Rational Health Care Reform
I believe Medicare can be expanded and improved and can serve as a base for the development of a universal healthcare system for the United Stated. Please consider the following.
The first step in health care reform is to issue to every person 65 years and older a unique healthcare ID number that is not their social security number. Except for the unique ID number, all cards would be identical and independent of financial status. Including those issued to Congress, etc. Then improve Medicare to make it an adequate product. Start by making a Medicare sponsored "Medicare Supplement"- available directly from Medicare for those current Medicare patients who want a supplement as part of their plan. Not everyone will want to pay for full coverage. Alternately, the supplement could just be rolled into the basic Medicare plan available to everyone. A Medicare Part D drug benefit would be part of the standard offering. Then to dismantle all of the Medicare Advantage plans and roll their existing patients back into Medicare, as expanded above. Fees currently being paid into those plans would be scrutinized for fairness, adjusted as needed, and paid directly into Medicare. Standard fees would have to be reasonable for everyone, though there will need to be a declining "co-pay"- schedule for those in lower economic classes. With this in mind, however, everyone needs to have to pay something to help them feel vested in the system and to help prevent over-utilization.
In the process, we need to ensure we have the infrastructure in place to handle the increasing administrative load. This might be a way to utilize some of the existing claims processing capacity of the current private plans, allowing many of their employees to transition into Medicare based employment, as opposed to losing their jobs as the private market contracts.
The next step is to organize the second most expensive segment of society, one that is in large part supported by a huge and inefficient patchwork of governmental agencies and programs, as well as private insurance. All persons under age 18 would be enrolled into the Medicare plan as expanded above. Each enrollee would have benefits specific for them, as opposed to being a member of a "family plan". Monies currently utilized for the current coverage could be consolidated and used to defer the cost of the new system. Costs would be further reduced by establishment of a reasonable resource based premium assessed to all. These monies would be collected from the parents or guardians, much as their current insurance premiums are at present. Again, time would be allowed for the consolidation of the infrastructure required to run the system.
Once the two most expensive age groups above are fully incorporated, we could then incorporate the remaining, and more "profitable" age groups into this expanded Medicare plan. Perhaps starting at age 64 and working backward till all are incorporated. The speed of this enrollment would only be limited by the expansion of the required infrastructure. As each age group is enrolled, they would begin paying their health care premiums directly into Medicare, as mentioned above.
One of the many downfalls of the current system is the inability of persons with heath risks to obtain insurance. Accordingly, premiums would be built on a much more rational consideration. A child born with a defect or an adult who develops leukemia have done nothing wrong and should not be penalized for the rest of their lives by doing without health insurance or by paying exorbitant rates for it. Accordingly, premiums would be established by age and would be independent of uncontrollable risks, as exampled above. We could elect to modify premiums upward in relation to controllable risks. Examples would be smoking, excessive alcohol use, and obesity. We could also consider charging some amount extra to persons for medical noncompliance. Examples are in not controlling their blood sugars, blood pressures, or cholesterol. These extra amounts need not be excessive. It is likely that many patients could be steered toward improving their health simply by getting their premium statement each month showing their basic premium and optional supplement plus the extra assessments for their controllable risks that are not currently controlled, each itemized with the related small extra charge. Those 65 and over would be assessed a flat age related rate modified as above for controllable risk factors. Correspondingly, we could consider reducing the premiums some amount for those people who successfully control their risks. Obviously, the monies need to be fully evaluated before the exact possibilities can be determined.
Provisions will have to be made for the collection of monies due to be paid to the Medicare system, such as premium payments. Industries/corporations currently play a role in supplying health care and they still would in the new system. Industry would benefit from controlled costs and protection from rampant heath care inflation. Payments for individual premiums would have to be collected. These payments could be deducted from payroll checks, as is currently done for persons who get their health insurance through work. For persons getting their support from the government, insurance premiums could be deducted directly from their checks as well. Self employed persons could pay monthly or have their premiums added to their income tax indebtedness. No matter what payment arrangements we try to make, there will always be people who show up needing health care, but who have sidestepped the system. These people will have to have care and access will have to be available. Additionally, foreign visitors would have to be covered. Their healthcare number could be printed on their visa, or similar ID.This type of approach would allow a step-wise implementation. Funding and infrastructure would have time to grow and would avoid the calamity of whole country implementation of an all or nothing approach.
Any laws that need to be changed to accommodate this reform can be passed through congress. There are, of course, many aspects and possibilities that need to be fleshed out as the current legal restrictions reveal themselves. It will be up to the American voter to force our elected officials to do what is right, and to enact any legislation that needs to be in place to see is done.