How about we extend the concept of health care to life care? Lets consider quality
of life rather than just quality of health (physical and mental health).
Health becomes just one element of quality-of-life care. Other
elements might include, for example, shelter, food, clothing, personal security
(safety), possessions security, free time, education/personal development,
recreation opportunities, rich personal relationships, a sense of purpose, etc.
And these apply from birth to death. Life care ensures everyone has
access to "care" in all these realms.
The implementation vehicle could be as described in a
previous post about a health care scheme for the U.S. - http://reasonspeak.blogspot.com/2010/09/competitive-universal-healthcare-scheme.html. The concept is to have private companies do
all the work of life care, in return for a fixed payment which can be thought
of as a quality of life insurance premium payment. This payment is made (effectively) via a
voucher from the government. Everyone, regardless of their situation and
regardless of their means, gets the same voucher. There is no means testing and no
conditions. They can choose which company to give the voucher to, and can change companies when they wish (say annually). The voucher value (insurance
premium payment) will likely vary based on need/risk (as explained in the
healthcare post), but the services available are identical for everyone
(standardized service plans).
This
proposal leverages the benefits of the private sector and real competition, in
a suitably regulated market, to minimize costs and maximize innovation and
nimbleness in addressing needs. The key is identifying suitable
performance (outcome) measures that can be tracked and used as accurate
indicators of how well each life care consumer and life care company is doing -
so consumers (all of us) can choose between the various companies competing for
our business in an apples-to-apples comparison. Identifying and measuring
such metrics would probably be the biggest challenge of implementing this
idea.
The health care concept (as proposed in the Competitive
Universal Healthcare system post) would be extended to life-quality care.
The life quality company is not paid a fee for service, but a fixed
amount regardless of how much effort they need to expend to achieve the desired
outcomes - hence they have built-in incentives to achieve good outcomes as
efficiently and inexpensively as possible. And as in healthcare, the
cheapest quality of life care is to prevent problems in the first place
(prevent it rather than fix it). Everyone is covered from birth and
companies can't force out anyone or refuse to take in anyone wanting to partake
of their services. Hence companies (via their social workers and
healthcare providers and housing specialists, etc.) will take care of people
from birth and will do whatever works best - for example, provide positive
role models, help ensure a quality home environment, help them maintain
sufficient income (throughout life including retirement), housing assistance,
childcare, help them achieve suitable employment or business ownership, help
keep them out of prison, help keep them off drugs, help ensure they have access
to nutritious food, help them achieve a secure retirement, provide direct assistance
in times of need, help students succeed at school, etc. To the extent
that government policy impacts their costs or ability to maintain people's
quality of life, they will lobby vigorously to align public policy with
cost-effective quality of life solutions. Consider as just one obvious
example, the quality of our public schools. And the life care company
would have to pay for the cost of incarceration while a customer is in prison.
So they will try really hard to keep their customers out of prison.
There are many details to be worked out and obvious debates
to be had around the minimum outcomes required of these companies. Poor
living conditions lead to high costs due to the cost of remedial measures, and
very high living standards will cost more than is needed for reasonable
outcomes. Hence, the challenge is to identify the sweet spot of
sufficient life quality without overdoing it. This is similar to the
current debate around what types of medical treatments are to be covered by
publicly sponsored health insurance (including Medicare). And numerous
other details would need to be worked out, but so far no fatal flaws have been
identified.
Such a system does away with the need for virtually all
existing government assistance/safety net programs - welfare, social security,
unemployment benefits, disability insurance, housing assistance, Medicare,
Medicaid, prisons (they still exist but the government doesn't have to pay for
them directly), etc. - virtually all forms of entitlement or assistance or
care. The size and traditional costs of government (federal, state, and
local) would shrink dramatically. All that government need to do in place
of all these programs is administer the life care system - and pay for it.
And there should be little further need for private financial charity for
the poor or disadvantaged. Volunteerism around helping less fortunate
folk will likely continue (to the extent that people like to do it),
coordinated by the life care companies. The life care companies can be
for-profit or non-profit, but they all compete for business on a level playing
field.
Due to competition and increased efficiency, the overall
cost should be less. In other words, our taxes should not have to go up. And outcomes should be much better, since for the first time (at least in
the U.S.), we will have a major segment of the economy having its economic
success directly tied (in the short term as well as the long term) to the
elimination of poor living conditions for everyone.
Hence the power and efficiency of the market is applied to solving, at
last, the problems commonly lumped under the heading of "poverty"
(where they are currently largely ignored in the political process - no one
with any political clout has a stake in improving their lot). And the
folk previously working in the abolished government programs and charity-funded
non-profits would be employed by the life care companies (either
directly or via contracted service providers).
Please leave a comment with your thoughts about this idea.
-oOo-
