Wednesday, September 17, 2008
Does this make me a liberal or conservative?
One of my cousin's is a recent graduate of a nursing program and has started to learn first hand how people suffer and die because of HMO's, big insurance (Aetna, Cigna, United Healthcare, etc) and Pharmaceuticals (Pfizer, Merck, Bristol Myers Squibb, etc) and their decision making process. They are, by law, beholden to their stockholders and the bottom line, and therefore have an ethical conundrum in that at times they have an incentive to deny needed care in the name of profit.
I am not for government healthcare because it suffers from much of the same problem as the current system. The government also is beholden to many of the same financial burdens. Imagine if the principles of open source were applied to healthcare where HMO's had to make their business rules publicly available in a well-formed XML format that could be inspected by others? Imagine the ability for a consumer to use an open source rules engine such as JBoss Drools and could proactively tell whether a claim is going to be approved or denied. The current model requires consumers to expose themselves to financial risks as they don't have a clue upfront as to their own liability.
Good governance is also required in that disputes should have an SLA attached to them. Consider the scenario of James Robertson being admitted to the local hospital for a mental disorder and is healthcare provider decided it didn't want to pay claims. While James Robertson couldn't figure out how to leverage a business rules engine since he uses an antiquated language known as Smalltalk, he could at least demand that a response come back within say four hours vs the current unknown/unbounded timeframes that exist today.
What if society at large were able to define the actual rules instead of actuaries in each of the HMO's? Folks could define four choices that HMO's would simply implement and determine the price associated with each set of rules. Consumers would know exactly what they would get upfront when paying premiums and be able to make better informed healthcare decisions. Likewise, the decision making process would also be normalized such that all HMOs would provide the same answers in the same situation...
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