Carolynn’s Blog

On health care I agree…we have a System From Hell.

In previous letters I’ve read about the nightmare that is Medicaid — I don’t want the same people who engineered the Medicaid system running my health care.

Why not adopt something like the Swiss have?

1.  Require everyone to buy some sort of private health insurance, but subsidize those who can’t afford it on their own.
BENEFITS:
-  Separates insurance status from employment status.
-  Forces everyone to take responsibility for choosing their own benefits (although I think minimums should be established at federal level, see below).
-  Allows everyone to see how much their health care really costs.  Right now I don’t think some people realize their place of employment may be doling out $12,000 a year in benefits.  If EVERYONE, not just the self insured, realized how much health care really costs I think there would be more political will power to force cost saving measures like letting Physician Assistants/Nurse Practitioners/Midwives/etc. handle more general care.  (Another great cost saving measure nixed by the Bush administration is allowing more centers of specialization, i.e., clinics that only do heart surgeries.  These were found under independent review to be 1) safer 2) less expensive, but they competed too much with existing hospitals which have more $ and better lobbyists).

2.  Set a federal minimum level of care (this could easily be modeled on the policies provided to government workers or union members).  Allow these “minimum standard” policies to be sold EVERYWHERE.
BENEFITS:
-  Many states have very arduous coverage rules that drive up costs for everyone.  For instance, here in Illinois maternity coverage covers 3 shots at invitro fertilization.  This drives up costs for everyone who wants maternity.  Invitro should be optional coverage…but any woman who needs maternity coverage should receive it at reasonable cost.
-  This could allow economies of scale for insurance companies.

3.  Require that premiums be based on amount of deductible and demographic — not on health status.
BENEFITS…self explanatory.

4.  Make it illegal for insurance companies to deny coverage or make exclusions to coverage based on health status.
BENEFITS…self explanatory.

5.  Possibly end the tax-free status of insurance.
BENEFITS:
-  Again, might give energy to cost cutting reforms.
-  Might actually wind up creating universal coverage that is revenue neutral.
-  It would be fair.  Right now wealthy individuals are getting an effective tax deduction at the federal level as high as 35% (even higher under Obama’s tax code).

6.  Possibly phase out the for-profit model of health insurance companies(?)  Have health insurance companies beholden to shareholders and to patients and you know who will lose out.  Forcing a publicly traded company to go private is impossible…but perhaps if there was public interest in such a company it could develop.  And if it a minimum standard of care could apply to every state–this would make it much easier for such a company to gain ground.

I’ve read that Massachusets is financially underwater because it implemented rules similar to the ones above…but listening to accounts of the Massachusets plan in action I’d say that they charge too LITTLE to some of their residents.  For instance, an artist profiled on NPR making $10,000 a year wound up paying only $4 for her cancer treatment.  Call me heartless and cold, but a *childless* woman can afford to pay more than that, even when she makes only $10,000 a year.  And quite frankly, I know too many artists who work part-time/full-time on top of painting/photography/writing etc who aren’t asking the rest of the world to subsidize their passion.  Unless you’re mentally or physically handicapped or caring for multiple dependents you can do a payment plan.

I’ve written a lot about getting insured if you’re unemployed or self employed like my husband and I, and have pre-existing conditions.  It is possible now, but expensive, and at times unfair (I have laughable maternity and am currently trying to save $16,000 to have a baby).  Still, its better than nothing — at least we hope.

Finally, everyone interested in this topic should read “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” …it is simply one of the best books out there on “rationing” and real health — and it is wonderfully NON-partisan.

UPDATE:  They accepted my letter AND gave it a starred review!  http://www.thenation.com/bletters/20090427/michelman

It was in response to this article:  A System From Hell