Wednesday, November 26, 2008

Health Care Reform in the United States

When I quit my job in the United States in 1999, I immediately lost my medical insurance. I could have I believe continued with the previous company’s insurance plan for a period of twelve months, to give me some grace to get insurance from a new employer which only kicks in after three months of employment or buy my own health insurance for myself. At that time the monthly premium I would have to reimburse my ex-employer to remain on their plan was US$350, and I suspect it would be nearer US$700 a month now. If I had a family it would be nearer $2000 a month now.

Is it any wonder using my example, why there are over 40 million uninsured Americans, that is those with no medical insurance at all, and in the case of catastrophic illness, one would have had to exhaust all one’s personal wealth before some sort of minimum medical care is offered by the state. It is again almost always the case, where people have become destitute by having to pay medical bills, that are either not covered by insurance or by having none.

There are many types of insurance plans in existence, and the costs of these plans are a big detriment to the hire of new employees even in a period of recession such as the case now. More than the loss of ones job these days, the loss of the medical cover is the most stressful as one fears getting sick or even being involved in an accident, through no fault of ones own. Many of the large corporations and US government both in the state and federal sector have good insurance plans.

The small business sector, which is usually the engine of growth in any economy, is the one that is hard-pressed to provide insurance owing to the high costs. It is also generally true that the larger the number of insured in the pool, the lower the cost per family or person, and vice versa. In that sense small businesses are penalized paying higher rates.

I will not go into the intricacies of the high cost of health care and the reasons for it, as that is a separate debate altogether, except to say that policies that provide choice of doctor and hospital cost a lot more than policies that restrict choice, as they usually are managed care organizations that pay the doctors salaries, rather than on the number of patients seen etc. This massive variance in the quality of health care even for those who are insured, results in many who are dissatisfied with the care they receive. How therefore can this existing system be upgraded to universal care for all?
Hilary Clinton was appointed by her husband to head the health care reform task force in the Clinton Administration. She simply failed to gain consensus due to the very strong positions taken by the vested interests, who have a lot at stake in a revamp of this. A single national health service such as in the UK is not an option in the US and one has to realize not to go that route, so how does one get comprehensive health care for all while existing plans to remain in much the same form as now.

I believe the answer to this lies in keeping the NEW plan simple and including all those not in a plan into this plan and allow others who already have insurance to join this plan. The larger the number in the plan, the lower the average cost. Another significant aspect is that this is a basic plan and not the Rolls Royce of plans, which the US Congress receives. Due to this significant difference, there will not be a rush of people who have insurance moving to it but will allow small businesses and uninsured to join this plan as the cost is expected to be significantly lower than competing plans.

One significant point however is that like every insurance plan those with high risk, will skew the costs upwards, and therefore provision must be made to ensure that other plans do not kick out people with high risk into this plan, allowing them to profit and the plan to possibly incur greater losses due to the poor health of the pool that is covered by the plan.

It is fair to say that like the Medicare plan that covers retirees and is extremely costly and subsidized by the government to a great extent, this plan will probably cover numbers even exceeding Medicare. The only way forward is to force people not on any other plan to join this plan and buy into it by paying the requisite premiums. Small businesses will also be required to enroll their employees into this plan but give some kind of tax relief in the first few years to ease the transition and the cost of providing care.

A point to note is that all people currently in plans should be given the option of including all their immediate family members up to the age of 18 for children. This will reduce the number enrolled in the new health plan.

In conclusion, the cost of this plan to the state will not be more than the cost of currently having to provide care for the uninsured. It is essential that a simplified plan such as this is enacted rather than provide a series of choices. This is merely the alternative plan for those who have no insurance and not one to replace existing health care plans covering the majority of Americans.

1 comment:

hesslei said...

The health care system in the U.S. has a vast number of players. There are hundreds, if not thousands, of insurance companies in the U.S. This system has considerable administrative overhead, far greater than in nationalized, single-payer systems, such as Canada's. An oft-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs, nearly double the administrative overhead in Canada, on a percentage basis.


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