As I’ve listened to the candidates talk about all the things they’re going to do for us, the people (when they aren’t talking about how bad the other is), I’m sitting here completing my elections for insurance for next year. And wading through all the gobbledygook that passes for “explanations” of my choices, I finally figured out exactly what the next president should do for us with respect to health care: clarify the problem.
I know, there are a ton of problems with the current system: people who are uninsured and uninsurable, people dropped by their insurance companies for pre-existing conditions or excessive claims, children whose lives start out behind the curve because of the lack of adequate healthcare that leads to diminished academic performance that leads to a limited future, and so on. I know all about those things. But What I realized is that a large part of the problem is that the policies and the rules supporting those policies were written by lawyers in a way that is intentionally indecipherable by the average joe. The result? Nobody knows exactly what is covered and what isn’t. And there’s no way to directly compare plans.
Here’s what I propose. All insurance companies must provide the same coverage. Period. No fancy titles, no confusing terms. No waffling on what gets covered. If the insurance companies don’t want to provide coverage for a specific condition, spell that out. Everything else is covered. No questions, no squabbles. I wonder how much we’ll save just from avoiding legal fees?
But wait, I can hear you saying. Why would someone choose one company over another if everybody is offering the same coverage? Price. But here’s where it gets interesting. The better managed a company is – that is, the less they spend on frivolous things like corporate retreats and stupid advertising and so on — the better their bottom line will be. That lets them lower their prices which, in turn, will draw more people into their fold which will, in turn, spread the risk over a broader base, lowering their total risk. That’s the whole idea behind insurance in the first place – to spread the risk.
And what about expensive experimental treatments, should they be covered? Well, that would be up to the insurance company. If they state that experimental treatments are not covered they can still choose to cover them if the evidence suggests that the treatment may be effective. But they aren’t required to cover it. Sorry, folks, not everybody can get everything they want in life. If you want to spend your money to support an experimental treatment that might benefit you, fine, otherwise I don’t want my dime used for it. And, if a company does choose to cover an experimental treatment for one person, they should not be automatically required to cover everyone. The decision should be a case-by-case basis.
So how will new treatments be supported? The insurance companies should be required to pay into a treatment development fund that provides financial support for new treatments. This way, new treatments can be developed and tested without overtaxing an individual company. The burden, and the eventual benefits, are spread over the industry.
I’m not leaving the consumer off the hook. The average Joe has a responsibility here, too. Let’s suppose that Joe has coronary artery bypass surgery. Prior to the surgery he smoked, drank , was sedentary and ate lots of unhealthy food. Following the surgery, he is helped to quit smoking, is taught how to exercise and why it’s important and taught how to eat more healthily. If he does those things and still develops additional problems requiring additional bypass surgeries, insurance should pay for them. If he refuses to do those things he has directly contributed to the problem and insurance should not be held accountable. The diabetic who refused to adhere to a diabetic diet should not expect to be covered for the consequences of uncontrolled diabetes. Diabetes is manageable, if the diabetic is willing to comply. This approach would encourage everyone to live a healthier life and provide consequences if they don’t. I call that personal accountability.
Would these changes really make a difference? I don’t have a clue. But it seems to me the system is broken now, so whatever we do has to be an improvement.
My students are in the nursing home. For many of them this is the first time they are confronted with the frailties of the human body and mind. Generally they approach this experience with a mix of excitement to be working with real people and fear/worry about what they’ll encounter and how they’ll handle it. 
