Tuesday, July 28, 2009

Health Reform Success Criteria: Part 2

OK, so the other day we talked about some basic things that would make for good health care reform: denying the "preexisting condition" clause that health care companies pull, and requiring that everyone sign up for health care insurance if they could afford it, and government assistance for those who can't.

With all of that money rolling in from an additional 50,000,000 new clients, this gives insurance companies plenty of money to provide care for people. But we still have a basic problem of how do we know we're getting *good* health care coverage? What's to stop the health insurance companies from just running off with the money? What if you sign up with a health insurance company because it's the cheapest - then find out you're going to die because the only thing they cover are cotton swabs and you signed up for a crappy insurance service. Congratulations, it's the market at work, and now you're going to die!

Yeah. Doesn't sound that great to me. So there are few more reforms so we can make sure we get a good health care system.

Minimum Health Care Standards

One of the things I got our of reading Tom Daschle's book is the idea of the Government Health Agency - kind of like the FDA or the FED. Now, hold up. People are now going to start running screaming through the streets. OMG THE GOV'MENT IS GOING TO TELL MY DOCTOR WHAT TO DO! WE'RE ALL GOING TO DIIIIIEEEEE!

As opposed to know, where INSURANCE COMPANIES TELL YOUR DOCTOR WHAT THEY'LL PAY FOR, YOU GIT. That's right. When you go to the doctor, and they say "Guess what - you need to have your filangee removed - but your insurance company doesn't cover that," you've just had a private industry bureaucrat decide your health care procedures.

That's not to say the doctor *won't* remove your filangee anyway - but now you have to pay for it out of your own pocket. That's what already happens, folks - if the insurance company doesn't pay for it, you have to.

What the Government Health Agency (GHA) would look like - if you follow the Daschle plan - is a committee formed of various doctor representatives, nurse representatives, some insurance representatives, patient advocacy representatives, and some others. How these will be selected is probably the same way the Fed is - the President appoints someone, Congress approves, and off we go.

The GHA would look at the various diseases and treatments out there, then say "OK - if you're a health insurance company, by law you have to provide these minimum things. Like, check ups every six months with tests A, B, C. If someone gets leukemia, you have to pay for X percent of bone marrow transplants. You must provide contraceptives for women as part of the package. So on and so forth."

Now, if a health insurance company wanted to offer *more* than the minimum government mandates amount, great! It's like how some states require car insurance if you drive - they have to offer at least a minimum coverage amount, but then insurance companies compete over who can offer more coverage and what kinds at the cheapest price.

This makes sure that everyone, even the people who get the cheapest health insurance, at least gets certain minimum of care. Highest on my list would be preventative measures, like checkups every six months with tests like mammograms for women, prostate checks for men - simple things that can detect diseases far before they get into trouble.

Now, with that, there will have to be minimum standards for the patients as well. If you don't get your checkups every six months or so, or don't show up for your tests - you can't complain if you get sick. Now, if you do the things you're asked to do - within reason, of course - and you get sick anyway, then the insurance company has to cover what they contracted to.

This does two things:

1. Makes sure people are getting preventative care which reduces costs for health insurance companies and the patients.

2. Makes sure insurance companies don't go broke when people people get sick, because they'll be catching diseases at the earliest, most preventable state. And, if they're really smart, they'll encourage patients to do things like lose excess weight, watch their diet, so on and so forth.

There is one other element that I believe will make health care reform a success. And that is - the Public Option.

The Public Option

OMG, run for the hills! It's government provided health care! Run for the wind!

Or, that's what some people want you to believe. Think about the FDIC a moment. Every bank is *required* to use some form of insurance on accounts in the event that they go under, their client's checking and savings accounts are protected.

The FDIC isn't the only game in town, though. There are other alternatives, but every bank is under a requirement to own account insurance, whether through the FDIC or some other institution that offers similar protection.

The Public Option Health Insurance plan would be like the FDIC - it's kind of the option of last resort for people. If you don't have any good health care insurers in your area, or they're too expensive, or maybe you can't afford insurance on your own - there's the Public Option to cover you. It will likely only cover the minimum level (I believe the current proposals have a 3 tier system, with minimum care being the lowest and cheapest).

Why even have the Public Option instead of just letting the private industry cover it? Well, for the reasons above. Some private insurance companies don't cover small towns or rural areas.

The Public Option would simply be a not-for-profit health insurance company, like the FDIC, started up with taxpayer seed money, and after that would rise or fall on its own. If it can succeed better than private insurance companies by not worrying about paying out stockholders or owners - then I guess private insurance companies will have to work harder to keep up. Which means people will get better care, and everyone wins.

I think that's everything I can think of for what I'd consider to be Success in health care reform. Will we get any or all of these? I hope so. I'd expect it.

I guess we'll have to see of Congress will deliver it - or give the insurance companies what *they* want - which is to keep the status as it to keep things the same so they make the most money while we spend more on less health care.

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