OP-ED

What if All Americans Had at Least Catastrophic Health Care Coverage?

Picture 9I really dislike the term healthcare reform. I think our system needs to be changed not reformed. I assume that I am not the only person who suspects that the recent health care reform act is not going to be the final solution for America’shealth care problems. The cost of healthcare is not really addressed at all, and even if it works better than expected some Americans will not have even catastrophic health carecoverage.

This post is really just my first shot at suggesting a way I think makes sense to address the problem of the large number of uninsured people in America, while at the same time leaving lots of choice and personal responsibility that seems to be needed and a part of the American culture. I am certain that I have not thought through all of the gritty details, and really don’t profess to have the talent or knowledge to write legislation, but I think this basic tenant might be a starting point.First my assumptions:

  1. The biggest issue facing Americans who are uninsured is the possibility of personal financial ruin from a major medical condition.
  2. Americans want personal choice in choosing a medical plan and providers.
  3. American corporations are at a global disadvantage in having to pay for expensive health insurance plans that put their cost of producing goods and services higher than in countries with governmental healthinsurance.
  4. If American’s were more responsible for their health care costs, it is likely that they would take a greater responsibility for how their dollars are spent on healthcare than if they are spending other people’s money.

Next the basic elements of a solution:

  1. The federal government provides every American with a catastrophiccoverage medical plan. This would be a very high deductible plan to cover expenses over a chosen amount, say $5000./ family per year. (This number could be different, depending on actuarial and legislative input.) This would be paid for by a national tax of some sort, maybe a combination of a corporate payroll tax and health coverage value added tax, or other individual tax.
  2. Individuals and employers could choose to purchase supplementalcoverage for themselves or their employers beyond this catastrophiccoverage. Most Americans would want to at least purchase access to a PPO type of network to access discounted fees negotiated between providers of services and insurance plans, much like PPO fees now. They could also choose to contribute to a HSA account to save/pay towards the deductible or to a supplemental plan to cover some or most of the deductible expenses. There would be no mandated services to be covered in these supplemental plans. Individuals could choose what services they want to have insured. This would allow insurance companies to offer plans tailored to the desires and needs of individuals, not the current every willing provider, cover everything for everyone that the many current mandates dictate. If we are ready for really big change, this could be for all Americans, and our less affluent elderly and our poor could have some sort of assistance in purchasing supplemental insurance to replace Medicare and Medicaid.

That’s pretty much it. Everyone would have catastrophic national healthcoverage to prevent most Americans from facing the risk of financial ruin from an accident, injury, or illness. We could all choose to purchase whatever other coverage meets our needs on a open market, without regulated mandatory coverage of any services we might choose not to purchase.

I’m hoping to have this topic be an ongoing forum for discussion. Comments, better ideas, suggestions for major problems I’ve neglected to address, and the expected outrage that this idea is a step toward socialism, fascism, or some other ism is welcome. Make comments and join the dialogue.

Ed Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news and policy from a primarycare physician’s perspective at his blog, DrPullen.com.

Livongo’s Post Ad Banner 728*90

Categories: OP-ED

Tagged as: ,

31
Leave a Reply

31 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
21 Comment authors
wilfred74irwwt.wordpress.comGailRon Kilcullenpayroll taxJim Bertsch Recent comment authors
newest oldest most voted
wilfred74irwwt.wordpress.com
Guest

Howdy, i read your blog occasionally and i ownn a similar one and
i was just wondering if you get a lot of spam responses?
If so how do you prevent it, any plugin or anything you can suggest?
I get so much lately it’s driving me mad so
aany support is very much appreciated.

Gail
Guest

Thanks for sharing your thoughts about best health insurance plans.
Regards

Ron Kilcullen
Guest
Ron Kilcullen

The more you are on the road, the higher your chances of getting in an accident. Insurance rates are higher for people who commute to work. So taking the bus or sharing a ride will not only help you save on parking and gas, but will help lower your insurance premiums.^

Our own web blog
<.http://www.beautyfashiondigest.com/mens-linen-pants/

payroll tax
Guest

Tax Attorney.com is your source for expert legal advice, and tax solutions. We help people resolve their personal and business tax liabilities by working with experienced Tax Attorneys, CPA’s, Enrolled Agent’s, and ex-IRS agents. Having a caring tax professional on your side can bring immediate relief and peace of mind from the stress of dealing with the IRS.

