Keeping it simple: Medical Insurance for All Americans

Sunday, December 12, 2008

President-Elect Obama is asking all of us to send him our suggestions for universal healthcare. It’s a trick, of course, the objective of which is not to provide his new administration with ideas it will seriously consider, and hasn’t heard before, but to make us all feel involved in the process. People who believe they are participating in a decision tend to be more supportive of the outcome and feel better about their leaders for including them. It’s a concept I believe Mr. Obama first learned in Political Science 101, a class he apparently thinks the rest of us skipped.

Is President Obama or anyone on his staff going to read through the millions of e- and regular mail we might send him, or is he assuming we won’t bother to respond which is probably more like it? Will the people who offer their ideas be representative of the 40 to 50 million Americans who don’t have any or adequate coverage, or of the rank and file medical services providers who struggle daily with the administrative mess and costs of medical insurance processing, and with taking care of those who don’t have any? Do any of us regular people really know what we’re doing, myself included? Of course not. Like I said, it’s a trick. I’m not fooled, but then I like to write and I’m certain the President-Elect reads the Wordfeeder religiously, so here goes.

We start by defining a minimum, but nonetheless sufficient level of medical insurance that we want all Americans to have. We define this “Standard Policy,” not only to take good care of us when we’re sick, but with equal emphasis upon preventive services which keep us healthier, which will improve the quality and length of our lives and, in the process, lower our total costs for healthcare, and increase the productively of our workforce. By “we” I mean our government working in conjunction with consumers, underwriters and medical service providers (doctors with their own practices and hospital management). It’s the challenge of consensus building Barack Obama was born to meet, or so he tells us.

We then require all medical underwriters to provide that policy for the same price – adjusted only for local economic considerations, the fact that it costs more to provide a given level of medical care in, let’s say, Manhattan, than in a smaller, less pricey community.

Everyone qualifies, for the same premiums, regardless of their medical history or current condition – as if the entire country were one large group.

All policy-related procedures, forms and other paperwork, including a guaranty of timely claims processing and reimbursement to service providers, will be standardized. All physicians and hospitals will be required to accept this insurance for the specific services it covers. Needless to say, the program has to be defined and priced in a way which enables the underwriters and service providers to make reasonable profits for the risks they incur and given the costs of the services they deliver.

The government then imposes a Medical Insurance PremiumTax on personal income. (I prefer a separate tax so that we can ask ourselves if we’re getting our money’s worth.) Like the income taxes we already pay, the lower our personal or family income, the less of that income we are expected to spend for medical insurance – as long as the total of these MIP taxes equals the costs of the premiums our government pays, plus the cost of program administration. (This is not to be a deficit spending program. Everybody, personally, is paying for the collective cost of everyone’s Standard Policy. The government’s only role is that of facilitator.) People and families with incomes below a certain level won’t pay anything, but will still receive the same Standard Policy from their choice of underwriters.

People will be free to pick any underwriter to provide Standard Policy coverage, policy premiums to be reimbursed by our government. Whoever wants better coverage, whoever wants more than what the Standard Policy provides will pay the difference out of his or her own pocket.

Underwriters will compete for our business because the Standard Policy is respectably profitable, if not wildly so, by virtue of the way the program is priced and because administrative costs should be lower, and for the premiums they stand to make on the extended coverage a great many of us will buy.

Doctors and hospitals should benefit from the uniform and prompt processing of claims in accordance with procedures they helped design.

And America? We benefit from having everyone covered at some minimum, but sufficient level. The advantages to our economy, by virtue of having a healthier workforce, will likely be many times greater than the net costs of our paying premiums for those who can’t afford them. Besides, it’s the right thing to do, helping to take care of those of us who are unable to take care of themselves.

So what do you think? Sure, getting everyone to agree upon a standard policy will be very tedious and take time, lots of it. We’ll be lucky to be ready to implement the program before the end of President Obama’s first term, but it’ll be worth the wait.

Think about how little I’m asking our government to do. Bring the three major players, consumers, underwriters and service providers, together to devise a Standard Policy, collect the taxes which is something our government does already, and pay the premiums to the underwriters we, the people, choose. It’s not only the least our government can do, it’s the most I want them to do. I want our government as far away from managing our healthcare as possible. I want to keep healthcare in the private sector, and leave it to the government to use our taxes to subsidize the development of improved healthcare technologies, and to protect us from consuming things that aren’t good for us.

What about all the companies, the federal and state governments that are used to covering at least a portion of the costs of medical insurance for their employees? Good news. Now they can find another way to give their employees reasons to work for them, while booking a portion of the savings they enjoy to their bottom lines or using it to help cover the costs of other government programs.

Did you notice that at no time have I suggested that businesses pay for this program? It’s no accident. I’m trying to level the playing field so that larger firms don’t have the advantage of being able to pay less for medical insurance they buy in bulk, the costs of which they can more easily pass through to their customers, while smaller companies can less easily afford to offer their employees comparable insurance benefits, and often don’t.

Unions will be a problem, but then unions are a problem. Witness their complicity in the demise of US auto manufacturing. If ever there was an organization whose time is up, it’s the UAW.

In fact, the biggest problem will be convincing businesses and underwriters that they’re no longer going to be doing business with each other – except, perhaps, when it comes to Standard Policy upgrades as employee benefits.

Problem solved, President Obama. That was easy. Now you can do something for me. Next time, try to remember that we elected you to solve our problems for us. The election’s over. Time for you to provide the superior management you promised. It’s time for substance over style. Patronizing the people by asking for our individual opinions on such a profoundly complicated and sensitive issue as universal healthcare is no way to prove you’re worthy of our confidence.

Why can’t I shake the sense that you’ve taken on way more than you can handle? Did you honestly think being a local Community Organizer and playing follow your party’s leadership for three years prepared you for all this? Next thing, you’ll probably be recommending public works projects to get our economy back on track. …Nah.

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