A Possible (but not likely) Health Care Option

[talon]

Having lived on the fringes of health care all my life, I feel rather confident in speaking on how to address healthcare for the lower income people.

Under insurance, the doctor must follow the health insurance company's dictates and guidelines with precious little consideration for the individual patient and their unique combination of health needs. The doctor needs to get the insurance company's permission for every test, every procedure, every non-generic drug, and having worked for an insurance company, I know the person(s) responsible for approving the tests and procedures are usually not MDs, but often nurses and ones who haven't practiced nursing in years. They are more concerned about the bottom line and not the health of the patient.

We need desperately to get away from the insurance model of health care.

I can't say that loud enough or strong enough.

We must get away from the insurance model of health care.

The reason I am so adamantly against Obama's health care reform is because he wants to give more power and more ocntrol to the insurance companies.

There are options to the insurance model, and I think we need to explore those options. We can live under a broken health care system a little longer if we know that in the end, we will have better health care, possibly even at a more affordable rate then now.

Let's look at a universal health care model that puts the control back in the hands of the doctor and patient, where it should always be.

Each citizen (naturalized or native-born) receives a Medical Account at birth or upon naturalization. Our tax dollars pay a set amount into these accounts each month. Citizens and employers may add to these accounts but only the account holder can withdraw from it - that means parents can pay into their children's accounts if they want and employers can offer matching funds for whatever the employee adds to their account - and those funds can be tax-free or pre-tax dollars. Since we already have Social Security numbers that are tied to Social Security payments, we could tie these accounts to those numbers as well. The money we now pay to Medicare/Medicaid would be increased and would be divided up among all citizens.

I know, at this point you're going to ask "What about non-citizens, people with green cards or who are working towards getting their citizenship? Or even illegal immigrants? And what about tourists from other countries?"

These people wouldn't have the Medical Account, obviously, but I don't see why free clinics, medical volunteerism, and medical altruism need to go away just because we have a universal health care plan for our citizens. These non-citizens, including illegal immigrants, would depend upon those healthcare charities. It's also possible that communities would vote to set aside a certain amount of tax dollars to care for sick or injured tourists and visitors. There are compassionate options. They just won't have the Medical Accounts citizens would have.

Now, having given care to non-citizens, let's return back to the citizens.

One thing that would be essential in starting these Medical Accounts is education. School children would be taught in their health classes how to manage their Medical Accounts and their own health. Adults would need educating and a portion of the taxes collected for these accounts would have to be earmarked for that education. They would learn to distinguish between when they needed to see a doctor and when they could self-diagnose and treat. They would learn how to communicate with the medical professionals. They would learn skills to improve their health. They would learn ways to be gainfully employed if disabled. They would learn how to manage their Medical Accounts, how to add to it and when they should use it. We already have many of these programs and are already paying for them with our tax dollars; we'd simply make sure citizens knew about them and took advantage of them.

Right now, the average cost of health insurance is (roughly) $400 a month per person. Most people use less than $1,000 a year in health costs, leaving a balance during their younger healthy years of over $3,000 a year. This could build, with interest, adding up each year so when they reached their senior years, they'd have a large sum to use for end-of-life care - and possibly even for funeral expenses. Any unused money in a Medical Account when the holder died would go back into the pool of money used to fund children, the disabled who can't work or work enough, and the unemployed to pay into the Medical Account fund.

There would be no deductibles, no co-pays for medical care. The account holder could choose to use the account to pay for all medical expenses including over the counter medications and aids, or only for actual doctor visits, hospital stays, and prescriptions.

Having a Medical Account will not end the need for liability insurance - why should a person use their Medical Account if someone else's negligence injured them in an auto accident, for example, or at work?

Costs would be upfront - patients have a right to know what they will be paying for tests and procedures - and doctors need to know the monetary as well as the physical costs of the procedures and tests they order. This way the doctor and the patient will be informed and can make good medical care decisions.

