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Friday, December 4, 2009

The Time to Hate Health Care Reform is Over

It's easy to find something to criticize about the House and Senate health care reform proposals. They either cover too much abortion or too little. There are too many taxes on health insurance companies or there is too much new business and giveaways for them. Cost containment is either not taken seriously or a single payer system is not taken seriously.

The names of the legislation don't produce exciting acronyms. The House's Affordable Health Care for America Act would be AHCAA and the Senate's Patient Protection and Affordable Care Act is PPACA. What about Health Entitlement and Affordable Reform Treatise or HEART? The opposition could offer Healthy American Treatment and Empowerment or HATE?

Would COBRA (the option to keep your former employer's health insurance if you pay for it) still be around if it were called HMGPH instead of being named for GI Joe's archenemy?

The time to hate is over. The status quo is not a sustainable option and Congress has made more progress with health care reform than the last 40 years combined. As reform ticks closer, it's time to shape the solution rather than point out the flaws. If you can't be with one you love, love the one you're with. Republican Party, are you listening or do you enjoy being irrelevant?

I have criticized a national blogger for only pointing out the problems. Pointing out problems is easy blog fodder that can be written while sitting on the toilet. With this post, I plan to stake out my ideas for 1) the current proposals and 2) my ideal health care solution.

1. The current proposals: A health care reform proposal that will realistically pass will reshape the current system. Health care is a complex system that will take decades of tinkering since not all the parties in government take it seriously. The health care system also can't take a month off to reboot. Therefore, it is not realistic to expect a dramatic shift to single payer or another country's model.

With those very real constraints, I have to say that I agree with most of the current health insurance reform proposals. They shift money around from those with lots of insurance to those with none. That's the basic concept of insurance. They try to create rules to encourage good behavior. There is the hint of cost containment with an independent body that will make recommendations for Medicare that Congress must accept or reject as is. No horse trading, smoky rooms, or ear marks. Here's what I would change:

  • A real individual mandate: For health insurance to really work, everyone has to participate. The basic concept of insurance means that everyone has to pay into it, even if you might not use it. There needs to be a real penalty for not buying health insurance. The House's 2.5% of income is getting there. The Senate's penalties are closer to what you would pay for marijuana possession and last I heard, that's being mostly decriminalized.

  • Stop Medicare geographic discrimination: Original Medicare pays providers differently based on geography. That payment methodology is mostly based on how much is being currently spent so frugal regions receive less money. That means providers are paid less and less likely to accept Medicare patients. That's geographic discrimination as seniors in Florida get twice as many health care dollars and access to more providers than seniors in other states.

  • Don't mandate gold plated health plans: Congress is passing various mandates for health insurance plans such as lower deductibles, out of pocket maximums (which is the most that someone would have to pay in a year for health insurance), and preventive services for no cost. These are fairly expensive, comprehensive plans that will continue to shield the consumer from the real cost of health care. These mandated benefits could very well reach the levels of gold plated or cadillac plans which would cost someone (usually the employer) $8,000 per year, that the Senate is proposing to tax. These mandates are moving towards providing more insurance than is necessary. It's kind of like offering a buffet and hoping people don't overeat.

2. My ideal health care solution follows the US educational system or Germany.

There is a baseline government funded level of benefits. Medicaid and Medicare are dissolved except to provide subsidies for those with low income. The baseline level is determined using the same methodology as the Oregon Health Plan. A budget is set that would be a certain percent of GDP. Medical services are ranked, cost is estimated, and when the budget is used up, no more services are covered. Just like public school, everyone gets reading, writing, and math covered but if there's not money for art, music, or playground equipment, it may not be covered.
Everyone who offers a healthcare service from doctors to durable medical equipement has to fully participate. The role of this baseline plan is to prevent startvation but not provide an all you can eat buffet.

The private sector can still compete to offer more: The rest of medical services or art, music, and playground equipment or fancy private schools with uniforms and SAT preparation can be offered by employers to attract workers and insurance companies to sell fancy new insurance policies. Providers can offer services to attract those who have these plans and fight it out with insurance companies on how much they can get paid. The competition of the free markets can be unleashed without casualities.

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