I've hesitated to dip my toes into the wide-ranging and increasingly rancorous debate over health care reform in America for several reasons. One, I'm not so desperate for mail that I want to start getting hate mail. Two, while I have a master's in public policy, I didn't focus on health policy and am hardly an expert. Three, I've been a little busy.
But with the passing this week of Senator Edward Kennedy, one of health care reform's most ardent supporters, I could no longer resist jumping into the fray. Besides, it gave me something else to blog about this week .
As stated above, I am by no means an authority on health care or the detailed minutiae of government regulations. However, I have a pretty good idea of what I believe are basic human rights that a nation such as ours should endow to all its citizens. I know that totally outs me as a bleeding-heart liberal and I am completely comfortable with that label. Yes dear readers, I give a shit about my fellow citizens. Let the AK-47s fire!
Plus, I have entirely too many family members who have battled chronic illnesses and I know the incredible importance of quality health care. It is beyond my imagination how anyone deals with health problems in the absence of comprehensive coverage. So here is my essentially unresearched, deeply personal vision for what health care should look like in our country. President Obama, if you're reading this - hi there - I'm still available for a new job.
THE SHTETL FABULOUS HEALTH CARE PLAN
PART ONE - The Working (not-yet) Stiffs
If your employer offers a health care plan that fits your needs and is affordable, take it. I know HMOs aren't perfect, but they are a huge piece of the puzzle and it would probably cost so much to dismantle them, that we'd piss away all the allocations right from the start.
Within the employer-provided plans, I do have one new policy in which I strongly believe. If you're like me and you're reasonably healthy, you should have the option at the end of each year to reinvest a portion of your unused (but paid for) premiums into a personal health savings account. That way when your health goes through an inevitable rough spot, you will have some cash in the bank to cover your ass, or your pancreas, or your lungs. Whichever goes first.
If you use up all your premiums and have cash leftover, then you can designate some for a special health savings account too. Or you can take some of that cash and donate it to me.
PART TWO - The Old Folks
If you're already on Medicare, just stay there. You're old and probably resistant to change and like in Part One, it would cost too much to make all the modifications so you might as well stay where you're at.
For those on Medicaid, it's a little different. It would be best if you could just get a job that offers full coverage, but if that isn't in the cards, then I suggest you stay tuned for Part Three.
PART THREE - The 47 Million
If you fall into that egregious statistic of the 47 million uninsured Americans, this is for you. Clearly, you've been stuck between a rock and a hard place for a while. You either are self-employed and not wealthy enough to buy insurance for yourself, or you work for a small company that isn't mandated to provide coverage, or you have some freakish illness that makes you like the kid who pees in the pool and no insurance company wants to take you.
Luckily, there's a ton of you in this category, so all your health shit more or less balances out so that we can average the costs to the "system" and call it even. One year, Mr. Gonzalez will cost a lot because he has diabetes and in the next year Ms. Wilson will cost a lot because she needs a hysterectomy. You get the idea.
By creating a government-backed, perhaps independently-run (or gov't-run) insurance company, all these folks will have the option to sign up and get the same level of coverage as those lucky bastards in Part One and Two. Yeah, it's the PUBLIC OPTION and it's a good fucking idea so stop bitching about it.
Is it going to cost a lot? More than likely, it will. Is it socialism? No, it's simply ethically right. And Medicall (my new name for the program), will also allow everyone in Part Three to get the same preventative care as those in the other categories that will ultimately prevent them from needed obscenely expensive care when their illnesses and conditions become acute. Like a hybrid car, it will cost more on the front end but will save our nation money in the long run with healthier citizens and fewer unnecessary procedures.
Besides, Howard Dean had some good stuff to say about it in the New York Times last week, “There are too many people who understand, including the president himself, the public option is absolutely linked to reform,” he said. “You can’t have reform without a public option. If you really want to fix the health-care system, you’ve got to give the public the choice of having such an option.”
Just like in Part One, people choosing to get their health insurance through Medicall would have the ability to invest their unused premiums into a savings account.
PART FOUR - Peanut Butter Jelly-Time
PART FIVE - Medicall versus the HMO
Over on the Republican side of the aisle, legislators are freaking out that a government-backed insurance company would easily trounce the private sector since profit would not be their bottom line. And on the surface, I can understand their fears. Capitalism is certainly the American way and allowing the free market to solve various societal problems has often proven to be the best solution.
However, there are people's lives at stake and we all pay for ridiculous deadweight losses when we consider what it costs to provide emergency coverage for those 47 million people in Part Three.
Also, since both liberals and conservatives will play a role in drafting the legislation for the new program (or whatever reform passes), the policies can be drafted in a way that forces Medicall to be competitively priced, subject to market changes and ostensibly similar to employer-backed offerings. It can also require people to first go through their employers' insurance companies.
Sure, people may still choose Medicall over their job-based coverage and HMOs may still be at risk unless they take this opportunity to re-examine their own offerings and to make them better. Here's just a few ideas I have to make private-insurance companies better enough that people would choose them over government-sponsored Medicall.
Better doctor choices
Discounts for gym memberships & yoga
No referral requirements
Coverage of vitamins & supplements
Full mental health, dental and vision care
Non-ER emergency help
Better preventative care
There you have it. Senator Kennedy can rest in peace if only the powers that be will listen to the wisdom of the Shtetl. And let the comments begin!