Even if we don't get Medical Accounts I think there are some things that need to happen regardless - and that's the price of every medical thing - doctor visits, strep tests, blood tests, castings, x-rays, bone scans, MRIs, whatever - needs to be public information. There can't be one price for this person and one price for that insurance and another price for a third. It's all one price and the doctor and patient can negotiate if they need to, but there needs to be a set price so we all know going in what we're dealing with.

Yes, I know, some people will abuse it,but they'll also find themselves short of funds if they do. At that time, they'll be required to re-take their education classes on the Medical Account and healthcare management, and they'll have to apply to gain access to the pool of money that (should) build up from those who die with positive balances in their accounts and from interest. That application will go before a review board and they may have a social worker assigned to help them manage their care until they are back on track. They may have to commit to paying into the account to bring it back up to average levels.

The disabled, the chronically ill, the acutely ill (cancer comes to mind as an acute, curable, expensive but not necessarily chronic illness), and the unemployed would also need a health care manager who would help them tap into the pool of funds to pay for their care. They may not need the educational training or the commitment to repay.

Children are presumed to be employable in the future and are being provided health care so they will grow up and be able to pay into the system. Disabled children would be assigned a health care manager - and the health care manager's job is to make sure the child had the funds int heir account to pay for their medical needs, not to control or dictate what care the child received.

The knowledge that any money left in the account will be added to the pool to support children, the disabled, and the unemployed may prevent the wealthier people from larding their accounts up, especially since the funds in it can only be spent for medical care (pharmacies, clinics, doctors, hospitals - and includes licensed alternative health care providers).

I suppose people could still buy limited insurance policies - like Aflac or insurance specifically for cancer or diabetic care or property liability or event liability, so the insurance industry would even still exist, just not in its current all-consuming form. I'm not opposed to insurance when you know exactly what you're getting, but current health insurance policies are written so obscurely that few people understand what they're getting and what it will cover and then end up with a huge medical debt they never expected. After all, they had insurance.

I think administering this type of universal health care proram that gives the decision power to the patient and doctor will not be onerous. The insurance employees who would lose their jobs because we eliminated that portion of the insurance industry would find work in administering the Medical Accounts, educating and counseling citizens on using the accounts, and even in the medical industry itself, unless they choose to work elsewhere.

Changing over will be a monumental task, but I think it will not be burdensomely expensive since we already have many of the agencies and administrative procedures in place now through social services programs, Medicare, Medicaid, Tricare, and Social Security.

I think it will take a while (I'm thinking a decade, at least) to acclimate people to it, but then, it took, what - 30 or 40 years? - to acclimate people to having health insurance, so I may be optimistic here. On the other hand, we have much better comunication abilities and it may be faster - and cheaper - than I expect.

I think if we divert the money we're spending on health insurance and Medicare and Medicaid to a universal heath care system via Medical Accounts tracked via a computerized debit card system and administered by the people administering those programs now (with retraining), the costs would not be excessive or add unreasonably to our national debt - and may even pay for itself over time.

The problem I see with this is that it may cost more upfront to convert to a system like this, but if we take the long view, it will actually be cheaper than what we have in place now. Our children and grandchildren will reap the benefits.

I think we'll also have a healthier population if people know more about he costs of healthcare than we do right now. Now, we don't really know what anything healthwise costs us - can you tell me what your doctor is actually getting paid for your visit? I'm not talking about your co-pay. I'm talking about the co-pay plus what your insurance gives the doctor. Do you know what that blood test costs, what you're charged for the blood pressure reading? Of course not. It's all invisible right now and the insurance industry likes it that way. You might find out what an inflated cost is in your itemized bill ($30 for a disposable 50¢ surgical staple puller for example). When the real costs are listed on an office marquee or in a menu-like brochure or on an information sheet, then we'll be better able to manage health care costs.

Yes, this has rambled, no I'm not taking time here and now to clean it up and organize it.

These are just thoughts on a possible re-vasmp of the health care system because I despise the one Obama is pushing. His will be costly, ineffective and leave many people paying for healthcare they'll never be able to receive.

Of course, the few suggestions offered up by the Republican Party are even worse, so there are no current political winners on health care.