Picking up on JeanJacques' diary here, I think in the rush to get a plan--and rushed plans are very rarely good or effective (and, since many here objected to the rush to pass the USA PATRIOT Act, the clamor to rush to pass a health care plan now is inexplicable)--we're losing sight of several key goals:
- Control medical cost inflation.
- Prevent people from going bankrupt because of health care expenses.
- Make sure everyone has access to affordable insurance.
- Ensure that plans are portable from job-to-job and state-to-state, and several other goals making it possible for individuals and families to make their own lives.
Therefore ....
...I would propose the following plan to ensure that everyone is covered:
- All individuals must obtain health insurance coverage.
- All insurance companies must accept anyone who applies for coverage. Premia may vary by a number of factors, but not by the presence of pre-existing conditions. Factors to be included would include deductible and co-pay amount; and we might want to use those used by the Dutch system which "groups enrollees by age, gender, labor force status, and region, as well as by 20 pharmaceutical cost groups (based on past drug utilization) and 13 diagnostic cost groups (based on past hospital use)." ( Source--p. 26 ). People would apply annually during an open enrollment period, and could change plans and/or companies each year as their circumstances changed.
- A risk-sharing plan (aka reinsurance system) is set up to cover companies which have a higher-than-expected claim history (the report cited above indicates that including hospitalization and drug history in the premium rates increases the accuracy of the risk-prediction, and thus the sufficiency of funds, at least if I'm understanding the report correctly).
- The funds currently used by employers to pay for employee HI coverage become generally available to provide HI premia.
- Poor folks receive subsidies to purchase HI, or are provided HI through Medicare/Medicaid.
- Rich folks can buy whatever they can by. Showoffs.
- HI companies would be set up as quasi-non-profits, although a guaranteed return, per the traditional public utility model, to the shareholders would be available.
- HI companies must limit the compensation of the top employees to no more than 100 times that given the lowest paid employees in order to participate in the risk-sharing plan.
- Portability of plans is, I think obviously, available through this system.
- Medical malpractice claims are handled similarly to worker's comp. claims--guaranteed payment for actual damages, including medical care and lost wages, but no unpredictable pain and suffering awards.
- People would be able to set up Retirement/Education/Health Care Savings Accounts, which would be funded with pre-tax dollars.
- The Health Insurance non-profits would have the ability to negotiate payment rates with health care providers and drug companies.
The variety of plans available under the Dutch model--which does NOT allow preexisting conditions to prevent the sale of the HI policy--vary by deductible and co-pay; the healthy 20-something in a decent job might choose to go with a 5K or 10K deductible. The 50-something couple could elect to drop a 'pregnancy component' on the policy, but might want a lower deductible since they're getting to the stage in life when they will be using more health care.
Copays would be present to prevent running to the doctor for a sniffle. Everyone knows that you treat a cold with plenty of liquids and rest.
Everyone should pay in some way to use the system. Under this plan, everyone does--the health care providers, the health insurance industry, the people, the lawyers, everyone.
I admit to believing that the goal of a liberal state should be to enable people to do their own thing--to be able to live largely as they choose; most one-size-fits-all schemes are, to my mind, as dangerous and wrong-headed as most zero-tolerance policies. My school district pays almost $10K per year for my HI policy; I have not used $10K in health care billings total in the past 20 years. My sense of Scottish frugality is outraged by this extravagance (as it is outraged by the salaries the top executives at these companies receive, especially since they have a clear conflict of interest between their obligations to their insureds under the contracts and their fiduciary responsibilities to their stockholders).
I recommend the report linked above to everyone.
BC