Tuesday, November 24, 2009

My Healthcare Plan

Get ready, we are far from hearing the end of this debate! Talk of Trillion dollar programs, inadequate patient care and how "we" as a nation will care for those with health issues are rising to a fever pitch. Those who want to spend money on government programs to fix the problem will argue on the side of care, that millions of Americans do not have adequate health care. Those on the other side of the issue will argue about the future of our nation, and the debt we are saddling the next generation with. 2000 pages of health care, with references to addendum and appendices and research that at the very least is hard to understand and at the very worst possibly tainted. Who really knows what is going on?
I fear that we are reaching for solutions that do not address the problem. The problem to me is not adequate care, it is rising costs and allowing personal care to become a ward of the state instead of neighbors. When I hear politicians say "Millions of Americans do not have adequate Health Care," what they are really saying is that "Millions of Americans do not have adequate Health Insurance." There is a huge difference here, insurance is the mechanism to pay for this grossly overweight system of health care, but it does not affect the care that we can expect. The fact is that any person can get care for any problem at any time, whether they can afford it or not. Although emergency rooms are perhaps not the most appropriate place for every problem, they are certainly not the contributor to rising costs as have been claimed. E-room docs are efficient, the process moves far more patients than an average exam setup, and in case you have not noticed; the Emergency room doesn't have million dollar paintings and teak boardroom tables.
What I am getting at here, is that the establishment is to blame, from the hospitals to the politicians to the insurance companies. Everyone has a piece of this pie, and instead of fixing the problem of rising costs and robo-care, they are going to use their well heeled lobbyists and PR machines to convince all of us to perpetuate the problem instead of solving it! The real issue at hand is that no one knows what it costs, because the patient is not the customer. The insurance companies and the federal government are the customers, let's face it, the actual consumer is not the customer. When was the last time you took your car in to have the oil changed, did you ask how much it would cost? Did you receive an answer? The same situation is not true of any medical service that has been provided to you, you don't have a clue of the cost other than "What's my co-pay?" It is no wonder that costs are out of control, no one even knows what they are.
Now, you will claim its not the same thing, I will counter that it is exactly the same thing, and even worse. For example, do you expect your auto insurance to pay for oil changes? Of course not, no more than you expect your home insurance policy to pay for a garage addition, but we expect our health insurance to pay for routine visits and pregnancies. In my mind, that is ridiculous, on top of having no idea what that oil change or garage addition will cost before having it done. We are mired in the thought that "someone else will pay for it," not realizing that someone else IS paying for it, and the someone else is US. Part of this problem may be due to treating entitlements as a badge of honor, unlike earlier in my lifetime when they were treated with a measure of shame. Using food stamps or getting reduced cost lunches at school used to be something to hide and be embarrassed about, today kids will brag about not having to pay full price. This mindset is seeping into our entire culture, and at the root of the healthcare argument that if not checked will spend us into bankruptcy. Applied to healthcare, why not eat Twinkies for breakfast, someone else will pay for it when I need help anyway.
Providing care for those that need it is as basic a human responsibility as it gets, and one that any of us would undertake when the need is legitimate. What person would leave an accident victim on the side of the road, instead of at least stopping to see if they are OK? We feel an obligation to help the cancer victim all over America's towns, with spaghetti dinners and cans on luncheon countertops, and it feels right to help a fellow human being whether in our own town, city or across the world. It is the right thing to do. The problem with universal health care, is that it removes that personal contact and places it in the hands of a government institution. We don't need to take care of that cancer patient or accident victim, we are paying our health insurance and dialing 911 so that should take care of it. That is just wrong.
To really fix the healthcare problem, we have to fix the costs. To find an example of a health cost that is not covered by insurance, let's use corrective eye surgery. When it first came out, it cost several thousand dollars and was considered dangerous by many people. Today, this type of surgery costs only several hundred dollars and you can find a reputable doc with credentials that can tell you exactly what it will cost, how many patients have been helped and even give you referrals on the safety of the procedure! So, without the health care industry involved, we are better informed and get better care at a lower cost. For ideas about what managed government health care will look like, we need to go no further than the process of getting an H1N1 shot.
Taking care of each other does not involve spending us into oblivion, it involves creative solutions to complex problems by focusing on the core issues. Covering major catastrophe like cancer is the goal of most Americans, not having their family suffer or going bankrupt if they end up with some terrible disease. So let's cover everyone with a basic policy that has a very high deductible, say $25,000, that will reduce the approximately $12,000 annual cost per person to around $3000. Give every US citizen (everyone, even the 11 million that are not covered under the current proposed plan that spends over a Trillion dollars) an Health Savings Account (HSA) account that is not taxed, can be used for regular care, that can roll over into the next year and be funded by the employer, citizen, support group or government. Most HSA expenses over a year would total around $4000, so we are already ahead by $5000 per person. The balance of any costs between $4000 and the $25,000 deductible would be covered by the individual, local support, the government depending on the economic condition or a government borrowing mechanism that would allow individuals to borrow against he future value of their HSA. This would also work with Social Security, but that is another story. When a patient goes to the doc, they can expect to be told what it will cost in addition to the procedure, and wold pay the cost out of the HSA account.
The result of this plan would allow the patient to become the customer, focus on the actual costs of care and allow the free market to begin reducing costs and improving care as in our eye surgery model. Groups of like minded individuals may decide to form health co-ops to share costs, churches could provide outreach health care through "Parish Nurse" programs, to deal with normal maladies, educate people about living healthier lives and generally keep people healthier and out of the system. There are infinite areas that could result from a system like this one, which would improve basic health, reduce costs and allow personal care for each other.
How can the government help, after all, we don't want to totally discount the coordinating and pooling effect of government. For starters, help initiate a nationwide system of electronic records. Create a fund to assist different economic classes with deductible and premium assistance. Promote wellness programs. Pay for lower income folks to get regular checkups. Promote healthier foods that are given away at low income food banks across the nation, instead of filling bags with high carb and fatty foods that no one wanted in the first place. Provide information on doctors and hospitals that are providing the best care. Allow health care across state lines.
Here is a plan that will work, can be started today and will have an immediate impact on the core problems. There are many areas you might not agree with, or want to change depending on your focus, but this plan will work to address the core problems of cost and personal care. We simply cannot sustain this system, and expanding it will be an act of lunacy, there must be another direction. So, for those of you that say there are no good ideas out there, try this one on before you adopt either spending us into bankruptcy or saying we don't have a better idea.

