This country has been attempting to achieve health care for everyone for decades. Health Care Reform will require timely access at an affordable cost to have any chance of benefiting the American public. The Congress has suggested several proposals of health care reform. The House of Representatives has two health care proposals and both of these plans call for a government-controlled program that the public in town halls across the nation has rebuked.
Approximately 47 million Americans are without health-care insurance sometime during the year. Several million of the uninsured are young people whose health is good and they choose to do without health-care-insurance even though they have the economic-means to purchase it. Millions more of the uninsured are undocumented immigrants. This leaves us with approximately 15 million Americans denied health care either because they lose their job, have a precondition health illness, or they simply do not have the income to afford health care coverage. About 80% of the public is content with their current coverage but they are concerned with the rising cost. Therefore, controlling rising cost and insuring the 15 million uninsured appears to be the main needs of any health care reform proposal.
Government Employees Insurance Company [GEICO] provides federal employees with auto and life insurance. GEICO operates in the private sector and most of GEICO is now available to anyone that wishes to participate in his or her coverage. Employees of the federal government have an excellent medical provider program. The federal employees get their medical insurance in the private sector. The same program available to federal employees should become available to any citizen or American company the same way GEICO is. Low-income people could be provided vouches [pro-rated] based on income to acquire the coverage.
Tort reform is a must in order to control rising cost of medical attention. Doctors, to protect themselves from lawsuits conduct expensive and wasteful medical examinations. These defensive examinations drive medical coverage prices equal to or more than most of the cost needed to provide medical insurance for the 15 million uninsured. Therefore, tort reform must be part of the solution in controlling the spiraling cost of health provision in America.
Small businesses and individuals should be able to purchase health insurance at group rates. Many states only allow a few companies to sell health insurance in their state, thus restricting competition and increasing cost. Individuals need the ability to purchase health insurance from any insurance company nationwide. Insurance companies must be required to provide health care to all people with any precondition illnesses. Also, insurance providers should not be able to drop current coverage for people who develop an illness. Insurance should be transportable for people who lose their job or leave their job. Duplication of a patient’s medical test should not be required when another doctor sees the same patient, unless a second opinion is required or requested. Duplication of medical examinations is a costly and wasteful use of resources. Individuals need the option of purchasing major medical insurance coverage, which surpass a previously agreed amount. Major medical insurance is far less expensive than full coverage insurance.
To stir emotions the health care reform debate doesn’t have to peel the onion back very far. There are those who could always afford health insurance and are worried that their costs will significantly rise in the attempt to cover the cost of care for those who have gone without. There are those with numerous and expensive to treat medical problems, who have no health insurance or inadequate health insurance coverage and they need relief, now! And there are those who are healthy, have chosen not to have health insurance, and resent a mandate requiring them to “buy-in” or face monetary penalties.
How to provide health care.
The Health Care Affordability Act of 2010 is wide in its scope and goals. First, it moves us to a place where most Americans will be covered by health insurance. This will remove “the” key impediment to “routine” health care services for millions of Americans. Subsidies will insure health care insurance regardless of an ability to pay and just because you have pre-existing medical conditions you will still be eligible for “reasonably priced” coverage. Stated another way, insurers will not be able to reject you or drastically increase your premiums if you suffer from chronic illnesses that generate a high level of claims, nor will they be allowed to set dollar limits on health insurance coverage.
To fund these objectives the Health Care Affordability Act requires all Americans to purchase health insurance. There will be subsidies if you are in a low income category and if you have no ability to pay anything you will be eligible for Medicaid as these state level programs will be more accommodating and act as the ultimate safety net. Through its mandates, the law requires millions of healthy individuals to pay into the system. The idea here is that those of us who are not in need of health care will fund those who draw from it. Since any of us can succumb to a health emergency at any time and thus become in need of potentially costly health care interventions those who support the mandate feel that this is fair – we are simply looking out for each other. Next, there are numerous plans in testing phases that are designed to make the delivery of health care more efficient and more cost effective. These pilot programs are being managed by the Center for Medicare and Medicaid Services (CMS) and include the cooperation of health systems throughout the country. These are complex to say the least and in early development stages and until proven, which is years from now, it is not known what their effect will be.
I support the attempt by the Obama administration and others to get something done on this pressing national issue. But there is a lack of candor about the cost, where the funds will come from, what treatments and medical technologies will be restricted due to very high costs and how the demand of millions of newly insured patients will be managed in terms of timely access to care and treatments. I have spent forty-one years of my life in a medical technology career that focused on global health economics and reimbursement issues and believe me, something will have to give. In every country outside of America, health care budgets are limited and capped. Fees to hospitals and physicians are set, annually reviewed and kept in check and new medical technology prices and access to them are restricted in subtle and not so subtle ways. And if you think that these policies won’t happen in America – think again, as spending limits are being set and will be set and we will have to live within them!
Having said that, let’s continue on with the reforms, some government mandated, some driven by the market place as conservative health policies propose. Just know that we will be dealing with health care reform for a very long time and there are going to be a lot of disillusioned folks along the way, newly enfranchised and otherwise. The emerging health care system will be “more just” but it will require real and noticeable sacrifice from the majority of Americans who heretofore never much worried about the fairness of it all.