Our prescription for health care reform
Not since the early days of the Clinton administration has this country engaged in such a robust debate about health care. Now, as then, the countless interlocking pices of the health care puzzle, the massive amounts of information and the overheated rhetoric make it difficult for Americans to reach agreement on the issue.
We don’t pretend to have all the answers to these complicated questions. But we have reached a number of conclusions about what we think would work best.
First, while there are millions of people in this country without health insurance, very few people who need health care in this country are denied access. The uninsured, unemployed, poverty-striken, even those in this country illegally can obtain health care through a variety of programs and through hospital emergency rooms.
But that sort of treatment, for which hospitals and others are not reimbursed, drives up health care costs for everyone else. It’s particulary frustrationg because many of those without insurance choose not to have it — from healthy young adults to low-income parents who decline to sign their children up for programs such as SCHIPS.
So the first item on our agenda — one that President Obama and many industry groups also support — is a mandate that every American have health insurance. Those who ignore the mandate would pay more in income taxes to cover their insurance costs.
Under this plan, low-income families and individuals would need to be subsidized in some way. And, because our current system is tied so much to insurance provided by employers, it is nearly impossible to make this mandate work without a pay-or-play requirement for all emploayers. Businesses would have to either offer health insurance to their workers, or pay a fee to the government to help cover their workers to obtain insurance.
Related to the individual mandate is the need for insurance portability. People shouldn’t fear losing their health insurance if they switch jobs or lose their jobs.
Public insurance options — Medicare, Medicaid and Veterans Affairs health care — already make up a huge portion of our health care system. But any expansion of the public option should be very limited, a last-chance option for those who can’t obtain private insurance. And
it should be priced comptetively with private insurance, not designed to undercut private firms and drive them out of business. Many people quite reasonably fear that eliminating private insurers is the ultimate aim of those who most adamantly support a public option.
Any public option should be constrained — limited to those with low incomes or people who are, for physical reasons, unable to obtain private insurance. Those who have the means should be required to buy private insurance.
The idea of developing regional, nonprofit cooperatives to provide health insurance is also worth pursuing. Although not quite a cooperative, Rocky Mountain Health Plans, which operates in this area, could proivide a template for what might be developed elsewhere.
Although polls indicate a majority of Americans want some sort of health care reform, they
also show most people in this country are satisfied with the quality of health care they receive. They don’t want to lose that care or their choices when it comes to doctors, hospitals and other health services. Any reform must guarantee those choices remain and should not attempt to impose one national standard on the entire nation. Regional programs, such as what has developed in the Grand Valley over the past decades, should be allowed to flourish.
Some regulations are needed on how health care is sold to consumers. Convincing people to request prescription drugs based on television ads or medical-equipment arrangements that encourage doctors to push costly procedures more frequently aren’t in the best interest of consumers or our nation.
We’d like to think this can be done without increasing taxes, but the reality is that’s not likely.
Current debate about taxing health care benefits, frankly, we find bothersome. But it may be the best alternative. If that is the case, those taxes should be levied only on those plans that provide premium services, not on basic health plans.