Keeping what works - Consensus building on solutions to Health Care
There are parts of our Health Care system that are so strange that it defies logic. We really need to all get together and make some policy decisions that we can live with on health care. So, here are just a few decisions we can make to keep a more humane "free market" insurance plan along with what would be a reasonable approach for the government. First order of business: we must decide if health insurance is a right, requirement or a gigantic crap shoot on our future health.
My personal belief is that all people must have insurance. Although most of us hate to have the government tell us what to do, we do not question that if we want to drive, it is the law that we have car insurance, or must prove that we are wealthy enough to cover any liabilities. It does not seem like a quantum leap to require that everyone should have medical insurance either through their employer or a private policy. Many have chosen not to pay for insurance because they would like a bigger house, the latest in technology or they feel invincible. For those who truly cannot afford insurance, there could be a subsidy based on the ability to pay and that could be covered by private or government insurance. My preference would be a private policy, but with much more control and communication on coverage by the companies. Also, pre-existing conditions must be eliminated as a way to decline coverage by companies. We can no longer allow individuals to wait until they think they may need insurance to get it. The uninsured are taking much more of our medical dollars because of the visits to the Emergency Rooms and lack of preventative care.
The second requirement would be for everyone to know what the coverage involves. Medicare does not pay enough to cover many of the costs, but the doctors and patients know what is covered for each diagnosis or abnormal test. The insurance companies must really clarify reasonable and customary costs allowed. Some major insurance companies explain on their websites that R&C means "...charges made by most physicians or providers for similar medical care in the same locality." I have found that it really means the lowest price that they have, somewhat arbitrarily, decided to pay. If Medicare has information available on what will be covered, there is no reason that Insurance companies could not do the same. They have considered their R&C allowed to be a closely guarded company secret and that will have to change.
I expect to have some personal responsibility in decision making on what tests I have. For example, I have a small (5mm) spot that was picked up by a CT scan this year. The gold standard would be to have a PET scan for metabolic activity. Medicare has a limit that you can only have that covered once. That actually seems reasonable to me since it is so small it would not even appear on an X-ray. The doctors and I have decided that it will be monitored every 6 months, or so, and if anything changes we can go to the next step. I am fine with that and it makes good financial sense. Sure, it would be nice to have a few PET scans this year, but that would be extremely expensive unless other tests show there is a real need. If the insurance companies would be more transparent, I think we all could live with that. I think that most people would be willing to pay a little more for coverage if they could maintain some control over their medical decisions.
I am sure that we cannot salvage our system by the government cutting costs to providers and concentrating on preventative care. Doctors must be paid more for office visits to allow time for prevention and soon the doctor shortage will be worse. It won't be rationing...just more people trying to see a dwindling supply of doctors.
These are a few things to think about. It will not make everyone happy and some will be angry that I would even suggest such a thing. But I make the above comments only as an alternative to what could cause us to have a national policy that could destroy many of the innovations that have increased the availability of health care. Now we need to find a way to improve the accessibility.
I will have more serious things to think about later, but I must get back to posts making fun of the absurdities of health care for my on line therapy.
TVP tvp@dyingforinsurance.com
Posted by The Virtual Patient at 7/19/2009 10:31 PM 
Categories: Costs,Universal Healthcare,Patient Responsibility,Socialized Medicine,Medicare,Pre-approval,Insurance,doctors
Tags: Politics universal health reasonable and customary cost Socialized Medicine coverage Medicare Insurance doctors
Categories: Costs,Universal Healthcare,Patient Responsibility,Socialized Medicine,Medicare,Pre-approval,Insurance,doctors
Tags: Politics universal health reasonable and customary cost Socialized Medicine coverage Medicare Insurance doctors
I too have the same opinion as you that we really need to all get together and make some policy decisions that we can live with on health care. It is new information for me that the uninsured are taking much more of our medical dollars because of the visits to the Emergency Rooms and lack of preventative care. All your opinions described here in this post seem quite important for me and all readers. The point that you put forward that everyone should have a medical insurance is very brilliant one and I think that would be helpful for all those who don’t have much savings to spend if they met with some serious medical problems.
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