4 Questions to Ask When Analyzing Any Health "Reform" Proposal
Posted by DrSteveB on Monday, Jul 7, 2008There are many proposals for “reform” of the U.S. health care system out there. For the newcomer it can be very confusing. Here are the four simple questions to ask of any health care proposal.
- Is it Universal? Does it cover all people? This would seem to be pretty basic, insofar as all other developed countries do it. But just being, or claiming to have, universal coverage is not enough. It is a common error to claim universality and then let it go at that. When thinking about a so-called health care reform proposal you must also explore how the proposal deals with items 2, 3 & 4:
- Is it Comprehensive? Does it cover all needed conditions, prevention, treatment? What care is included under the proposal? What care is not covered? And given the way the for-profit private insurance companies actually operate in the real world, one has to ask what is REALLY covered: does the health proposal allow insurance companies to deny medical treatment, diagnosis, referrals recommended by a patient’s physician because of cost? Does it stop insurance companies from refusing to cover patients with pre-existing conditions or rescinding policies for people when they get sick?
- How much is it going to Cost Individuals? Is it affordable year-in and year-out. How much does it cost you and your family if you are not sick? Can you afford to get sick. What is the total cost of the system to you and your family including taxes, premiums, deductibles, copays, uncovered conditions/expenses, denial of care/coverage refusals/claim rejections. What is your total out of pocket costs? If you get sick are you going to go bankrupt?
- How much is it going to Cost Overall? What is the cost to the system, to the country, for example as a percent of GNP? How does it control costs. How is it paid for, and who is paying, all the pieces, direct and indirect?
Too many folks fall for the trap of hearing “reform” or even “universal” and don’t realize that it is not really Universal Coverage, IF that Coverage is really “coverage” because it leaves you with too much legitimate care not actually covered, leaves you and your family with bankruptingly high out of pocket expenses when somebody does get sick, and the total system costs keeps rising as percent of GNP.
Any real reform has to do all 4.
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JillSH
July 9th, 2008 at 7:13 pm
About item #3:
I feel we need to talk about the cost of health insurance as a personal percentage of income.
In our society, if you go for a mortgage, get a divorce, apply for welfare, etc., there are standards of how much of your income should be spent on housing, transportation, food, etc. We need to assign a portion to health care. And it should be the TOTAL cost, premiums plus all out of pocket.
The most direct route to this is, of course, a progressive tax that would support the single payer system. If we pay that way, we would never lose coverage if our income goes down, or we’re unemployed, or if we only work part time. And put an end to medically induced bankruptcy.
And then all those wages currently being lost to increasing health insurance costs might end up back in our pockets (at least, if the corporations don’t call them profits instead).
ERdoc
July 9th, 2008 at 9:08 pm
One other element has to be present in any health care reform in the US…people must be given the option to obtain health care outside of the single payer system if they choose to…reform is not taking place in a vacuum – the current private, employer driven system insures nearly 90% of those citizens who actually vote, and unless we can come up with an unequivocally as good or better coverage for these people, focusing on the uninsured (or even underinsured) who disproportionately don’t vote is futile. The voting/employed public must be given the option to pursue other /extra care if they can afford it (a la Great Britain)…in order to get universal coverage under a single payer, by all means everyone must pay/play and be part of the large pool, but this is America and coercing the upper middle class to accept a new system that locks them into standard care/fee schedules will only produce very effective opposition. The analogy is in education, where everyone pays into the single (public) system but can pursue free choices. The tax deduction will probably have to disappear eventually as well in order for everyone to be in the same boat tax wise, if not care wise. We cant achieve a utopian “everyone gets the same care” notion and single payer . We can achieve single payer, and baseline care for all regardless of ability to pay/employment/age if we allow affluent Americans to pay extra, at least for amenities such as private rooms, etc. Single payer can prevail in the US, but not a la Canadian -physicians need to decide if they want to transform health care in this country or are simply make a political statement ?
Bob the Health and Health Care Advocate
July 10th, 2008 at 12:21 am
What about “Mostly or exclusively non-profit?”
The 4 questions deal with cost and coverage
1. Everyone covered? 2. All care covered? 3. Individual cost? 4. Overall cost?
Focusing on #3 and #4 for a moment …
A bottom line question: will the complex “for-profit + government” bureaucracy involving 50 states be replaced with a simple “non-profit public agency” with the existing 10 Medicare regions … in order to achieve a high degree of efficiency that will provide the most positive initial impact on the costs for individuals and the country?
Since at least a 1991 U.S. Govt Accounting office report, it’s fairly well-known that non-profit single-payer efficiency and the associated elimination of bureaucracy will allow everyone to be covered with the same money or less. Thus, it seems like an associated question can be whether or not the health reform will be non-profit and will eliminate the bureaucracy of 1300+ health insurance companies and multiple programs that involve the federal government and 50 states.
Bob Haiducek Bob the Health and Health care Advocate
http://www.99oh9.org
EvaB.
July 11th, 2008 at 6:06 pm
Insurance which is tied to employment is not reliable, as people can lose jobs which come with benefits. Universal coverage needs to be funded with some % of everyone’s incomes, or government-provided, as is Medicaid, for people without income. Employers, like me, should pay a tax in lieu of providing insurance for employees.
SJ Seeking Reform
July 21st, 2008 at 3:27 pm
Dr.SteveB
I believe HR 676 is the best antidote to our ailing health care system and have spoken to many others who think there are different solutions. Thanks for leading me to think about four simple questions regarding the many proposals for “universal reform” to help people get through the maze of diversions on this important topic. The rhetoric is confusing and people need to consider the sources and motives.
1. How did I learn about it, is it described or promoted by an organization or media outlet that receives significant advertising revenue from the corporate system of big medicine or big insurance? People need to be skeptical consumers of information and carefully consider the origin of the info. There are too many questionable, potentially self-serving agendas from various organizations and individuals. AARP is now training an army of well-intentioned volunteers to go out and speak to groups of people. Their magazine is loaded with insurance and drug-company advertising but people still seem willing to trust them.
2. Is it elitist, or truly universal, comprehensive and humane with coverage that includes all U.S. residents for all conditions and necessary treatments while preventing providers and facilities with a preference for more lucrative payment plans to opt out? Enabling the healthy and wealthy to have availability and standards of care with reduced availability and standards for others is unjust, inhumane and (when subsidized) a waste of taxpayers money. There must be true choice of provider so sick people with low incomes are not pushed into a two-tiered system limited to a few overcrowded, overstressed medical providers.
3. Does it follow a successful model based on experience from this or another country with high quality health outcomes, and lower costs? Fragmented, incremental change is a diversion that wastes money, time and energy while sick people suffer because sweeping reform is what is needed. Our own experience with Medicare and successful plans from other countries can show us the way.
4. Follow the money, where does it go and who benefits? Patients and health care providers should be the beneficiaries. Financial resources must not be siphoned-off and diverted to non-medical systems. Taxpayer funds should not be diverted to obscene corporate profits and drug prices need to be negotiated and regulated. It’s sad to think of the many people who struggle to make ends meet, pay their taxes and insurance then fall into bankruptcy after an illness takes everything from them in order to support insurance, pharmaceutical and other executives who live like royalty.