I'd like to explore some outside-the-box solutions to universal health care today. Reading ralhpdog's diary yesterday ( My daughter's tragedy: U.S. health care in a nutshell. ) was the motivation for writing this, but these are some concepts that have been noodling around in my brain for some time now.
Over the past year or so, I have come around to the fact that single-payer is probably the only really efficient solution to providing health care for all Americans. That will not happen in this Congress. So, how else can we achieve the same goal in a more politically acceptable manner?
Follow me below the fold for one idea..
Every American - insured or not - fears losing everything they've worked for all of their lives to a catastrophic illness. Sometimes, one wonders if you are luckier to die from an illness or to be cured, as devastating financially as the cure can be.
So. I think even the hardest hearted conservatives could agree a society such as ours should never let an illness throw a person into bankruptcy..losing their home.. their job.. sometimes everything. (That may be wishful thinking, but staunch conservative friends of mine have agreed - depending on cost, of course)
So, why not start the discussion of universal health care from that point? Why not start from the idea that we all our responsible for our fellow Americans as far as not allowing any person to suffer from catastrophic medical bills?
How could anyone argue against universal catastrophic coverage, politically speaking?
Here's how it would work.. and then we'll talk about some of the big advantages that come out of having this coverage as universal.
Catastrophic coverage, if purchased from a private insurer, can be downright cheap. This, of course, depends on the out-of-pocket amount you choose and deductibles, as well as your age and health level.
So, first we pick a number beyond which our universal catastrophic coverage kicks in. Let's say $5000, but the number is up for debate. That means no one in America could ever be liable for more than $5000 per year in medical bills.
Why, you might ask, is this cheap to provide coverage? Won't there be lots of really sick people in this pool? Sure, but we know what the risk is.. we have a pool of 320 million people.. and we know from past years what to expect as far as bills per individual over that amount. So, we know going in what it will cost taxpayers. (but we can improve that number - more on that below)
But $5k still seems like a lot.. and, for most families it is! But think about what that does to private health insurance.
Private health insurance plans will only ever be liable for the deductible amount below the set limit on universal catastrophic coverage.. in this case $5,000. Private insurance rates will plummet, because there is very little risk involved.
All private insurance now becomes a supplemental policy, if you will.
Now, this also greatly simplifies the debate in Congress on healthcare reform.
First off, simple regulatory changes allowing insurers to work across state lines encourages competition and drives prices down further.
Second, Congress needs to mandate a universal billing system.
Third, any healthcare reform bill should include tax credits for anyone below a certain income level (say 300-400% of poverty) to help pay for supplemental insurance.
Last, insurers cannot refuse coverage for anyone, and they cannot drop coverage once instituted.
Optionally, a health care reform bill could stipulate levels of service for supplemental plans. In other words, what service levels constitute a basic health care insurance plan? Private insurers can elect to offer these plans or not. But the consumer would know what to expect from the coverage in a government approved plan... no questions asked. This is not "socialist government run health care" - it is simply guidelines for consumer protection.
The only question that remains is should we mandate the supplemental coverage. I would lean toward yes as the answer. Any pool that contains young health people makes the insurance premiums lower. But, I think even without a mandate, this is a very workable system.
The first advantage is that the focus of private insurers now becomes one of keeping their clients healthy. This can be encouraged by allowing primary care to be performed with no co-pays at clinics (even the ones in Walgreens and Wal-Marts that are springing up across the country).
Secondly, as more Americans can afford basic healthcare, the dollar amount of catastrophic illnesses drops. This assumes preventive care is part of the basic health care plan. (And that people have access to primary care - see item above)
Thirdly, small (and large) businesses will rejoice at lower insurance costs. They will be able to offer their employees full supplemental coverage at a fraction of the cost they are shelling out today.
Last, the government will be able to negotiate the prices for costs of major illnesses. The government should pay no more than the best negotiated rates of private insurers. This drives down real costs and hospitals and doctors are no longer left wondering if bills for catastrophic illnesses will be collectible. They will always be collectible, albeit at reduced rates (as it should be).
Yes.. On one level, this is kinda sorta single payer through the back door. (Actually more like the Dutch system) But, I think it is a way to keep private insurers involved, would be palatable to most members of Congress, and would really reduce health care expenditures in this country from day one.
Thoughts?
Mr. Obama - Have your people call my people.. we'll do lunch and talk about it! This is an idea whose time has come.