Since the ill-fated efforts of the Clinton Administration to pass a universal health care bill, middle class Americans have continued to strain under the weight of health care costs increasing annually well beyond the normal rate of inflation. Access to affordable health care has become increasingly elusive. The burden to American families has already become unbearable in many cases and will rapidly approach crisis for millions more within the next few years. Insurance costs alone for a family of 4 range between $500 - $1,500/MONTH! That does NOT count out of pocket costs for deductibles, copays and uncovered expenses.
I understand that the health care crisis is complex and multi-faceted. Higher expectations and demands for quality care on the part of consumers; more costly technology; too few health care professionals; the aging population; uncollectible bills; the outrageous cost of malpractice insurance (and lack of tort reform) and other problems all contribute to the high costs of care. However, there has not been any genuine effort made by Congress/the Executive Branch to tackle this convoluted social disaster that touches all Americans. If all Americans had the Congressional health plan, this would not be an issue.
Ideally, any successful plan must use the delivery systems in place as much as possible. “Socialized Medicine” a la Canada, Great Britain or Germany is surely not the answer for Americans. However, with some creative thinking, our nation’s policy makers could come up with a workable solution—or at least make a good start at fixing this problem. Since no answers seem to be forthcoming from Congress, here are a few suggestions.
The U.S. offers the finest health care in the world, bar none. It is based primarily on private sector health care providers compensated through a private, insured payer system. There is nothing wrong with this model, in my view. But, here’s where it could be dramatically improved with some help from Congress:
1. EVERY working individual would contribute 5% of wages (up to the taxable wage base) toward their own health care and automatically become an insured “member” as a condition of employment. Individuals outside the standard employment environment would contribute 5% of taxable income up to the wage base. They could opt out of “membership”, but the consequence would be: a) medical service providers would NOT be required to give care without proof of cash payment and b) the “non-member” could not sue a care giver.
2. EVERY employer would contribute an additional payroll tax of 5% on each employee. The “pool” of payroll tax money comprised of employee and employer dollars would be used to purchase medical coverage for all employees. Any excess funds could be used to offset deductibles, copays and unreimbursed medical expenses or simply added to the employee flex plan pro rata.
3. What this would do is provide an infusion of capital into the health care system and all employed individuals would have a “stake” in health care issues. This would also increase the pool of insured individuals and spread risks over more people. Currently, the uninsured are largely the young, healthy, low-wage earners who could drastically improve the risk pool if they were a) included in it and b) helping to pay for it. This major initiative will pay for items 4. and 5. below and could possibly augment first dollar care for employees whose employers make cost effective insurance choices.
4. Tax CREDITS should be offered to employers who subsidize medical insurance costs beyond a basic minimum. Now those costs for employees are tax deductible, but an additional CREDIT could be offered to encourage more generous private employer participation.
5. Tax CREDITS should be offered to INSURERS who will discount their costs under a variety of conditions. For example, insurers who negotiate with a regional coalition of private employers would receive the credit; a trade association or state Chamber of Commerce would receive a “grant”. Insurers could qualify for a credit by providing reduced-cost coverage to a group of the lowest paid workers—such as fast food employees—under a “group” plan unrelated to specific employers.
6. Another option might be to eliminate for-profit insurers. For example, insurance could be provided only by private nonprofit insurers like the Blues with “grants” earned as above for cost-cutting negotiations with groups of employers.
7. A Tax DEDUCTION should be offered to physicians and other health care providers who will reduce costs to conform to a “usual, reasonable and customary” DISCOUNTED scale for their area. There should also be tax incentives given for building “Urgent Care”, “Quick Care” and “Outpatient Clinics” meeting certain requirements for low cost, but effective delivery of medical care in a community—not just for the indigent, but for the entire community with all participating private health care providers receiving some of the revenues.
8. Nurses and Physicians’ Assistants need more legal authority to provide a broader range of medical services. In some cases, these fine professionals are more capable of delivering routine care than the physicians they serve and may shift some of the patient care to lower cost providers with outstanding results for patients. (This measure, of course would require buy-in by the physician community [perhaps the trade for greater tax benefits] AND tort reform.)
9. Tort reform and malpractice reform are a must. The incidence of truly negligent or malicious malpractice is minute, yet multi-million dollar judgments are awarded daily in this country for what could only be described as medical “maloccurence”. If huge settlements were awarded only for a legitimate breach of professional responsibility, malpractice insurance premiums would plummet and a real case could be made for physicians to reduce fees and they would comply, especially when offered the tax deductions available for negotiating their charges (See 4. above). Judgments AND attorneys’ fees would be limited since attorneys constitute a monopoly in each state (known as the BAR Association). In cases of so-called malpractice, their fees should be regulated in the same way that states regulate their power companies.
10. Somewhat off the main topic, but an important consideration in this discussion is prescription drugs. It is nothing short of criminal that other countries may “pirate” our R&D and knock off drugs at low cost. Where does AARP think these medications come from? As a nation, we should be CHARGING other countries “development fees” to help offset the enormous cost of discovering and testing medications that prolong and improve the lives of people worldwide and for which U.S. companies get hammered because the high cost of prescription medication in the US.
11. Finally, a word about unemployed and retired Americans. The Medicare system has worked reasonably well for decades, but Medicaid bears a social stigma AND does not have adequate accountability features. It would be more effective to provide a health care “credit card” to the able-bodied unemployed that required a demonstrable effort to obtain legal, above the table employment to continue its use. This would have the two-fold advantage of insuring more of the uninsured unemployed and eliminating some of the money that changes hands without taxation—including gains from organized crime.
12. Not all of these suggestions are without cost, although several do bring more money into the health care system or into the tax system in general. However, none of these reforms would require a fundamental change in our outstanding health care delivery system or a large, new bureaucracy to operate. The savings achieved by reducing the number of frivolous lawsuits (and their attendant financial drain on our economy) might significantly mitigate the revenue required to implement the main parts of this program.
No comments:
Post a Comment