- Healthcare costs are skyrocketting out of control
- Too many Americans don't have access to preventative care because they lack health insurance
- The lack of insurance, and subsequently treatment, for those with pre-existing conditions is unconscionable
- Coverage caps lead to serious financial problems and even bankruptcy in too many cases (you could argue a single case is too many)
I am going to attempt to avoid the relentless debate regarding the constitutionality, effectiveness and cost of the bill in question and focus instead on an alternate approach to solving the problems noted above. I urge the reader to ask him or herself what Americans really want or need right now? Is the goal to overhaul the current system, which is more than adequate for the vast majority of Americans, or do we simply want to address the issues described above? Do we really want to grow the government and dramatically increase the tax and debt burden of Americans, both today and for generations to come? How about considering some alternative solutions which would have a more immediate impact without significantly growing the government or the debt burden on Americans? I will address each of the points above with specific steps we could take to either eliminate or considerably reduce the number of people affected by the respective problems.
First, skyrocketing healthcare costs. In order to address this issue, I want to point out some of the most significant factors associated with the current costs as I understand them. These are, in no specific order: high profit margins for insurance companies; the lack of interstate health insurance commerce; high cost of practicing medicine; and current government protections to the health insurance industry precluding them from being subject to antitrust regulations. That's quite the laundry list, but I believe there are relatively straight forward solutions to most of those factors, while others will require further investigation.
How should we address the allegations that health insurance providers are seeking too much profit? I acknowledge the position many have taken opposing any profit model for providing health care. However, that is not a productive approach to solving this problem. It is undeniable that the free market health care system, which leads to profits, has been a major contributing factor of medical advancements. Therefore, I submit the goal should not be to prevent anyone from making a profit, but rather to keep them honest and fair. The best way to do this is to remove the barriers preventing Americans from buying insurance from the best provider, regardless of what state that provider lives in. This model works for property insurance and should be equally effective, if given the chance, for health insurance. The goal is to increase competition.
No doubt if you have made it this far through this article, you are probably thinking "here comes medical malpractice tort reform." Though I do support some form of medical malpractice tort reform, I also acknowledge it is unlikely to reduce costs significantly. My estimate based on data sources available on the Internet leads me to believe the potential savings are likely to be somewhere within the 2-8% range. I am aware of the various studies and articles posted on insurance-reform.org, but also notice a glaring omission from their cost calculations in this report titled "True Risk: Medical Liability, Malpractice Insurance and Health Care". The study doesn't consider the cost of attorney fees, defensive medicine, administrative fees and services lost by doctors having to spend time with attorneys and in court rooms. Therefore, I must conclude the true numbers must lie somewhere between the <1% claim made by Americans for Insurance Reform and the >10% potential saving estimated by the Wall Street Journal opinion piece titled "CBO Underestimates Benefits of Malpractice Reform." This appears to be another industry seriously lacking competition. Maybe the government should find ways to encourage more competition in this industry? I haven't done a lot of research on this, but it may be worth the effort to find out what regulations may be prohibiting more competition in the industry.
Another cost cutting idea, though it would certainly not be a "quick fix" is to identify ways to get more people to and through medical school? How about some tax incentives for these insurance companies to offer scholarships to medical students? The logic makes sense to me. More doctors, means more potential insurees which would mean more money for the insurance companies over time.
My final recommendation towards stemming the rising cost of health care is to reverse the McCarran-Ferguson Act of 1945. This move essentially told insurance providers that federal laws such as interstate commerce and antitrust regulations did not apply to them unless explicitly stated to do so. There was a previous effort to reverse the 1945 act in 2007, but it never made it out of committee. There are several efforts in both houses of congress today attempting to end the McCarran-Ferguson Act and the language is being added to the current healthcare reform bill also. There is of course some irony here. Why are Republicans vehemently opposed to move forward with this? Why are they arguing this is just more government regulating private industry? It seems to me like the Democrats and Republicans are on non-traditional sides of this debate, most likely due to their respective lobbys.
The next issue is how do we get broader and more affordable health insurance coverage without health insurance exchanges or government insurance providers paid for by you and me, the tax payer? What reason do we have to expect dealing with government insurance would be any different than the SSA, DMV, or Medicare? My proposed solution for this problem is based more on tax incentives. Why not consider an incentive where insurance companies are encouraged to insure low income Americans for a reduced, or even free, rate and receive a tax break in return? I would even consider some quota system if necessary, almost anything would be better than the direction the current legislation would take us in. Of course I haven't done any studies, but I am pretty confident that we can get close to 100% coverage using this approach. The legislation can even contain language stating if the industry couldn't meet specific coverage goals by a certain date, the government could then proceed with the public option. This would also eventually lower healthcare costs as we have seen numerous statistics which confirm more preventative care will lead to less severe and emergency treatments.
I will address the final two points together as one, since I suggest the same solution to treat both pre-existing conditions and coverage caps. First, pre-existing condition clauses should not apply to those who are moving between insurance companies, but only to those who have made the choice to wait until encountering a serious health problem. It is not our place to enforce responsibility on an individual. My solution is based on the premise that those with pre-existing conditions would be accepted and covered by an insurance company up to the standard coverage cap of the policy. Now for those who have hit their coverage caps, I believe this is a reasonable place for Medicare to kick in with unlimited coverage. This isn't the best solution, but I believe the number of people that fall into this category is relatively low. Therefore, the overall impact on Medicare should not be significant.
In summary, I believe conservatives and liberals can come together and focus on the issues rather than their personal political agendas for the good of the people. They can come up with creative, low impact, low cost solutions to the specific healthcare problems this nation faces without mortgaging our future or completely tearing apart the current system. There really isn't very much compromise in my suggestions. Conservatives win because they get health care reform without compromising the constitution while liberals win because they get health care reform without the unnecessary debt that would be associated with a public system.
