Imagine

by: KayStreet

Sun Aug 30, 2009 at 14:06:25 PM EDT

In the current climate of the health care reform debate, it seems like all our questions are motivated by fear. Undoubtedly, this is an effect that some with a vested interest in maintaining the status quo are working to achieve. They seem to be quite good at their jobs. At this time, however, I would like to ask you to imagine what it might be like when we implement needed reforms. Instead of asking what might reform do to us, imagine asking what reform will do for us.

Along with asking, "Can I keep my current insurance?" We could ask about choices. What choices will the reform legislation give me? Imagine being able to get better coverage. Imagine being able to lower your premiums with more and better choices. We could ask about portability. Imagine insurance coverage that stays with you if you change jobs. Imagine coverage that is there for you and your family even if you lose your job. Imagine the security and piece of mind of knowing you and your family's health will always be taken care of. When your children grow and leave for college, or new jobs, and a place of their own, coverage will be waiting for them.

We ask, "What about my Doctor? Can I keep the same Doctor?"

Along with asking, "Can I keep my doctor?" We could again ask about choices. Imagine being free to change doctors at any time. Imagine making a move with coverage that moves with you, and being free to find a doctor of your choice in your new home. Imagine coverage that pays for screenings and preventative care keeping your family healthier.  Imagine coverage that pays for in-home care in the case of a long-term illness, and without limits on the number of days or the total costs. Imagine being able to have that loved one home with you during this most trying of times. Imagine having your doctor decide when you need to see a specialist. Imagine the freedom of being able to seek a second opinion from a doctor or specialist of your choice, and not the insurance company's choice.  Imagine the security, the piece of mind, in knowing that all your health care choices will always be your choices for you and your family.

We ask, "Will I lose my insurance?"
We ask, "Will I have to pay more for health care than I do now?"

Instead of asking, "Will I lose my insurance?" Or asking, "Will I have to pay more for health care than I do now?" Imagine an efficient coverage system open to all, one that can control costs thereby making both coverage and health care less expensive for us all. Imagine the freedom of knowing coverage will always be there for you and your family. Freedom from the worry of losing both job and coverage during troubled economic times, when your family needs it most.  Freedom from the medical debt and medical bankruptcies that plague our nation's people and drive up the cost of providing health care for us all.

Imagine the freedom of never being rejected for coverage. The current insurance model seeks out the healthiest, and least likely to need medical care as preferred customers, and typically does their best to reject or limit coverage for anyone else. Those with a pre-existing conditions (PEC), even in the unlikely event they can get coverage, the insurance companies refuse to offer benefits for any treatment related to the PEC for a period of up to two years.

Consider this true life example:  A hard-working, self-employed woman that has always played by the rules, paid her own way, made comfortable living, and accrued a tidy savings for retirement. At 50 years of age, her former insurance coverage was priced into un-affordability. During the next 2 years, as she searched for new, affordable coverage, she developed adult onset diabetes. This made the improbable search for coverage virtually impossible. Even in the unlikely event she could find affordable coverage, nearly every ailment for which she might seek treatment could be related to diabetes, and therefore denied benefits. So under the current insurance model, she would have to pay two years of premiums, plus her own medical expenses, and all with no guarantee that her coverage would not be dropped by the insurance company at any time¹.

Imagine freedom from the limitations of the current insurance model. Freedom to have care provided no matter how long it takes or the how high the costs may run. In a typical "Standard Plan" in Maine, lifetime benefits are capped at 1 to 2 million dollars. This lifetime limit is absolute, even while insurance companies double or triple the yearly deductibles for a family plan, this lifetime cap remains the same - after reaching it, you're on your own.

Imagine being able to decide, along with your doctor or other practitioner, how often you need to see him or her. Under the same typical plan in Maine, the insurance company may limit the number of visits per year for certain treatments and for home care.

Imagine the freedom to be covered for all treatment equally, and the freedom of having your practitioner decide how much treatment you need and how often. In the typical Maine plan we are using, lifetime treatment benefits are sometimes severely restricted by categorizing the treatment. For example, mental health and substance abuse treatments can be subject to a lifetime limitation of as little as $7,500.  Insurance companies also typically adjust the co-payment for these categories, often raising out of pocket costs by 150%; from a 20% co-pay to a 50% co-pay.

Imagine freedom from huge deductibles. In Maine, these out of pocket expenses can run from $250 per year for a high-end plan to $20,000 per year for a "major medical" plan for singles. For a family plan, these deductibles are doubled, or even tripled. These are applied anew each and every calendar year.

We ask, "What about taxes? Will you be taxing my benefits at work?"

Imagine a way to make taxation a boon to small businesses. Imagine cutting costs for providing health coverage for their employees by 50%, and ensuring every single worker -- from the business with 1 employee to the one with 199 employees (the cut-off point for the small business definition). These are the very businesses that supply 80% of new jobs! How exciting would that be?

