This is the first in a series of articles on health care reform. I am trying to address this in a logical fashion not the attack mode that both sides seem to be taking in DC.
a. Start the conversation by asking - Who are they?
People without insurance are all people who do not get coverage through work. That puts them in the individual insurance market (remember the words "individual insurance market" - more on that later). These people include:
Medicaid serves the destitute but there is no program to help those who are laid off. People who have lost their jobs cannot afford COBRA and cannot qualify for Medicaid. Why not government funding to help them for a period of time - say as long as their unemployment comp runs - to afford coverage
Provide a similar source of funding for people who are working but who do not get coverage from their employer and who would have to spend too much money to get an individual policy
2. Longer term - reduce the costs of health care (to be discussed in detail later)
3. Introduce competition - bringing 47 million potential customers to the individual health care market will create new levels of competition (to be discussed in detail later)
- What are the problems that need to be solved:
- Cost - The overall costs of healthcare are too high. There is a difference between the cost of healthcare and the cost of health insurance. There are also relationships between the two: the cost of healthcare drives the cost of insurance higher, the way insurance works drives healthcare costs higher.
- Quality - Studies show that hundreds of thousands of people die each year and many more suffer prolonged illness due due to poor care. Poor care that results in added treatment also drives up the cost of healthcare.
- Provide coverage to those who are uninsured - This is not the same as increasing benefits. We have 47 million people (according to reports) who have no benefits. We should find a way to enable them to get coverage.
a. Start the conversation by asking - Who are they?
People without insurance are all people who do not get coverage through work. That puts them in the individual insurance market (remember the words "individual insurance market" - more on that later). These people include:
- People who cannot afford coverage - easily the majority of people
- People who cannot qualify for coverage due to pre-existing conditions - there are not as many people in this category as one might think because President Clinton signed a law in 1996 that went a long way towards eliminating this barrier
- People eligible for government programs who do not want to apply - there are indeed people too proud to apply for government help. Also, PA until a few years ago would attach a lien to your house to recover any Medical benefits paid by Medicaid. NJ used to do this too - I do not know if they stopped. So if you're laid off, would you want to put your home at risk to get Medical Assistance benefits?
- People eligible for government programs who cannot get approved - Applying for Medical Assistance can be a daunting task with all the paperwork required. And then to be eligible you have to be almost bankrupt - as any family with a loved one in a nursing home knows. Applications for Social Security Disability, which carried with them Medicare benefits, used to take a horribly long time to get approved. Veterans Administration benefits can take that long as well. When a person is eligible for for Social Security and Medicare they are told to apply for benefits months in advance to be sure to get approved by the date they are first eligible.
Comment: President Obama, Speaker Pelosi, and Senator Reid should be ashamed of castigating insurance companies when millions of people are denied access to existing government programs due to red tape. No insurance company does any of the things I just described in the previous two bullet points
- People who do not want coverage - easily the second largest category of people after people who cannot afford coverage. This category would include all the "young immortals" - people in their 20s working jobs without coverage who are not willing to buy individual coverage because they feel they don't need it. Cost plays a role in these decisions too.
- People who can't afford coverage
Medicaid serves the destitute but there is no program to help those who are laid off. People who have lost their jobs cannot afford COBRA and cannot qualify for Medicaid. Why not government funding to help them for a period of time - say as long as their unemployment comp runs - to afford coverage
Provide a similar source of funding for people who are working but who do not get coverage from their employer and who would have to spend too much money to get an individual policy
2. Longer term - reduce the costs of health care (to be discussed in detail later)
3. Introduce competition - bringing 47 million potential customers to the individual health care market will create new levels of competition (to be discussed in detail later)
- Pre-existing conditions - eliminate the use of these on individual policies. Apparently the law signed by President Clinton was good but was not enough
- People eligible for government programs who do not want to apply or who cannot get approved - Eliminate all barriers to applying for coverage, such as applying liens to property and change the way these agencies think about handling applications. They should be reaching out to potential beneficiaries, not creating application processes that turn them away
- People who do not want coverage - you can require them to get coverage but that is like imposing a tax. Instead, I'd suggest letting the new competition that will emerge from increasing the number of people in the individual market attract these individuals
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