REAL HEALTH REFORM = INSURANCE REFORM
Well, now that the presidential election has finally come to end, we can focus on what is really wrong with health care and how we can have meaningful, reality and real world based reform that improves the system for all.
Your comments are welcome as the plan being proposed is outlined and circulated. (see THE PLAN BELOW).
Thanks for reading. Our goal is to have as many hits as possible with support for the type of reforms outlined here. Join in!
Adding 47 million (the number that all seem to quote – who took that poll?) to the insurance rolls will NOT reduce overall costs. Increasing access to healthcare NEVER reduces costs. It always increases them. Simple formula, give me access, I use services, services cost money etc, etc. The so called offset from lack of use of emergency rooms and productivity etc is soft and longer term and never fully realized due to the current construct of the system. For example, presidential elections are never for the long term.
What is the flaw? Health insurance period.
How to fix it. Well, here are few thoughts.
(1) Private health insurance must be re-structured to function as a regulated utility. Their rate structure should be only that needed to operate (process payments, review claims etc) plus a set profit of 8-10%.
(2) As a regulated utility, the prices set should be wholly market based and not risk stratified for individuals or select groups
(3) By extension, adoption of item 2 means pre-coverage physicals, pre-existing condition exemptions and the like will no longer be necessary – the premium is set and if I can afford it I buy it. Companies will have to compete on efficiency of their systems and overall quality of their services.
(4) As a regulated utility the base package of services required to be offered is pre set and supplements can be offered. However, the base must be very broad to make sure the pricing factors in overall gross population risks, as opposed to sub group risks.
(5) The truly financially disadvantaged should be folded into the current Medicaid system with revisions, in that they should pay needs based premiums as with any private plan.
With this format alone, the lack of access to health insurance should essentially disappear.
This solution however does not address the concerns about rising overall health care costs (overall, not specific) nor issues related to coverage provision (ie employer based etc) However, with adoption of the above, availability will only be a factor of cost not employment.
A format of the type above, would be a great place of either of the presidential hopefuls to start.
SEE “THE PLAN” AS WE EVOLVE IT TO REALISTIC ONE FOR THE IMPLEMENTATION OF REAL HEALTH REFORM
“THE PLAN”
KEY Features *
- All persons must have health insurance from the private sector or government sponsored plans.
- Proof of insurance would be required to get any type of license, enroll in school, apply for job, yearly confirmation will be required, etc. just as with automobile insurance.
- Fine of $1,000 if presenting to Doctor, Hospital, etc., for service without insurance, and must pay all expenses for services.
- The truly financially disadvantaged should be folded into the current Medicaid system with revisions; in that they should pay needs based premiums. As such, Medicaid, Medicare, disability, workers compensation, Government employees, Veterans, Retirement and children’s programs would not be significantly changed.
- All company-sponsored programs would be phased out over three years (better than a tax break).
- Minimum wage increased by $2.00 per hour so low income workers would have no excuse to offer for not having coverage.
- Private health insurance should be re-structured to function as a regulated utility. Their rate structure should be only that needed to operate (process payments, review claims etc) plus a set profit of not more than 8-10%. Rates to be set nationally not state by state, or group by group.
- Eliminate state oversight of health insurers in terms of rates. Continued monitoring implementation of federal standards.
- As a regulated utility, the prices set should be wholly market based and not risk stratified for individuals or select groups
- Adoption of item 9 means pre-coverage physicals, pre-existing condition exemptions and the like will no longer be necessary – the premium is set and if I can afford it I buy it. Companies will have to compete on efficiency of their systems and overall quality of their services.
- The base package of services required to be offered is pre set and supplements can be offered. Minimum basic policy defined (like auto insurance) with individual deciding on increased benefits. However, the base must be very broad to make sure the pricing factors in overall gross population risks, as opposed to sub group risks. Minimum basic policy defined (like auto insurance) with individual deciding on increased benefits.
- Fine of $100,000 to any insurance company that denies writing the policy (basic) regardless of age, gender, sexual orientation, race, genetic assessment, pre-conditions, etc. Policies are not cancelable except by death or qualification of coverage under item (1) above.
- Hospitals and similar, fined $50,000 for refusing to treat presenting patients (patient non-compliance, refusal of treatment by patient, leaving against medical advice etc. would remain in force as currently practiced).
