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Reinsurance is a term of art for an insurance company buying some insurance from another company, in case its own finances prove inadequate. In this case, we propose the creation of a re-insurance fund whose purpose is to fund the last four years of life, by repaying Medicare for them. At present, half of Medicare expenditures are for the last four years of life, so the ultimate result is to cut Medicare costs in half by funding the last four years of life independently. Depending on the adequacy of Medicare records, at first it might be necessary to compile the costs and pay them individually. However, the likelihood is the law of large numbers would soon smooth out the costs, so the reinsurance might then reimburse Medicare its average cost. That would not only reduce the administrative costs but speed up the transfers, and apply a little pressure on consistently high cost institutions to match the performance of consistently low cost ones.
Maintaining a clear goal of effective cost reduction is a permanent need.
The overall "accordion" strategy is to start with the last years of life, add childhood costs (Look ahead a chapter or two) combining them with maternity costs. To these two ends of an accordion, would be added the second year of life, then the fifth year before death, and so forth alternatively. Meanwhile the remaining costs of health care can be shared but reduced, as other diseases yield to science and better practices. But most important of all, the patients share some of the costs until the costs are eliminated, however long that takes. The structure of medical care is left undisturbed. To the extent possible the pace of change will depend on the pace of scientific progress, rather than the intensity of complaint about it.
If you know where you are going, you don't waste so much time going somewhere else.