Wednesday, September 9, 2009

My Healthcare Plan

On July 26th of this year after pondering healthcare for some time I produced the following tweet:

My healthcare plan: Preventive Care--everybody, Core Care--insurables, Expected Care--not easily insured, Elder Care--quality of life at end

Here is a post explaining in detail the plan, which is tiered:

1. Preventive Care--the value of free preventive care for everyone is one of the least debated critical elements to a solid healthcare plan. The tweet notes that everyone is included.

2. Core Care--Health insurance companies get a lot of heat for trying to only insure healthy people when from their perspective that makes sense for profit, which is a huge issue which has created a lot of pain and misery.

This plan suggests that you can turn a negative around and see healthcare companies as being adept at figuring out people who are likely, or "expected" to get ill at some point, so that they can get help NOW, while allowing health insurers to still be for profit when it comes to the healthy, who would make up the Core Care tier.

So they are the insurables--those who are currently in healthcare plans now. For them, little would change except preventive care would now be guaranteed free.

3. Expected Care--Here those selected out as likely to become ill or who are currently ill who no longer are easily insurable under normal plans are now in a government paid for plan that is third-party administered by the health insurers.

So everyone gets the same health insurers, but those who are part of the Expected Care tier are third-party administered and the government pays for their care.

They pay premiums to the federal government, not the health insurer. If you're in Expected Care you get a bill from the federal government, not the health insurer.

Health insurance companies are then rewarded for figuring out which people are likely to get sick later and properly placing them in Expected Care because the government pays, and we're all benefited as they can get proper care as soon as possible. The health insurers now become part of the first line of defense for detecting those who need help!

But whether you're in Core Care or Expected Care you carry the same insurer's card and the only difference is with payment: If you are Core Care and get ill, your insurer pays. If you are Expected Care and get ill, the government pays.

4. Elder Care--Is the final tier handling issues specific to the elderly with an emphasis on quality of life at end. It is also a government paid tier.


One critical feature of this healthcare plan is that it rewards health insurance companies for being businesses by putting their strengths to public good. For instance, an obese smoker with a history of hypertension in his family might find himself put in Expected Care, which could be a wake-up call in and of itself. But it also means he is at risk, and healthcare workers can focus on the specifics of that risk simply by noting into which tier he has been placed by the experts who need to get it right to survive.

If healthcare companies do a great job, then their profits come from the healthy--by them remaining healthy. Those with underlying conditions are not discriminated against, and have the same health insurance carriers, who for them are third-party administrators, with payment for claims coming from the government.

Some might still worry about discrimination against those ill or likely to get ill, but it has a built in protection.

To understand the beauty of this plan imagine healthcare insurers put all the people who are sick or likely to get sick into Core Care, and all the people who are healthy into Expected Care, then what happens?

They pay to their coverage limits at a much higher rate, while the government pays at a much lower rate as its Expected Care population remains healthier than expected, so there is a natural check-and-balance built into the system, rewarding for-profit companies for proper selection and punishing them financially for getting it wrong.

And that is the expansion of the 140 characters from the original tweet. It is exactly 140 characters as I needed every character I could use to get an entire healthcare plan in there.

James Harris
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