12 October 2009

Health Care Reform Points, beyond Public Option • What's Not Being Included in Current Bills

Although I am and continue to be a strong supporter of a viable and robust public insurance option as a key component of health care reform, I think it's important to bear in mind that other components are equally if not more important, and many of them are unfortunately not included or not adequate in most of the versions of health care reform legislation pending before Congress right now.

To really work, a public/private reform must:
  • Prevent discrimination by age or state of health;
  • Really regulate what insurance companies can charge, (e.g., by setting a floor for so-called medical loss-ratio for adequate standard health insurance, of approximately 90% minimum);
  • Even better, All insurers could be mandated to be non-profit, at least for the "adequate standard health care" component of health coverage (ideally, health providers should be non-profit too, but that's less critical);
  • Require health carriers to cover standardized adequate health care; they can compete for add-ons (this is the system in Germany, France, Holland, Switzerland, etc.). There need to be standard reimbursements and no open-ended patient liabilities; within this system, insurers will have no right to deny claims, and costs are controlled because the costs of all routine medical procedures are regulated;
  • Provide for continuation of coverage in the event of unemployment and retirement;
  • Public Insurance Option with the ability to negotiate discounts on prescription drugs;
  • Prohibit pre-existing condition exclusion and all rescission;
  • Truly universal affordable coverage; subsidies for the poor, including the working poor, paid for by taxes, (or "fees," it doesn't matter what they're called).
I think one way to achieve a good deal of savings in the critical 50-64 age group (to which in full disclosure, I belong), is to set up a Medicare Buy-In option for this age group. Medicare, with the cost-per-patient as calculated by the Congressional Budget Office amortized to a monthly premium. (In other words, the patient, not the government, pays the premium). Again, subject to partial-to-complete subsidy for the poor and working poor. This could replace Medicaid for people in this cohort; and eventually I would like to see this option available to everyone. (One necessary reform would be to allow Medicare to negotiate Pharma prices across the board).

UPDATE:  Now we have the AHIP report, which was dumped late last night with no warning to the White House, despite the fact that the White House was having good faith discussions with their representative over the weekend. It's high time Democrats in Congress not only stop trying to negotiate with Republicans, they must stop trying to placate the "Insurance Industry" as well. These voracious predators have said that even though the Finance Committee Bill, and the other bills for the most part as well, leave their precious profits and price-fixing abilities pretty well alone, they will spike rates if reform passes. So, I say, the hell with 'em. Regulate them to the hilt, set their prices and force them to provide standard coverage on a non-profit basis, and if they don't like it, they can go try to write health insurance in Bolivia.

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