Monday, June 22, 2009

Here are a few things I want to see in health care reform - given the absence of single payer

Here are a few provisions I'd like to see in whatever bill passes short of single payer.

One thing that would help is a single universal health risk pool. A private insurer who operated in the Health insurance market would be required to accept any applicant, regardless of prior history, and would be forbidden to selectively rate up any applicant.

Add to that "risk adjustment" and the health insurance system would be operating pretty much on a level playing field. Everyone would be forced to make their money by paying lower health care costs. There's a lot of room for innovation in that.

Also we need a single standardized definition of the terms used in medical billing, so that physicians and hospitals would have to hire only enough clerical staff to deal with one basic system billing system. The idea that every insurance company has its own system is simply a ploy to lock in health care providers to that insurance company. Any efficiencies found in medical billing could go to physicians and hospitals or to the insurance company. That's another incentive to lower costs and streamline the billing system. It would also lower what it costs to run administration for medical billing in the physicians and hospitals.

I am assuming that insurance companies will be allowed to sell supplemental insurance policies that cover costs above what the standard benefits the new health care system will provide, but such policies should clearly be add-ons to the normal insurance, not included in as part of the normal insurance like the private insurance companies offering Medicare benefits do today. That way the purchasers would know what they were paying and could see whatever additional benefits to supplemental policy provided. Again, the cost of health care needs to be up front and transparent as much as possible.

I'd also like to see a single universal appeals board for all denials of payment, private and government. Without that standardized appeals system the patients have no real recourse usually, which is why the insurance companies have been able to get away with the rescissions.

Sweeten the pot for physicians by paying off parts of the student loans taken by them. My DO graduated from medical school with a 30-year payment schedule. For each year in the system, pay off a year of loan (up to a max each year to prevent gaming the system, perhaps. That would require research, but the date would be easy to get.)

I'm sure all of that could be gamed, but the profit in gaming it would be a lot lower that what we currently pay. Remember, the federal government already pays of half of all health care expenses in the nation.

No comments: