Health Care Solution

The View
Through The Windshield
About Cars ... and Everything Else I See
by Joe Sherlock

Greatest Hits: Health Care Solution
(posted 3/3/2008)

After a great deal of thought, I hereby propose a substantial revamp of the U.S. health care system, based on private sector, market-based solutions.

The current tax code encourages home ownership by allowing people to deduct the interest on a mortgage. A similar tax incentive will be created in order to encourage individual purchase of health insurance. (And/or Medical Savings Accounts.) As an individual, you can determine the degree of risk you want to take by choosing different health care coverage and deductible amounts. (Your employer can still pay your insurance premium if it wants to but it will get no more of a tax credit than if it paid, say, your car insurance premium.)

In my plan, all insurance payments will go directly to the individual. Individuals prepay medical institutions or physicians with cash or credit cards and then get reimbursed (if insured). But, because the individual is making the payment, he/she can negotiate fees and charges with the institution beforehand. Just like buying a car. Or having a fender repaired.

Insurance policies will be available across state lines, with offerings from Level 3 basic care to more encompassing programs ending with Level 6: The Gold Standard - an ultra-premium plan. (Levels 1 and 2 are government-sponsored programs to ensure that no one in America need die on the street in medical agony.) Insurance firms may impose reasonable surcharges on unhealthy individuals (or individuals with unhealthy lifestyles) but cannot deny coverage to any U.S. citizen.

You can move up as many levels as you want by supplementing your insurance coverage with cash. Your own - or, if the medical procedure is beyond your means, with contributions from your friends. Or from your church or social organizations. (It pays to be well-liked and a 'joiner'; angry loners should probably open a Medical Savings Account.)

Medicare remains in place but covers fairly basic medical needs. If a Medicare recipient wants a more elevated standard of care, he/she will have to purchase supplemental private insurance. Or make up the difference with cash.

The concept of various health care levels represents the best of America - freedom of choice combined with 'ya get whatcha pay for' capitalism and rugged individualism. Here are the various care levels, presented with easy-to-understand illustrations ... because we Americans love pictures and comparison tables:


Level 6: The Gold Standard	Level 5: The Silver Standard	Level 4: The Stainless Steel Standard
Analogy: Like an S-Class Mercedes, a night at The Four Seasons or dinner at Morton's	Analogy: Like a Toyota Camry, a night at a brand new Red Roof Inn or dinner at Outback Steakhouse	Analogy: Like a 5 year old Honda Civic, a night at a modest B&B or dinner at Applebee's
Cost: $$$$ = Paid for by high-premium private insurance. Or cash. (Medicare will cover only 20% of all charges.) No indigents need apply. AmEx welcome, no Discover Cards. We do transplants; ask to see our Concierge Selection of the Month.	Cost: $$$ = Paid for by above-avg. private insurance policies. Or cash. (Medicare will cover 50% of all charges.) No indigents, please. All credit cards accepted. Limited transplant options based on policy coverage & personal ability to pay for extras.	Cost: $$ = Paid for by typical private insurance. Or cash. (Medicare will cover 80% of all charges.) Indigents not accepted. Visa/MC, cash or certified checks. Transplants almost nonexistent.

Level 3: The Polyethylene Standard	Level 2: The Canvas Standard	Level 1: The Iron Bar Standard
Analogy: Like a 12 year old Ford Escort, a night at a hostel or dinner at McDonalds	Analogy: Like a rusty bicycle, a night in a tent or dinner at a soup kitchen (or Hardee's)	Analogy: Like walking (but with ankle bracelets), a night in a jail or a dumpster-diving buffet dinner
Cost: $ = Paid for by budget private insurance. Or cash. (Medicare will cover 100% of all charges.) No indigents accepted. Debit cards OK, no checks. Don't even ask about transplants.	Cost: Free = For U.S. citizens with neither money nor insurance. Basic medical procedures, emergency care and palliative care provided. (aka - Indigents-R-Us)	Cost: Free = For criminals. Or non-U.S. citizens with no money or insurance. Life-saving treatment may be available if we're not too busy. Otherwise, palliative care only.

PS: John Derbyshire sums things up succinctly, if a bit bluntly: "The entire problem with healthcare is that it's a risk-reward curve. How far do you want to (or: can afford to) let people go along the curve? About 95 percent of the healthcare that people need can perfectly well be supplied by nursing assistants with a couple of years' training, or Third World providers like the ones I discussed."

"When you climb up into the remaining five percent, you are in the zone where real doctors and expensive equipment are needed. Keep going and you enter the zone of million-dollar drugs, teams of specialists, experimental technology, and months of intensive care. A billionaire can of course travel all the way along the curve. Should the rest of us be able to? Our system is organized around the answer 'yes'. This is probably untenable. Sooner or later you're going to die. Get used to it."

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Disclaimer

The facts presented in this blog are based on my best guesses and my substantially faulty geezer memory. The opinions expressed herein are strictly those of the author and are protected by the U.S. Constitution. Probably.

Spelling, punctuation and syntax errors are cheerfully repaired when I find them; grudgingly fixed when you do.

If I have slandered any brands of automobiles, either expressly or inadvertently, they're most likely crap cars and deserve it. Automobile manufacturers should be aware that they always have the option of giving me free cars to try and change my mind.

If I have slandered any people or corporations in this blog, either expressly or inadvertently, they should buy me strong drinks (and an expensive meal) and try to prove to me that they're not the jerks I've portrayed them to be. If you're buying, I'm willing to listen.

Don't be shy - try a bribe. It might help.

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