How? Imagine a payroll tax, like Social Security, where small businesses pay into a trust that is used to finance employee health care.  A flat tax, where everyone pays the same. One rate for single plan and a higher rate for a family plan. With an income cap, like Social Security, that would keep those with higher incomes from paying outlandish premiums.

How does this help? Small business, as a whole, suddenly rivals even the largest firms in terms of both the number of people to be covered, and buying power. They can command the best of plans with the minimum of premiums, and maintain a large degree of employee benefit cost flexibility by letting the business decide the proportion of tax that is paid by the employer and by the employee. How do we arrive at the 50% savings figure?  One example: compare the health benefit cost per person of GM to that of your neighborhood barber shop.

Another example: imagine the end of the sophisticated insurance scams that have arisen since the passage of the Employee Retirement Income Security Act of 1974 (ERISA). While very beneficial to controlling employee benefit costs of very large firms, this act blurred the lines of authority to regulate insurers between the states and the federal government, and into this gray area moved the insurance scam artists. "According to a study by the General Accounting Office, between 2000 and 2002, there were 144 bogus insurer cases that sold policies to some 200,000 people, and left them a combined unpaid medical debt of $252 million dollars¹." The lion's share of this cost was borne by health care providers, which raises the cost of providing health care for all of us.

We ask, "Will there be cuts to Medicare reimbursements? How will poor, rural areas compete for trained medical personnel?"
We ask, "How much will it cost? How much will it add to the deficit spending and the total deficit?"

Imagine expanding this system to cover every single person regardless of PEC, regardless of age or infirmity, or likelihood of needing medical care. Imagine a return to the "community rate" model that worked so very well in the 1930's and 1940's, the heyday of the original Blue Cross.

Imagine a time when our grandmothers no longer have to choose between food and medicine. Imagine a time when her coverage provider works for her; using it's market power on her behalf to get the her the best deal possible.

Imagine a system where we actually get costs under control.  Imagine a move from the world's most expensive health care system to the most efficient system that our ingenuity can invent. Imagine lowering costs by nearly half, from 16% of GDP to under 9%, where doctors, hospitals, and all other manner of health care providers know that everyone has health benefits, and everyone's bills will be paid. No more need to inflate costs for the uninsured, the under-insured, denied claims, or catastrophic illness that exceeds a patient's coverage. Imagine a system where Medicare reimbursements will be right in line with costs, and no one will lose by accepting them.

We ask, "Will a public option lead to socialized medicine by wiping out the private insurance industry?"

Imagine that it doesn't have to. Imagine a non-profit, low overhead provider, like the original Blue Cross, providing broad-based insurance coverage. Other companies can adapt to fill the inevitable niches that emerge in such a system such as gap coverage and disability coverage. But they will have to adapt to a leaner, more efficient system to survive. They will lose the market power to extort from us a 30% surcharge on our health benefits, and lose the power to limit our access to health care products and services, but these should never have been theirs to begin with.

We ask, "Is this a government take-over of health care?"

Again, it doesn't have to be. The government could manage a system such as I have imagined, but so could a well regulated, tax exempt, private, non-profit organization. Blue Cross did it exceptionally well for quite a numbers of years. However, the government has done as well for far longer with the portion of the health care system they currently manage. Medicare, VA and Native American health plans are extremely well liked and well managed. All government employees have excellent health benefits - just ask your Senators and Representative. Military health care for active duty personnel is almost totally socialized. There is no charge for any medical treatment of the active duty person or their dependents. This includes dental and eye care for the active duty personnel. The facilities are government owned and operated, and almost all medical personnel are government employees, and I don't hear many complaints about that system.

We ask, "Will illegal immigrants be able to get health care?"

I can't say for sure, but I can say that I prefer to be guided in my vision of change by a compassion for all people, so in a personal sense, I do hope so. But I doubt it. The number of illegals is so small in relation to the total population, that I can't see the harm, but I know that many feel the rights of Americans in America should be reserved solely for Americans - as if we can somehow claim the credit and entitlement simply for being lucky enough to be born here. But that's a philosophical debate I leave to those smarter and more just than I.

In summary,  imagine a new health care landscape. One that eliminates the worst of the current system, and keeps the best intact. One that works for all Americans, and because of this - not in spite of it - allows us to control costs and emerge with the most efficient model we can devise. We can do this - make no mistake. By imagining the best of what American creativity and ingenuity can accomplish - we can do this!  But we have to stand together! Together against the special interests for whom change seems undesirable. Together against the short-sighted, out of touch, "we can't" attitude in Congress. Together we can face, without fear or compromise, what we are being told is the worst that can happen, and we can stand up and demand the very best.

Note 1: True story, quote and other facts from: Sick, 2007, by Jonathan Cohn.

Other facts and statistics from:
The Kaiser Family Foundation and Health Research and Educational Trust
maine.gov's Consumer Guide to Health Insurance