September 7, 2009

What Should We Look For in Health Care Reform?

Health care reform. It has become a firestorm topic, but most people agree that we do need some type of reform.

I have heard the rumors, researched some of the current House bill (H.R.3200 - America's Affordable Health Choices Act of 2009), listened to debates, read editorials, and finally, just tried to put most of it all together in one item. Hopefully, this post addresses most of the issues that everyone wants to know about and some that people are leaving out.

Looking at the Problem

The problem is we currently have about 46 million people in the US that are not covered by insurance. The Census Bureau provided the following statistics regarding the uninsured:

Total uninsured people in the United States46.0 million
Less non-U.S. citizens (many here illegally)(9.7 million)
Less household annual incomes greater than $50,000(10.0 million)
Less household annual incomes greater than $75,000(7.0 million)

From what I have read, most of the people in the under $50,000 in annual income qualify for programs or medical insurance from their employers but they either do not accept coverage or do not know about the coverage. Those with income over $75,000 can afford the coverage but they either do not want it or are self-insured.

Everyone should be signed up, but if you don't want it should you be forced to have it? In Massachusetts (state mandated plan), they said yes. If you do not have insurance, you are "taxed" on your state tax return. The end result is if you don't want it, you are pretty much going to pay for it anyway. Besides if something happens, the system will need to take care of you, and you should be able to receive care.

The interesting thing is the "healthy" people would spread the cost and make insurance actually cheaper for all. Think about your car insurance policy. You MUST have at least liability, but most also have collision, comprehensive, and uninsured motorist coverage. You have the additional coverage because you do not know what will happen, but you must have the basic liability coverage to drive the car. If everyone had insurance, we could pay less because there would not be a need for uninsured motorist coverage.

"Of the total uninsured, roughly 40% are age 18 to 34, and they are in basic good health. They have, apparently, elected to put their dollars elsewhere in the economy rather than in buying medical coverage. It is presumed that those with annual incomes greater than $50,000 do not buy medical insurance because they do not feel they need it or they are self-insured. They clearly could afford coverage, but elect not to purchase it." - Healthcare Relief Without Universal Health

What We Should Do

First, Congress wants to argue everything all at once, and some of the controversial issues are holding up the whole plan. It would be a good idea to divide the bill into three bills - one that has all of the things people agree on, one that has things that most agree on, and the ones that are causes the biggest problems. This lets the President and Congress say they have done something, and then the can go to work on the nitty-gritty stuff.

Be responsible! We all need to be responsible for ourselves. We all hear about the role that our doctors, insurance, and government should play, but what about pointing the finger a little more at ourselves. Eat right, exercise, sleep, watch your body fat, etc. If we all did these things, our population would be healthier with fewer ailments, and just that would start to lower costs. We can all go to doctors, clinics, etc., but we all must start to focus some of the issue on us as well. If we were overall healthier, we could focus even more on cancer, blood disorders, mental disorders, Alzheimer's, etc. that have nothing to do with how healthy we live.

Control costs!!! How? In Vermont they have 39 Federally Qualified Health Centers that are essentially a "doc in a box" that takes everyone (Hard to Believe! By Bob Herbert - The New York Times). They have a sliding scale for those without insurance, and it has relieved a strain on the system because these people are not going to the ER.

People without health insurance traditionally go to the ER for free medical coverage because they cannot be turned away. If you do go to the ER for say a sore throat. You will wait hours, probably see a PA (physician's assistant), and most likely get billed more than a $500. If you go to a local clinic instead, you will wait less time, get at least the same care (possibly by a doctor), and get billed about $150 or so.

Remove the crush on the ER, and suddenly health care costs will be cut. Save the ER for real emergencies. The ER wait times will improve and the cost will come down... a win-win.

Illegal aliens? None of the current plans even address it. A plan without addressing one of the largest issues is like buying a house without a roof. As long as it doesn't rain... no problem, but when it rains, you are in huge trouble.

If we had the clinics, you could make them not rely on resident status. Also, we must come to grips with the cost they provide on the system with little or no contribution. I am not trying to say to go after them for money, but if they are working in the US and being paid, FICA should be levied and the employers are also to blame.

The government option... get rid of it. Every program the government runs turns into an issue. Medicare, Medicaid, Social Security, Cash for Clunkers, Congress, etc. If you make it a government bureaucracy, you have done nothing but raise the price and lower the benefit.

Private Insurance... should be regulated on the national level and not by all of the various states. We should at least have a national regulatory agency that sets the standards, and if the states wish to go above it, then we cannot stop them, but the basic coverage should be the same from Maine to Nevada.

As with natural gas in Georgia, there should be a "last resort" insurer. This means that if all of the private insurers have higher rates, there should be a government subsidized plan that kicks in for those based on their income. Think Kaiser, Blue Cross/Blue Shield, etc.

Living wills? Yes! Everyone should have them, but the issue is do not allow a stage 4 cancer patient to not receive treatment. Terminal cases where the patient is non-responsive is one thing, but to deny a cancer patient treatment is something else.

Insurance Portability? YES!!! This is one of the biggest problems from a society that continues to change jobs and careers. Make the insurance portable with guaranteed coverage for pre-existing conditions and if you get sick. That is why you need the insurance in the first place.

Preventative Care is a must. It has shown time and time again to reduce overall costs even though the short term may seem more expensive. We have a long term problem, and the short term is of little consequence.

What We Cannot Do

Tax the rich... The "rich" cannot continue to foot the bill for the entire country and the fix for all too. They cannot fix social security, health care, etc. by raising taxes a few points. It will not work. Congress is already probably going to let many of the Bush tax cuts expire, so revenue "should" increase. Are we to also add a "surtax" on their income too?

Not Compromise! This is a plan that is supposed to benefit everyone, and neither party has exactly been the picture of thinking of the greater good. Both republicans and democrats MUST come together for a plan that the country will get behind, or we will continue to have a fractured nation where the people do not trust the government.

Where to Look for Answers

There are a million different good ideas, facts, figures, and articles written about health care. I am going to mention a few below:

I have probably read more on this one topic in the past month than for any other topic I have written about. We are in the midst of having full coverage, but it must be done responsibly.

I worry that the cost of the plans the democrats have will be so great that in 5 years we will be trying to fix or undo what has been done when the program is in shambles. I also worry that the republicans are missing the boat to actually come together on a huge social issue and make it the best possible plan for the good of the nation.

We need reform, and we do have the possibility of having it, but let's make sure we get it right the first time.

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