CRANKY GENIUS

As Congress continues to debate the future of health care and as the President makes yet another compromise to motivate legislators to produce a bill he can sign, no one in the real word really knows what health care proposals are under consideration and which ones are off the table.

Meanwhile, every, and any, lobbyist who has the slightest financial, political, or religious stake in this history-shaping legislation is pulling out all the stops to make sure the new health care system is shaped in their image. Some have adopted a fear mongering “scorched Earth” approach, hoping that the average American will be so confused that they will demand nothing be done. But (using a double negative to make a point) we cannot allow “nothing to be done” because America already pays more for health care than any other nation in the developed world.

This article is not going to recount the nightmares associated with the current system if you can call it a “system.” You can go anywhere else for that. Rather, here are honest to gosh solutions. With health care, we go forward, and here’s how we do it.

Unified Billing

Say what you will about Medicare, the one thing it does well is billing. Let’s leverage those cost savings and have all health insurance payments go through a single billing platform. This will reduce costs significantly.

Universal Catastrophic Care

What’s really at issue is not if we can get a mole or in-grown toenail removed, but how will you pay your health insurance premiums if you get too sick to work or to keep up payments or if you lose your job.

The answer is a universal program to cover catastrophic care.

To pay for it, every employer – irrespective of whether their employees are full time, part time, or temp – would pay into a single insurance program managed by a non-profit organization. Every insurance company in the US that’s in the business of providing insurance to cover health care would be required to participate as a cost of doing business in that field. A certain amount per employee would be contributed that (when accumulated) would buy catastrophic health care for every man, woman, and child in the country.

And if you are self insured, you could join a guild that gives access to the program. Catastrophic health care insurance is a lot cheaper than full coverage and accommodates the most precarious health scenarios facing Americans today.

We HAVE to do this!

Choice From A Catalog of Insurers

Consider this. Every Federal employee (and most state employees for that matter) have what’s called “open season” where, each November, they receive a booklet that catalogs a couple dozen different health care providers, from which they may choose the one that best matches their circumstances.

And rather than pay an insurance company directly for the premiums, the Federal government manages the premium payment process through a single benefits office, the Office of Personnel Management, one of the most efficiently run departments in the entire Federal beauracracy; and the leverage they have with health insurers is unmatched.

We need a domestic version of this – a non-profit organization tasked with managing a system just like that of the Federal government’s OPM.

This is how it’s done in Germany and France, and how it should be done in the USA. Again every employer, rather than paying the insurer directly, would be required to contribute some amount per employee to this system (slightly less, as it turns out, than what they pay directly to the insurer per employee now), and the non-profit organization would have all the bargaining power to keep premiums low and uniform.

Again, the savings will be huge, especially since catastrophic health care is covered under the univeral plan described above. Plus if we require employers to chip in just 5% more, this could be the seed money to be used by the government to cover the uninsured, under-insured, self-insured, and the non-insurable.

Everyone is Covered, No One Is Denied

Single payer health insurance is a fiasco and nothing but fantasy. It applies the “cost benefit analysis” to individuals as if they were being judged by their credit worthiness. Except that heath is most often a product of genetics and environment – something, unlike creditworthiness,  no single person has control over.

Allowing the self-employed access to group leverage results a significant savings in overhead and removes the lack of bargaining power small employers are currently faced with. And these savings could be used to help purchase premiums for the under-insured, the uninsured, the self-insured, and the non-insurable.

Instead, we require health insurance companies to cover everyone, not just those who are healthy and prime for picking. Everyone. This spreads around the risk, and when it comes to open season, those shopping for health insurance would have all the leverage – they’ll buy from the company who treated them well, and for once, competition would exist within the health insurance system.

On top of all that, the single most expensive sector of the health care industry is that department within the insurance company that disputes claims. With no more disputed claims, the cost of a claims dispute office is eliminated and the cost savings is enormous.

Reward Savings

Your veterinarian can publish process, why can’t your doctor? It’s because the current insurance system is a mess.

But what if we require a doctor to post the prices for the hundred most popular procedures offered by that office, and then allow health insurers offer cash back to those patients who find a cheaper provider or procedure? We force doctors to compete for the patients and not for the insurance companies. We motivate patients to become informed health product consumers. And this puts the choice back into the hands of the consumer.

Do you prefer more expensive care, or do you choose the slightly cheaper procedure that has the same net result but puts cash in your pocket? You have the choice.

You want more cash? Follow your doctor’s recommended health regimen to minimize chronic illness and get cash back. Go to substance abuse clinics to kick the habit and get cash back. Eat healthier to reduce the chance for high blood pressure or diabetes and get cash back. You save your insurance company the expenses; they pay you part of the reward.

And guess what? Once you start getting a cash reward for eating and living healthfully, you’ll start shopping for healthful choices -  and all those junk food companies will have to clean up their act to compete for your business.

See how money talks?

Flexible Spending For a Lifetime

Singapore has a wonderful system for allowing its citizens’ flexible spending programs to roll over and accumulate over the lifetime of the patient. So, like now, we require the employee to pay their share of the premium and to contribute  a portion of that into a tax free flexible spending account. But under the new health program, that flexible spending account accumulates and draws interest. At a young age, a patient won’t need to tap the account very often, but as he or she ages, the larger sum is there when needed.

Put Doctors On a Salary And Make It All Non-Profit

There are already non-profit health plans and providers today whose doctors are not paid per service, but are on salary.

Blue Shield of California is one such service and has one of the highest consumer satisfaction ratings in the US. Kaiser is another, but with a wrinkle – its doctors own shares of stock in the medical services portion of the program, but the rest of Kaiser is non-profit.

When a doctor is on salary they’re not motivated to schedule expensive tests for services that have a marginal benefit to the patient. If on salary, the doctor would be motivated to actually care for his or her patients rather than use them as a slot machine.

This continues to be an excellent model and should be one used by any nation-wide health plan. With doctors on salary, and health insurance as a non-profit, the focus would finally shift to health care and not caring for maximizing profit. The United States is the only first-world country where medical insurance companies are for-profit and it’s high time we re-examine this.

Put The System Out Of The Reach Of Congress

You read about it all the time, that some politician is campaigning on the promise to reduce the costs of Medicare by “trimming the fat” or “eliminating fraud” and what really happens is the program ends up cutting fees paid to doctors. Consequently, doctors respond by ordering more tests for their Medicare patience, tests which are performed in clinics owned by the very doctor prescribing the test. To eliminate fraud and fat, we just put doctors on a salary as mentioned previously.

But to really keep the health care system strong, we need to keep it out of reach of those who run for elected office. The United States Postal Service is one such example where the service receives little or no subsidies and has been operating in the black for years (excepting, of course, the current recession).

A United States Health Service needs to operate the same way, out of the reach of all politicians.

Make The Pharmaceuticals Subsidize the NIH

Finally, the NIH covers much of the risk for researching new drugs, and pharmaceutical companies often can take over research just as the treatment looks promising. Huge profits follow, with little or none of it going back to the NIH.

But the NIH should have the power to collect licensing fees from the pharmaceutical industry who profits from drug based on NIH research. And if a pharmaceutical company doesn’t want to pay the licensing fees, they would be required to either pass the savings along to the end consumer, or to fund a program that cares for, say, adult autism.

Whatever the solution, the entire health care industry must adopt a sensible, universal, quality service for all Americans, like those ideas outlined in this article.

It’s the enlightened thing to do. It’s the economical thing to do. And it it’s time to bring America’s health care kicking and screaming into the twenty first century.