I've followed the battle for healthcare reform very carefully, but standing on the sidelines. I joined Harvard Community Health Plan in 1973 directly from Harvard Student Health Plan and have maintained my family membership continuously since even when we lived abroad and couldn't use it. Some friends called that stupid and wasteful, but my wife was adamant that we had the best and we should keep it.
In the mid 80's I began my struggle with PTSD. No problem. I received fantastic care from a Board certified psychiatrist who taught at the Harvard Medical School. Through annual checkups and regular visits to my PCP, we discovered my Type II diabetes very early and were able to control it with exercise, diet and oral medication for more than 15 years until I recently became insulin dependent. And ten years ago when I contracted a mysterious disease, a team of specialists were able to determine it was Wegener's Granulomatosis before the damage to my kidneys required dialysis.
I take twelve perscription medications every day, plus insulin at a cost to the plan of more than $3K per month and a cost to me of $182 per month. I told my PCP the best thing HCHP could do was have me killed in that I was bankrupting the plan. He didn't think the idea was very funny.
So, I have never had any of the heartbreaking problems other Americans have suffered through, but my experience has kept me thinking about creative solution to our healthcare crisis.
Why is the health insurance industry fighting so hard to prevent reform? Simple answer - they don't want to lose their stockholders' investment. And of course the obscene compenation of the top executives. But let's take these one at a time.
When I was doing strategic management consulting in Asia, there was a saying, "If you can't beat 'em, buy 'em." Applying that to our situation here is simple. Select a date in the recent past - say Obama's inauguration day. Announce a government tender offer for stock in all health care insurers at the closing price for that stock on the selected date. Have a lottery to determine the order in which the tender offers will be made. Any and all stockholders would know what their shares were worth and roughly when they would be bought by the federal government by the Treasury and then re-distributed to the Department of Human Services to manage. Include the funds for the purchases in the regular budgetary process in order to control the expenditures. I suspect Congress would be very generous in their allocation to these, their favored corporate contributors.
No one would be forced to sell, but once the Treasury had majority control of any corporation, things there would change. Policies would be put in place to accept all applicants, require annual physicals and fix employer contributions to a fixed percent of payroll, say 9%. The insurer would offer a standard base plan designed by HHS, CDC and NIH, but could also offer a broad range of supplemental plans to cover speciality situations. The administration and marketing costs would be radically reduced, but some staff would be retained to handle the increased number of subscribers. However, most of top management, and their bloated compensation plans, would be eliminated, as would all lobbyists.
Within a few years the transition from private, for profit, health insurers to publically owned, non-profit plans would be complete and attention could then be directed toward drug prices and for-profit hospital chains. This approach may not satisfy everyone. In fact, it might piss everyone off. But another consulting maxim comes to mind. How do you eat an elephant? One forkful at a time.....
Thanks for reading. I'm only attempting to spark creative discussion, not offer up a completely formulated solution.