Health Care - My Version

I don't know all the details about the extremely complex nature of what is needed for adequate and acceptable health care reform but I have a few thoughts that seem like reasonable steps to providing a basis for reform. If I were in charge, here is what I would do:

1. Tie health care coverage to employment. If there should be one mandate, it should be that all employed people have to provide proof of health insurance coverage in order to be employed. Period. You want a job? Show proof of coverage before you can receive a paycheck. Much like proof of auto insurance is required to have valid vehicle registration. Now, I understand there is still a good number of people that somehow find a way to drive without auto insurance, so I'm sure this still won't get everyone properly covered - especially those that are self employed or day laborers. However, I suspect it would get more people into the system than there currently are - especially the 20-somethings that don't have health insurance because they think they're invincible and are the biggest segment of uninsureds.

2. Provide a form to be submitted along with tax returns that verifies health insurance. This would be yet another step in making sure people are covered. If the form is not submitted or cannot be verified, then an audit will take place that will either automatically garnish that person's wages for a baseline (catastrophic) policy or have the individual subject to tax evasion.

3. Do away with company provided health care insurance. Leave all insurance policies up to the individual to shop for and choose. Again, much like auto insurance. Have companies, if they choose, provide some sort of subsidy or contribution, by way of a clearinghouse, to the policy of the employee's choice. This creates more competition among insurance providers to reach out to individuals versus corporations - specifcally large corporations. Auto insurance isn't provided through corporations and it seemingly works just fine. Furthermore, costs/premiums are kept in check through healthy competition because there is always another provider that is ready to step in and provide acceptable coverage for an alternative price. You want the Cadillac of coverage? Pay for it. You won't minimal coverage? Pay for it...and accept the consequences when you need it. That's the risk you take and no one is to blame but yourself. As well, employers are still able to help with costs but not control care.

4. While I don't think this is something that can be madatory, I think insurance companies would be wise to be more accessible and user-friendly. Think for a minute about an insurance company having a kiosk or retail-type outlet for customers to come in and shop for coverage - much like how cellular providers do it. You want an iPhone? Where do you go? The Apple store. You can browse the store, ask questions and make an informed decision. You can ask about the details of the service plan and have someone show you how to add different applications to your phone. What if, instead of a phone, you were looking for insurance coverage? You ask a customer service rep about the pluses and minuses of different coverage plans and add different aspects of coverage to that plan. Your single, healthy with no kids and want a low premium? Let me show you this plan with a $1,500 deductible that covers you in case of a car accident or terminal illness. Would you like to add vision or dental to this plan? No? Okay. Our co-pays as part of this plan are 90% of prescription costs. Is that okay? Yes? Good. Sign this policy agreement and we'll start your coverage. You're married with two kids and have a pre-existing condition? Okay, here are a couple of plans that are popular for people like you. Most people choose option B which have a $250 deductible, 15% co-pay of prescription costs, $25 expenses for well visits and preventive care. Vision, dental and pregnancy care are included in this annual coverage. We offer this for $500 per month. Is that okay? Good. Sign here. This is a one-year agreement. At the end of one year you can change your plan to better suit your needs if you find that vision coverage isn't necessary or that you would rather decrease your premium in favor of a higher deductible or alternative co-pay pricing.

5. If the government wants to intervene to "help" control expenses or get more people covered, let them provide subsidies, like food stamps, to qualified individuals who pay taxes. This would hopefully motivate people to file tax returns so there is more money in the system to provide such help. The stamps could be used for mothly premiums, deductible amounts or co-pays. However the individual chooses to use the subsidy, they can depending on the need of the individual. It controls the extent to which those subsidies are used by the people that abuse the system now - i.e. I can't go to the doctor (ER) for every cold because I only have a limited amount of government provided assistance to cover such a visit. I would rather wait until something more "worthy" happens before I spend this subsidy or I would rather use it against my monthly premium.

6. Deny care to those that try and utilize the ER for general care without insurance. There's no other option to alleviate the cost associated with people that abuse the system. If you don't have insurance, we will not see you unless your bleeding, having a seizure, convulsing, been burned, have a compound fracture, a nail sticking out of her head or been brought to the ER by way of ambulance. This sets a guideline for care. If you have insurance, come on in if you think it's truly an emergency. If not, we will not see you unless it's a dire situation. If you're not bleeding, having a seizure, convulsing or been burned, etc., then you'll have to wait - you made the decision to not have insurance, not the hospital. I suspect this reality would cause most uninsureds to take a hard look at getting some sort of coverage. Tax payers don't pay to fix or replace your car when you get in a wreck without insurance, why should they provide health care if you choose not to have insurance? It's simple really. Just get some sort of coverage and you don't have to worry about a thing. For someone with a high deductible, the hospital may not recoup the deductible amount but at least they're covered for anything above and beyond. Better than what they're forced to deal with now.

Again, I don't have all the answers but it seems like these few steps would bring costs down and create a better health care environment. You get what you pay for. Probably way too simplistic. I'm sure there are many holes in my rationale but it seems like a good start.