It is possible to create a reformed health care system that is better, covers
everyone, and doesn't cost more.
Here's the step-by-step way, in broad strokes.
So much has been written about the Trillion-dollar Cost of covering the 47 million uninsured over the next ten years, that you'd think the arithmetic was written in stone. Far from it. In fact, there are reasons to think it would be cheaper overall to insure everyone, than to exclude 1/6 of the American people – if the expansion is done right. A Big If, but not an unrealistic one.
A. Every American must be insured, cradle to grave. (Sorry, illegal aliens should not be covered, though the egregious way we treat them is a subject for a whole other article).
All Americans should get a Health Care card, much like they do in Canada.
B. The care must not be worse than what is offered by the better plans now - such as, well, the plan the
President and Congress already have.
C. Co-Payments and deductibles, while allowable, must not be so onerous that they discourage people form seeking treatment (that means subsidies for those who can't pay).
D. The total cost of insuring everyone, including the 47 million currently uninsured, should not exceed what we pay for medical care right now. This is not as impossible as it sounds, and in any case, would shut the Conservative the hell up about their favorite straw man, cost-control. Because:
1. Many of the uninsured are actually young people who don't get sick that often. Including them would actually lower costs, as their contributions into the plan would help pay for the sicker population.
(I'm assuming here some sort of tax or direct payment for the plan that applies to all Americans).
2. There is tremendous waste due to Defensive medicine, as I point out in #6 below.
3. Going to Single-Payer alone could save up to 30% of the costs, through streamlined claim submissions, eliminated marketing, reduced doctor's staffs, superior drug and procedure price negotiation from a Single Payer's large size, Large & Efficient nationwide fraud prevention programs. 4. We are paying for the uninsured, through higher premiums on the insured, more expensive overhead by hospitals who try to collect from those who cannot pay, and legal proceedings, including bankruptcy.
Just because a cost doesn't appear in the balance sheet of an Insurance Company, doesn't mean there is no cost, to someone.
5. Private Insurers could still offer insurance as a form of
Premium Care, over and above what the Government offers. We need
competition, as the President pointed out, so that we do not engage in a race to the bottom, with only a government program to offer substandard care, and the only countermeasure being protests in the streets, as has happened in France recently. If there's something the government is not offering, and should, private insurers should be free to offer it, and if there is enough grass-roots demand for it from the general public in the Standard Plan, then Government can offer it later. We must not be naive to think Government will be generous with this new benefit - just look at what Medicare pays and how doctors are refusing to accept Medicare patients because reimbursement rates are so low.
6. Tort reform. The real reason for Tort reform, as Dr. Atul Gawande points out in his excellent article in New Yorker " The Cost Conundrum "
is that Doctors too often practice Defensive Medicine, and it is these
extra tests and procedures that really run up the cost of care - and to
the detriment of health outcomes, as Gawande makes clear. It's not the
actual legal cases that drive up costs, but the defensive medicine
practiced by doctors to avoid any possibility of being sued. Make no
mistake; while Insurance Companies may defend doctors, they
demand their pound of flesh from them later in much higher premiums.
7. Removal of anti-competitive
Employer-based insurance, which produces job-locked employees afraid to switch
jobs for fear of losing coverage, and adds costs to good and products other
countries with national health insurance don't have.
We must remember that insurance figures about costs are unreliable and biased. Even CBO estimates that don't take into account savings such as those above are unrealistically negative. Besides, other countries can cover people with better outcomes (The U.S. currently ranks 37th in Health Outcomes, right after Cuba), for less than half the cost, often much less.
If we really want to start saving money, beyond what I suggested above, let's talk about the national diet and exercise regimen...
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