1 comment:

The Mom said...

This is a hot button issue for most people, but doubly so for the "self-employed" clergy. I could give lots of examples, but this I know ~ In 1983 when our youngest son was born our insurance did not cover "well baby visits" and they were $18.00. At the rate of inflation, that same visit should be $38.77 at 3% inflation which is what the average has been. Now for me to go for a "well visit" to get my regular prescriptions filled it costs me over $200 out of pocket because to cut costs we chose a policy that covers only "well visits" and if there is a diagnosis on the paper it is no longer a "well visit". But, to get the prescription renewed there must be a diagnosis ~ to have the co-pay kick in there cannot BE a diagnosis, so there you go. But I could go on and on with what we've been through the last year and I've not even been "ill". Our insurance costs us $9400 per year for $2500 deductable per person, the 80/20 after that AND no sick visits to the doctor (and no well ones either apparently). Cost caps could go a long way to solve part of the problem. If "Minute Clinics" at the CVS in NoVa can charge $50 for a regular office visit, why can't a regular family physician? Oh, and combine that with the pitiful fact that our daughter lost her job with CIGNA after 12 years of doing claims from her home, (ie no overhead) because her job was shipped overseas. To add insult to injury the job she did all those years with a B.S. in sociology now requires a "certificate" which she doesn't have the money to back to the Community College to get even though she could pass the test with her eyes closed. So, even if there were a job in her field available... she not longer qualifies. See, Cole, you got me started... Reform, reform, reform ~ and if they must insist on Government Health Care, then I want the same policy that my Congressman has at the same price.