Tuesday, June 09, 2009

National Health Insurance (Again) !

Currently Congress and President Obama are grappling with the issues related to National Health Insurance. Quite reasonably they believe it important to try to pass legislation this year while re-election issues are a year away for many.

One may say:

1.) Why National Health Insurance at all?

a. Health insurance is not affordable absent one having a group plan,
b. Employers have increasing incentives Not to have health insurance plans
c. Health care costs in our current system are far higher than nearly all the comparably wealthy countries of the world and most of them have national systems,
d. "The market" - can not resolve this issue and it is no longer an issue that can be ignored without far more dire effects on our economy

2.) Why not have "a government option" that all could choose to take?

a. Such a plan would be prohibitively expensive for either the Federal Government, those enrolling in the plan or both.
b. People would enroll in the plan as their "best alternative" which would skim off a lot of healthy and younger people who would have better options other than it,
c. The costs - per enrolled individual or family would be very high - as there would be a strong incentive to enroll where one had high anticipated medical expenses and no better options.
d. Either a lot of people would not be able to afford the Government Option or a massive Government Subsidy would be necessary to fund it

3.) What options might exist besides a single-payer plan?

a. Continuation of the current system - very high costs which will continue to escalate - not viable - though will continue unless Congress passes a new plan.

b. Government Optional Plan - Such a plan - such as the current Medicare Plan - which per: www.medicare.gov includes in 2009:
1.) Hospital Coverage - $443/month (most get this for free),
2.) Doctor's Coverage - $96.40/month
3.) $1068 - deductible paid per hospitalization period - when an inpatient in a hospital
4.) $135 - yearly deductible on physician's bills
5.) 80% - of "customary and reasonable charges" paid for physician's bills beyond the $135/year deductible (also subject to "customary and reasonable charges"
6.) Prescription Drug coverage - sample - first listed company for King County Washington - costs $16.70/month with a $175/year deductible - with costs per prescription then from $4 and higher amounts depending upon type of prescription.
7.) It should be noted that the "customary and reasonable charge" may well be significantly below the amount physicians charge which makes the doctor's coverage more expensive.

c. Modifying the current system in some substantive way(s) such as:

1.) Providing some type of catastrophic health insurance coverage which is either optional or mandatory for all. This would mandate that the Federal Government paid for "high" medical costs above a ceiling - say: $10,000/year for example, subject to whatever limitations might exist. (Such a proposal might make potential liabilities for private health insurance carriers significantly lower and thereby allow both for more people to get health insurance and for the costs to be lower),

2.) Provide for a Government option or mandated coverage for whomever doesn't have other health insurance coverage,

3.) Allow - for all to enroll in the Federal Health Insurance plans which are currently open to federal employees and retirees, perhaps paying the "unsubsidized" costs of such plans - which for example, our Blue Cross - Basic - which costs us $216.48/month for family coverage ($92.44 for individual coverage) - would cost $865.43/month for family coverage or $369.76 for individual coverage.

d. National Health Insurance - Pro's and Con's?:

1.) If employers would pay into the system, it would cost employers who currently don't have coverage for their employees additional expenses per employee which would be a disincentive to hire employees who met the criteria for coverage,

2.) If employers would Not pay into the system, it would provide more of an incentive for employers to hire employees (particularly where they have health coverage and where the employees might be "risks" insurance wise),

3.) If employers would Not pay into the system, the costs of the system would be higher to either the individuals/families or the government itself,

4.) Start-up costs would be high - the Government would need to pay monies that currently are not its obligation,

5.) All would get equal coverage - which might result in "rationing" of some care or increased wait times for some treatments,

e. What's Best?

1.) I believe that we will pay costs regardless of what we do. The current system is not tenable. It will bankrupt our economy particularly as us "boomers" get older. Ideas such as making all eligible to enroll in the Federal System "at full cost", while perhaps marginally better, will Still not make coverage affordable to most who lack coverage or have poor coverage now.

2.) All the other options have clear High Costs and Liabilities,

3.) Any "optional plans" - will split off - the "haves" and "have nots" - making chronically ill and older citizens - paying much more and those who have low costs - paying relatively little (in comparison),

4.) I see only Two Viable Option Directions:

A. Single Payer - One Plan - for all - probably started with Medicare/Medicaid/Federal employees and expanded to others over time or,

B. Single Catastrophic - One Plan - for all - which doesn't deal with basic medical costs, but subsidizes the "high cost" care - of those who are chronically ill or have massive medical costs - such as with a $10,000/year deductible.

The latter option - basically leaves "the free market" - but recognizes that it can't pay for "high" expenses without leaving out virtually all with high expenses. The Lower its cap is: 1.) The more it costs the Government and 2.) The less discrimination will remain - for "high risk" people.

I think that Single Payer is the way to go. I could see Single Catastrophic as the "next best" option - perhaps - along with having a "government option" - such as Medicare - for all.

Any change that is substantive will be difficult to implement and need fine tuning! Not making substantive change will be Much Worse!


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