounty if there are discrepancies.

Social engineering will play a large role in designing this system to maximize its quality and efficiency. For example, co-pays must be required for most services, and should be set high enough to discourage waste but not so high as to discourage proper use of the system to address small problems before they become big ones. There must be an emphasis on preventative care, possibly including financial incentives to ensure healthy habits (e.g., possibly tied into the GSF (Defense and Disaster Relief) service requirement).

A person’s body is their own, and what to do with it is entirely their own decision. This applies most particularly in the realm of medical intervention including Do Not Resuscitate (DNR) directives and suicide (physician assisted or otherwise).

This directive also applies to children, for whom health care decisions, including vaccination schedules, circumcision (male or female), and any other medical treatments shall be governed by statutes defined by The People. As specified in the Matchspecs under Children and Families, children are not the possessions of their parents and so allowing parents to make decisions that are against the best interests of the children (e.g., Female Genital Mutilation) and denial of vaccinations or other medical care) is unfair to those children. They must therefore be regulated by The People.

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