Health Insurace Stuff

So, I was reading this summary on House Resolution 3200, that's the health insurance reform bill that is being vilified throughout the country, and I must jump on the bandwagon. The link to the summary is provided below. Some good things - it opens up this thing called health insurance exchanges. That's a good thing because as the CEO of my small organization, finding a good health plan for my 100 employees is quite a task.

The exchange, as described, would make that chore easier. Today, I must rely on an insurance broker to find the best deal for us. However, the broker does not work FOR me and therefore his allegiance is not TO me. He is paid a commission and there is a possibility that his primary allegiance is to a bigger commission, not to be confused with a kickback. Individuals and companies can look to these exchanges when shopping for health insurance.

The plan allocates "credits" to individuals. These credits are designed to make insurance more affordable and they are phased out as individuals' incomes rise. Further, the plan limits out of pocket expenses to keep families from being drained by medical bills. Sounds fair enough - so far.

However, the plan proposes to develop a public insurance option, expand Medicaid, and to improve Medicare. This is where the plan falls apart. We don't need ANOTHER public plan, we have too many public plans already. Medicaid, Medicare, SCHIP and VA plans are public plans and they don't have a good track record. These plans need to be combined into one comprehensive health maintenance organization operated by local non profit or municipal organizations.

Some of these are operating in various communities, in my hometown there are two designed specifically for Medicaid. Mandatory participation in this new HMO for those on Medicare or with the VA will be phased in so that those currently receiving Medicare/VA benefits may continue with their current plan or they may opt into the new HMO plan. Those on Medicaid or SCHIP will be rolled over into the new public HMO.

The house resolution does not address the medical care delivery system to any significant degree. If you ascribe to the "follow-the-money" philosophy, as I do, then this plan will reform health insurance substantially, but it will NOT decrease medical care costs. Follow the money and you see that most of the medical money ends up with medical companies and more specifically in the portfolios of investors who invest in the medical industry.

HR 3200 mainly targets the insurance industry for reform. More insured patients will only lead to greater profits for the medical industry and its investors. More profits does not improve medical care, it does not make health insurance more affordable, it does nothing but enrich a select segment of the population at the expense of the masses. As always, I have a plan to cut medical costs.

HR 3200 proposes to expand the community health center system of providers and to create community based programs to deliver preventive and primary care. Both of these are good options provided that they remain within the non profit or public sectors as they are today. But, these two community health center programs need to be preferred providers in the public health maintenance organization's network of providers. Whenever and where ever possible subscribers in the public HMO will go to public and non profit medical providers, with the option of going to "out of network" providers if they agree to pay any additional expenses.

This is how to build competition for the for profit network of providers, competition that will BRING DOWN costs. Private for profit providers will scramble to increase the likelihood that public HMO patients can afford to go "out of network" by bringing down costs.

Today, we have best medical care on the planet. Look at all the medical care that Michael Jackson was able to buy on the open market. However, it is not the smartest delivery model. The solution is not to change the insurance industry, the solution must be to change the entire delivery model. Insurance companies are essentially "financiers" of medical care and they exact a sizable profit margin by increasing premiums and limiting coverage. Their "fall-back" excuse is that costs are going up. This is only partially true, costs are going up because insurance companies are paying with other people's money.

If we are a healthier population with longer life spans, shouldn't costs be going down? Seniors are living fuller, healthier, longer lives, aren't they? Read the summary for yourself, and shame on you if you don't come with a plan of your own. I await with baited breath to see what you come up with, post your own plan on this blog. Please.

http://energycommerce.house.gov/Press_111/20090714/hr3200_summary.pdf