What if we started over?

I know that the ACA troubles that have and will continue to occur as the nation adapts to Health Care Reform will not likely be changed by the administration.  But what if we could start over?  What would meaningful Health Care Reform look like?  What would our priorities as a nation be?  I have spent a good bit of time thinking about those questions and from my perspective, one of a career health insurance agent; we are missing the mark by a pretty substantial margin currently. Let’s take them one at a time, shall we?

Could we start over?  Yes! We could and we should in my opinion.  The best laws of this nation are not complex, they are simple.  Due to the sheer volume of this law, it was doomed to calamity from the outset.  Although many bright minds were tasked to construct this endeavor, it was not a law that solicited the voices of the very people who would ultimately be charged with doing the grunt work.  That work is being done by the real and credible insurance companies. Like them or hate them, they are not the problem with this law.  And while having somewhat of a voice, they were largely dismissed as being self serving and narrow minded in the reform discussion.  This is my opinion of course, not supported by first hand observation as I was not invited to the meetings, but from conversations I have had with folks who were closer to the making of this law, I remain confident that the input of Insurance Companies were largely ignored.  The proof of this assertion is the final product.  It will fail, it has no hope of succeeding as currently fashioned because it defies the very principles that insurance relies upon to work.  So if we can start over, I would advise the powers that be to listen to and implement the ideas of those folks who handle risk for a living.

Meaningful Health Care, what does that look like?  I my mind, meaningful health care would provide basic access to the needs of our people.  This would be the starting point for all coverage and would not mandate un-needed benefits to any segment of our population. (No maternity coverage for men, etc) Based on means testing, this coverage could be completely free to a low income family, and provide office visits, hospitalization, and prescription drug coverage for necessary medications.  It would be a Medicare type system, and certain doctors and hospitals would either choose to accept those patients or not, however, if you chose not to accept those patients you would not be eligible for federal funding of any kind. As your financial situation improves, you would have less and less subsidy for the basic plan.  This plan would not be mandatory for anyone; it would be voluntary and available if you chose to participate.  For those who could afford to pay for the plan, a premium for this basic coverage would be charged.  All other insurance policies would be available through private insurance companies, and just like buying a home or a car, your preference would determine the plan features as well as the cost. 

Many people might look at what I just wrote and say, “That is what the ACA did.”  Not true.  The ACA went far beyond providing basic coverage by mandating “essential benefits” which for many people are not essential at all, thus driving the price of the “basic plan” to an unaffordable level.  In my opinion people need the following:

·         Office Visits with affordable co-pay (preventive services included)

·         Emergency Room access with affordable co-pay

·         Hospitalization coverage with a reasonable deductible

·         Lab work included in the appropriate level of care

·         Prescription Drug coverage at the generic level unless no generic is available

·         Physical therapy appropriate for injury or condition (best practices)

·         Mental/ Nervous therapy appropriate for condition(best practices)

·         $5 million lifetime  maximum on services

·         Maternity and prenatal care for females only

What is affordable and reasonable?  According to ACA, the bottom tier coverage is a Bronze level plan, which pays about 60% of the medical costs that a person incurs, and that person would have to come up with the other 40%.  That seems like a good deal if you only incur $10,000 worth of medical expenses.  But if you have $100,000 of medical expenses, it is a different story. (Note: There are out of pocket maximums, but with a deductible and out of pocket expenses the money gets real, and quickly) 

I have talked about this before, but it bears mentioning again.  The statistics just don’t add up to a massive overhaul of the system.  It is estimated that 20% of the American public are uninsured.  I would guess that about 8% of that group is chronically uninsured, and those folks are more than likely poor, very poor.  We as a nation need to address that sooner rather than later, and health care is just the tip of the iceberg on that issue.   There is probably another 2-3% of that population that are in and out of health insurance, due to job change, financial conditions changing or other issues beyond their control.  I get that, it is a hard place to be.  However, the remaining 9% or so in this group are uninsured by choice.  They can likely afford to purchase a policy but choose not to do so.  The breakdown continues that 50% of the people are covered by an employer plan of some sort.  30% are covered by a government entity.  So in my feeble mind, what are we really talking about?  We are changing the entire system of health insurance (like it or hate it) for 11% of the people who are legitimately in a bad spot.

What do our priorities as a Nation need to be?  These are my thoughts.

·         Help the legitimate poor get health care

·         Prohibit prescription drugs advertised on TV from being covered by health plans

·         Pass meaningful tort reform that preserves the rights of legitimate malpractice victims

·         Prosecute fraud and abuse to the fullest extent of the law every time

·         Electronic medical records conversion within the next decade

·         Eliminate costly barriers to practice medicine (HIPPA  and the like)

·         One pay all pay pricing by doctor’s and hospitals (Lowest pricing enjoyed by all carriers)

I am sure that these are not all of the things we need to address but it is a start.  The whole mess is complicated, but we weren’t too far off with the system that we had.  One thing that has gotten away from all of us is that you must have PERSONAL RESPONSIBILITY for making sure your health care needs are addressed.  Somewhere along the way we as a society have taken the attitude that someone else needs to pay for my misfortune.  Well, in some cases I agree, but for the most part, people have got to start making better choices.

Peace!