February 26, 2017:
THE most critical issue right now is the “War on the Affordable Care Act” (which those who hate it can only call it Obamacare). It is not only a very divisive issue, but it is one which is critical to the well-being of millions of Americans. Most Americans will continue to have health insurance through their employers, but there is more to this difficult problem than just an insurance policy.
First, should the Republican-controlled Congress decide to void the A.C.A., approximately twenty million people will lose their insurance coverage. Will that cut the premiums for everyone else? No, of course not! The real villains are the insurance companies who now have those increased premiums and will not easily drop them. The “penalty” for not having insurance will be voided, which will do nothing but encourage more people to “buck” the system, depending on doctors, emergency rooms, and hospitals to treat them when they get sick. There are two groups here: those who truly cannot afford health insurance and those who choose to not pay for insurance (they just get care and don't pay!).
Second, unless the Congress immediately enacts a new program which does everything that the A.C.A. does, there will be ramifications for the medical providers across this country. Rural hospitals have benefited enormously from Medicaid Expansion with the A.C.A. Unless the new program does the same, many rural hospitals will close due to lack of support. Arkansas has been the Number One state to benefit from the expansion of Medicaid. Health care has improved dramatically, but that positive trend will be reversed if the new law doesn't provide the same support to them.
Health insurance is, possibly, the most complex problem that this country has ever faced. I can't begin to understand all of the facets which are involved in having multiple policies for 325+ million people, providing appropriate coverage for different age groups and groups which have different needs. Women's health concerns are much different from those of men. Ethnicity, age, state of health, genetics, etc. all create so many variations that one policy could cover it all, but that doesn't seem to be something which people want. It's a shame because that's what makes the most sense.
Young people who are healthy think that they should pay less for health insurance than a family or someone who has serious issues. That is true and could be accounted for if EVERYONE carried insurance. However, the real problem is the “risk” for insurance companies. Does anyone blame them for not wanting to be stuck with all the “riskiest” people?
Perhaps it would be possible for there to be a “fixed set of policies” that insurance companies could offer. Each policy would cover specific things only. If you happen to have that policy and get sick with something that is not covered, you have to pay for it yourself, period! That policy would cost $X for whoever is in that group. A different policy would cover more things, so it would be more expensive, and so on as coverages increase. Of course, you would have this policy for your lifetime. You don't get to buy car insurance after an accident that covers that accident. You don't get to buy life insurance after you find out that you are dying of cancer. These policies would be one solution, though this would be a risky choice for someone.
Personally, I think that there should be a single policy which covers everything with no lifetime limits. Every insurance company would compete for clients through their “reputation for good service.” The premiums would be based on personal income, regardless of your age. Still, cosmetic medicines and surgeries would not be covered. You are covered for whatever you need as prescribed by your doctor. Doctors would be scrutinized by the insurance companies to help keep costs to a minimum. Doctors who oversubscribe narcotics would be especially monitored. Half of the premiums would be deposited in a “Risk Pool Trust Fund” where companies would apply for reimbursement for expensive treatments such as cancer, transplants, and expensive drug treatments. No insurance company would have to bear the brunt of the cost of these events, which is the current reason that health insurance variations exist!
One more thing must be mentioned. There will always be “cheaters,” whether it is providers who falsify treatments or people who try to “hide” their income, “work off the grid” so-to-speak. They will be rooted out and severely penalized, given prison time if appropriate. Any system that we can create can be infiltrated by the “thieves” among us. Due diligence and the help of the public will solve that problem.
What the percentage that will be used to create this “universal” payment system, I can't say. However, I think that it would be much simpler and still be out of the hands of the government. It would be a private system, only the percentage would be set by a joint committee of the insurance companies and the Congress. The one thing which must be set by law is the “percentage profit” allowed for each insurance company. There must be an incentive to negotiate drug prices and the cost of surgeries and treatments. Those doctors who went into medicine to become millionaires should find other jobs. Of course, the wealthy always have the option of paying cash for whatever they want, wherever they want to go to get it! That will always be the case. Of course, the 95% of the population will love a system like what I propose!
Robert G. Butler
P.O. Box 193
Marmaduke, AR 72443
"...Therefore, never send to know for whom the bells tolls; it tolls for thee...: Meditation 17 by John Donne 1624
