REAL Health Care Reform (Part 2)

We know the problem, health care is expensive and the cost is destroying our economy. So, what is the solution. If only it were that simple...just spew out an answer. The issue with finding a solution is that so many people have so much to lose that no one is able to offer up a sufficient plan.

As a father, husband and health care provider, I'd like to offer my humble suggestion to the powers that be on a viable solution to our health care crisis.

1. Offer a catastrophic policy available to anyone and everyone who is willing to pay (be taxed) for such policy. The purpose of this policy is to protect Americans from a family catastrophe such as cancer, heart attack or stroke. These diseases and their treatment are crippling to families, as are many others not listed. This catastrophic policy has a $10,000.00 deductible with a $12,000 out of pocket portion. This means that the policy holder pays the first $10K of health care bills, 20% of the next portion until the out of pocket expense reaches $12K. At this point the catastrophic policy begins paying 100%. This policy will have a limit of reimbursement to the health care providers based on individual utilization of services. For instance, reimbursement to the providers would be at usual and customary fees for the first $25K in services, then a decreasing percentage as the services increase. It may look something like this: 0-25K reimburses providers at 100%, 26-50K at 80%, 51-75K at 70% and over $76K in procedures is 60%. How this looks in the real world would be something like this: A young boy is sent to Mayo Clinic for diagnosis of rare disease. Over a period of 17 days the family racks up a bill of $260K. The Clinic would be paid 100% of the first $25K in bills, 80% of the next $25K and so on. This plan would offer the following benefits in the Health Crisis:

• Universal coverage available to anyone and everyone.
• Rates are low so that the majority of Americans could CHOOSE to have it.
• Significant cost containment with the high deductible and descending reimbursement rates.
• Higher quality in care as Physicians will make better decisions regarding testing and treatment as Health Care Facilities will want to maximize the highest reimbursement rates to prevent losing money. Instead of trying to treat "on the cheap" to save money, care would be delivered on the "best possible"standard.

2. Free market Insurance Plans offered by the usual's (BlueCross, Medica, etc) aimed at filling the gap created by the high deductible of the Universal Plan. Insurance companies would be allowed to compete for consumers business by offering a variety of plans based on consumer needs. The purpose of these plans would be to cover the large deductible of the Universal Plan, ie. a plan may pay 80/20 of that initial $10K. These plans would be filled with wellness incentives that would help reduce consumer expenses and, ultimately, reduce insurance expenditures. One example would be smoking. If you smoke, and no we are not picking on you here as facts are facts, your policy will cost more as your utilization will be higher than a non-smoker. However, incentives to quit built in to your plan would allow you to save money the longer you are insured as a "non-smoker." The same can be seen for obesity. Insurers would also offer Wellness Plans that pay for services from providers aimed at keeping one healthy, similar to what they are doing now with Fitness Membership reimbursment. The key to these policies would be in rewarding the policyholder with lower rates by making lifestyle and health changes that reduce their risk for chronic, late in life diseases that are the most costly like diabetes and cancer.

3. Develop a co-pay system for the Universal and Private policies that makes the consumer responsible for a larger portion of "routine" office visits. This would drive up the the quality of care delivered as the consumer would now choose a clinic or physician based on standard market factors rather than if they are "in" my network. Under this system, clinics and doctors would compete for consumers business just as other businesses must compete to survive. When the consumer is given the chance to choose, wasteful spending will be reduced and results will improve.

So there you have it. Does it solve all of our problems? I think it's a great start and with any new idea it would have to evolve to meet the changes in the market, but I think overall it has great merit. I'd love to hear first impressions on my ideas as they are just that, ideas.


Please be sure to check back regularly for more insights. In the meantime, why don't you stop by my website at www.lifequestchiro.com and explore! Be Well!