The massive changes that are being pushed through Congress are too narrow, too focused on coverage instead of care, and will do nothing but give more of us more of the same.
The only way to provide appropriate, cost efficient, effective care is to re-write the rules of the game, not just put more people into the system. This will include redefining the role of the health insurance company, supporting an open market for insurance, changing the way we think about and pay for health care, refocusing the education and practice of our medical professionals so the impetus is on preventative care versus acute care, and reducing the costs and professional burden of medical education and malpractice coverage. Obviously the devil is in the details but this is where it begins - not a rushed bill that really truly isn't reform at all.
- Commercial health insurance should truly be insurance
We don't use our home or auto insurance for anything other than to repair damage caused by catastrophic events, so why do we treat health insurance any differently? We've become accustomed to using our health insurance to pay for all of our health care, whether it's a major heath care event, or a well patient checkup that could easily be paid for entirely out of pocket. Health insurance plans should reflect a catastrophic event coverage structure, such as $1,000,000 lifetime/$15,000 per 'health care event' with an annual total deductible, and monthly or annual premiums, like home or auto insurance (which we don't actually use unless we absolutely must).
Health Care Event: A 'health care event' would be defined as any provided care related to a single disease state. If a patient sees a doctor 5 times a year for migraine treatment and monitoring, it would be considered 1 health care event. If a patient is seen in the emergency room for kidney stones and then follows up with a urologist 3 times over the next 6 months, that would also be considered 1 health care event.
Healthy Person Benefits: Just like auto insurance companies offer 'good driver' benefits such as reduced premiums and better coverage, health insurance companies could also offer a 'healthy persons' benefit.
Public Option: The public health insurance option would provide catastrophic coverage with lower premiums and deductibles based on income, but would not offer a full credit towards these costs. The patient will still be contributing to their health care costs.
Medicaid & Medicare: The role of Medicaid and Medicare would become that of a safety net for those that can not afford commercial or public insurance.
Claims Management: The patient could be responsible for submitting a claim to their insurance provider and be reimbursed after the service - like an auto claim. Health care facilities and providers could also opt to submit claims as well and could provide payment grace periods to their patients who submit their own. Claim forms would allow the claimant to provide proof of payment towards their plan's deductible.
Triggering Event: Deciding when a claim is paid would be determined by the specific health insurance policy, as agreed to by the plan purchaser. It would no longer be a sometimes arbitrary decision made by a panel after the health care event. Everyone will already know what their health insurance will and will not cover and why.
- Non-catastrophic health care should be paid for by the patient
Physicians and patients need to set prices for care, not insurance companies, and in order for this to happen the patient needs to pay for their health care. Currently a hospital or physician bills an insurance company for the service at the rate the insurance company allows, not at a real market driven rate. Once a health care provider is forced to actually set prices based on what the real patient market can bear, prices will go down. Health Savings Accounts are the best vehicle for putting the patient in the driver seat and allowing them, along with physicians, to set true market prices for care. Supply and demand needs to be part of this equation, not artificial prices and markets created by Insurance companies.
- Health Insurance companies should provide insurance, not medical decisions
Insurance companies would be removed from the role of approving or denying point of care medical decisions, a role best relegated to the physician and health care providers. They no longer approve or deny health care, but pay claims as required by the patients' insurance plan - just like with home or auto insurance.
- An open market is the best option for reducing costs and providing appropriate benefits
Health insurance companies would provide plans and benefits at-will, as the market allows. Any company that currently offers any kind of insurance, such as Geico or Allstate, would be allowed to offer commercial health insurance plans.
- The focus of health care will need to change from acute to preventative care
Changing the focus of health care from acute to preventative care is paramount in changing the health care landscape and reducing costs.
- We need to cap malpractice awards and reduce the cost of education for health care providers
There are other more effective means of punishing physicians and providers for willfully negligent care than through punitive awards. That said, litigation is not unnecessary for all negligent events. Capping awards however would reduce malpractice premiums across the board, while providing relief in limited cases to the patient population. We need to provide affordable education to physicians so they don't begin practice with $200,000 or more in debt, which in the end is paid for by the patient as the physician and their employer seek ways to pay for this cost.