I 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:
- The biggest issue facing Americans who are uninsured is the possibility of personal financial ruin from a major medical condition.
- Americans want personal choice in choosing a medical plan and providers.
- 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.
- 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:
- 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.
- 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.