Here is a simple way to think about universal health care in this country. Let the 50 percent of the American population on employer-sponsored, insurance company-administered health care keep it. Let people 65 and older keep Medicare, but expand it to the rest of the population who can afford to pay a Medicare premium but cannot afford a private insurance premium. For those who cannot afford the Medicare premium, offer them Medicaid under a block grant to each state based on age and income administered by highly successful managed care organizations such as Centene and Molina Healthcare.
Concerned about the cost? Let’s attack it with management efficiency such as 1) a rules-based system for ordering expensive and often unnecessary diagnostic tests; 2) “Alliance-based” purchasing of pharmaceuticals, which has been shown to reduce cost; 3) state-mandated capping of malpractice awards, which will reduce the “pass-through” effect on patient bills of sky-high physician liability coverage; 4) more rigorous monitoring of excessive hospital and physician charges (infamously referred to as “upcoding”), which up to this point has not been rigorously pursued by the for-profit insurance sector for fear of alienating their doctor/hospital providers; and 5) encouraging alternative forms of treatment such as payment for home care of the elderly (where appropriate) versus more expensive nursing home facilities.
The advantage of this recommendation for universal coverage is that it works within the existing system under which patient populations, medical and insurance groups are already operating. By way of stark contrast, both the American Medical Association and the American Hospital Association as well as some Republicans and most Democrats are not supporting the current plan on offer in the U.S. House of Representatives. Time for Plan “B?”
Mike Meehan, CFA