- Physicians and all other health care providers fined for refusal to treat $25,000 (dismissal of patients for non-compliance or other ethically accepted reasons as outlined by the professions would be maintained).
* Key Contributors and Thought Leaders for “THE PLAN”:
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Being a less-is-more-in-government kind of girl, I’m not crazy about items 7 and 8. I also don’t like item number 2. It’s not the ideas here I have a problem with, I just don’t like the government mandated aspects of them. Would it be possible to offer health insurance with credit unions as a model? A not for profit insurer instead of a company trying to make a profit for their stock-holders. But where would the capital to start such a thing come from? How does USAA (which I think is a for-profit company) do it with auto insurance? What about just starting an insurance company with the set profit of not more than 8-10% like in your plan?
rachel has some great thoughts on “The Plan”. Here are some of the issues that lead to these ideas:
(1) Starting with item 2, the need for proof of health insurance is the only way to force the public to resume personal responsibility over their health care – one which over time has been abdicated and usurped by large health insurance interests. This is really no different than the need to prove current coverage for those with auto insurance.
(2) The concept of a regulated utility, I know, does not appeal to many free market personalities (and I assure you I am one). However, vital free markets can only succeed with limited BUT needed regulation. That “needed” regulation is dictated by the excesses or failures of the market. Since health insurance is in my opinion an item vital to the national interest, there must be some form of regulation to limit profiteering to prevent premium structures from inflating beyond the reach of average Americans.
(3) Item 8 only works if item 7 is in place. State oversight of rate setting could still occur if desired as a modification to the “The Plan”, so long as guidelines met the Federal standard.
Under this plan, any private entity certified as financially solvent and capable of offering health insurance could – so credit unions could indeed play a role if they so desired.
The key is that it removes health insurance from the list of employer mandated benefits (which is not the case for auto, home or other hazard insurance) and returns to its proper place as an exercise of citizen responsibility.
rachel, thanks for these thought provoking comments. Keep them coming!
#1) Stop treating illegal aliens without being reimbursed by their country of origin.
#2) Repeal the federal law that makes it illegal to transfer medical indigents to teaching hospitals,ie county hospitals.
#3) Broaden tax deductible medical savings accounts that can be rolled over year after year after year without aligning it with expensive insurance coverage.
#4) Make available lower cost catastrophic health insurance that comes with a large deductible. As one’s medical savings accounts accumulate then the deductible can increase and the premium will decrease in cost for the same catastrophic coverage.
#5)End anchor baby situation and require American citizen status of the parent/parents
These are some thoughts that are consistent with the beliefs of many who are concerned about controlling costs and expanding options for Americans. The fact that HSA’s are not available to Medicare beneficiaries as an option is discriminatory and something that Congress should address now. Your comments about illegals and illegal births equating to citizenship are correct. We as a nation are long overdue in correcting these abuses. Good points, thanks for reading.
[…] The Plan […]
I think that on the whole, the plan for Real Health Reform sounds like a very good starting point and certainly is a logical beginning to address this major issue.
On the delivery side of the cost equation, there must be some changes as well. To continue to allow unfettered access to specialty physicians, while wonderful for the specialists and other providers, i.e. hospitals, surgery centers and imaging centers, will do nothing to curb the upwardly spiraling costs we continue to experience. This is the responsibility of both the patient and the provider.
Accountable care organizations (ACOs) hold real promise for the delivery of care that is appropriate, timely, cost-effective and of high quality.
Having worked for an ACO, a Medicare Advantage plan, I know that this works and works well. The focus on quality, access and cost for the most expensive population group results in significant improvement in both quality and medical cost.
Food for thought…
Unfettered access equals limitations on services for patients. I agree that ACO’s have a place, however, referral and proper workup are essential for best medical outcomes. There is a disconnect between diagnostic technology and its costs in many cases. Most diagnostic technologies should be considered extensions of the basic physical examination. Cost is relative and limitations on consults, referrals and tests is, in the end, a form of rationing. As long as citizens have the option for direct access on their own (and in some cases, perhaps at their own costs), reform can still be personalized to some degree.
[…] The Plan […]
The debate over health care reform in the United States centers on questions about whether there is a fundamental right to health care, on who should have access to health care and under what circumstances, on the quality achieved for the high sums spent, and on the sustainability of expenditures that have been rising faster than the level of general inflation and the growth in the economy….
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