Jim Bertsch
Guest
Jim Bertsch

50% of health care costs in this country are borne by the federal and state governments. When you add-in the 25% borne by corporations, people are only paying 25% of the actual health care costs. The hidden health care costs are bubbling up and will eventually be so bloated our government will collapse when this bubble bursts. Every problem and I mean every problem in health care has one simple cause rooted in the payment system. Every health care provider has two motives, which drive their business: the financial motive and the caring motive. These two motives are in conflict… Read more »

M Selk
Guest
M Selk

Medical care in the U.S. is already rationed by income. Those of us fortunate enough to have medical insurance can see a physician. In a poor neighborhood, you may not even find a doctor; if you are wealthy, you can see a doctor of your choice. I agree that catastrophic care for everyone should be covered. Where we disagree is that some payment for care would discourage “frivolous” medical care. We all need basic, pre-emptive care that means a pre-diabetic patient learns of his condition and does not become a patient in the emergency room. What about the child with… Read more »

meditation music
Guest

The only insurance I have right now is catastrophic and that seems to be the best thing for me, since I rarely need a doctor for medical issues in my life. But it would be nice to have a reasonable medical plan.

Nancy
Guest
Nancy

The truth is that people don’t have the common sense to understand that we all really have more than we need. This society has lost the reality of what is really valuable. It isn’t “stuff” and should something catastrophic happen and we are forced to barter for water (something we take for granted) it would be a game changer. Once handouts in this country started, it began to erode our society. I am always shocked that people think all doctors should give up their services freely when they worked so hard to achieve their stature. I don’t own an ipod… Read more »

Rob
Guest
Rob

“The biggest issue facing Americans who are uninsured is the possibility of personal financial ruin from a major medical condition.” False. The biggest issue is of DYING because poor people aren’t a parasitic drag on the population and maybe DO want to pay their bills, but can’t. So they will go without care, because they can’t pay. And all your pretty financial and “healthcare” words won’t change that. I render I.T. care to doctors for free, too. I render I.T. care to other people, too. I do it because it needs to be done. Doctors aren’t the only people with… Read more »

Doc99
Guest
Doc99

“The poor–whether on Medicaid or uninsured–receive sub-par care in this country. ”
Considering the care I’ve rendered personally and that of many physicians in NY City, I’d take issue with that remark. I’m beginning to get the idea that Ms. Mahar has some grudge against doctors.

Jane
Guest

I completely agree with your post. Thank you for voicing your opinion.

ExhaustedMD
Guest
ExhaustedMD

Ask Maggie to reply about this link:
http://www.cato.org/pub_display.php?pub_id=12003

ExhaustedMD
Guest
ExhaustedMD

Ah, Ms Mahar, isn’t reality about choosing what we can afford? Who writes your blank checks, and can I be sent some so I can spend what I can’t afford, but what this other person can?! You are out of touch with reality, Ma’am! And, by the way, people are afraid of dying or disability, but have you given a thought of those who have to pay the bills for the others they support? Again, it is not about Maggie Mahar, it is about the general population that inhabits this country. And, if this monstosity called Health Care Reform survives… Read more »

Nate
Guest
Nate

it would be nice if individual PCPs could capitate their services and sell directly to consumers

MPK
Guest
MPK

Ed, Well reasoned analysis and a reasonable proposition. I would like to add a few comments: 1) The fundamental problem with health insurance in the US is that there are third party payers. This distorts the ability of price to automatically match demand and supply. Patient and provider should consider the cost of treatment alternatives – such as $700 for MRI vs. sore knee. 2) The contributing problem is that health insurance is really no insurance if it compensates for routine medical care. Primary care should be completely free market that is cash based. Imagine how much will auto insurance… Read more »