There is a crisis in the American health care system. The government got very excited about health savings accounts a couple years ago, but HSAs have not fixed anything. There are 41 million uninsured people in this country – and that doesn’t count everyone who’s already on government-sponsored Medicare and Medicaid. It is not uncommon anymore to talk with people who are spending more on their health insurance than their mortgage.
I find this situation appalling, but I also have a problem with irresponsible people who don’t think that they need to buy health insurance. I’m not talking about people who qualify for Medicaid and are living in poverty. I’m talking about a family earning $50,000 a year, driving a 3 year-old car, watching cable tv, going on vacations to Disney World, and saying that they “can’t afford” health insurance. I consider health insurance to be a necessity, right up there with food, shelter, and basic utilities. If you can’t afford health insurance, you better not be spending money on anything that is not essential for life – and there is very little that’s actually essential.
That said, I’ve done a lot of thinking about how I think the health care conundrum should be solved. I don’t think we should just start providing free health care to everyone, because I believe that rewards irresponsible behavior. Instead, I propose the following:
Health insurance should be mandatory.
Health insurance should be a government program, similar to flood insurance. This would give the government tremendous bargaining power with providers, and would eliminate the profit costs that private insurance companies add to the price of insurance.
Health insurance premiums could be payroll deducted and sent to the government by employers, they could be included in the estimated taxes of the self-employed, they could be billed on a monthly or quarterly basis – the government usually finds a way to get their money.
Health insurance premiums would be based on the number of people you’re covering. If you choose to have 6 children, you would pay more for your insurance than someone who chooses to have 1 child (as opposed to child tax credits, which lower the tax burden for bigger families)
Health insurance premiums would not be based on age. Hopefully we’ll all grow old eventually, and need more medical care. But we can spread the burden of paying for it across the whole population, regardless of age.
Health insurance premiums would also be based on your income. There should be a base rate per person that is charged to families earning perhaps $50,000 to $90,000 per year. Families earning less than $50,000 would pay a lower amount per person for their insurance, and families earning more than $90,000 would pay premiums higher than the base rate. If the health insurance is going to provide the same care to everyone, I don’t think that it’s fair to expect a family earning $30,000 a year to pay the same price for their care as a family earning $200,000 a year. And for someone who is genuinely too poor to afford health insurance, the premiums would be waived as they are with Medicaid.
There should be several levels of coverage available, similar to what is currently offered by private insurance companies. So if a family is willing to assume more risk and take a $2500 deductible, they should pay less than another family that wants a $500 deductible.
There should be no advertising of pharmaceuticals.
Purchasing pharmaceuticals from other developed, reputable countries should be readily available to the government, patients, and pharmacies, in order to keep the competition high and the costs down.
Medical malpractice payouts should be strictly limited to the actual cost of correcting the mistake or caring for an injured party, including loss of income. Pain and suffering compensation should be limited to perhaps $20,000 maximum. No one should profit from a medical mistake – including the malpractice lawyer.
There should be total transparency in health care. Patients should be able to easily see how their health insurance premiums are being used. Since all the premiums would be paid to one government entity, there should be a website or annual report showing exactly what percentage of the premiums are used to pay providers, what percentage is used for overhead, etc.
Health care should be non-profit. Essential health care that is… I have no problem with profits being made on procedures like collagen lip injections or lasik eye surgery.
Universal health care works. The US is one of the only developed countries in the world that hasn’t implemented some form of universal health care. No one is expecting America to go out on a limb and invent some radically new form of public health insurance that’s never been tested anywhere. If we want models and examples to reference, we need only look to Western Europe, Australia, and New Zealand to see how it’s done. It seems that the people who are protesting the loudest about universal health care are the ones who have something (money) to lose if such a program takes hold in the US. Pharmaceutical companies, private health insurance carriers, and providers would all lose money, but the greater good of the American public would outweigh these losses. I am a health insurance agent. I understand that the advent of universal health care in America would require me to find a new job. And I would consider this a worthwhile trade-off for the overall benefit that universal health care would bring to our country. I wonder if everyone else in the health care industry is looking at this issue from an objective viewpoint.