Thursday, January 12, 2012

Health Insurance Responsibility

One of the most contentious issues in President Obama's healthcare plan is the requirement that people have health insurance, and while I supported him and Congress in getting the healthcare law passed, I've put forward what I think is a better idea where people can be responsible without being forced, while being kept accountable.

The healthcare idea I have is an important element of the Core Middle Party, an idea for a new political party that I put forward back in October.  Critical to any party platform is a healthcare plan and a tax position.  I'll talk here about the healthcare plan and how it removes the need for a healthcare mandate.

The key idea of my healthcare plan is allowing health insurance companies to remain businesses, and not charities, while leveraging their key strengths to help people stay healthy, and limit fraud and abuse, as keeping up with how some people try to cheat is what they do.  It's their business.

Our federal government is just not as good at figuring out fraud and abuse as private companies, and is not as fast in implementing the best practices as learned from the market, meaning there are continual concerns about waste, fraud and abuse, so I recommend third party administration.

That is what the last company where I worked did, where despite being an insurance company themselves--though not in healthcare--they used United Healthcare to administer their healthcare plan for workers, but the company itself actually paid out claims.  That is just a smart way to do things.

So how does that remove a health insurance mandate?

Under my plan people who are healthy and able to pay keep their health insurance like they do now. The one addition is that preventive care becomes automatically part of all plans.  Otherwise, no changes.

They are under what I called Core Care.

Health insurance companies pick them because they are insurable.  It is a business decision.

If someone is not normally insurable, they still have the same insurance company if they wish, and no health insurance company can refuse anyone.  But the health insurance company might put them in the Expected Care tier, where they administer but the government pays.

That person would pay their insurance premiums to the U.S. Treasury.

So let's say someone chooses not to pay for health insurance despite being healthy and despite having the ability to pay.  Then they get sick and apply for health insurance!  No problem, the health insurance company signs them up and puts them in Expected Care, which also covers indigents who lack the ability to pay.

That is, the system covers everyone, and if someone cannot pay for regular health insurance, even if healthy, they'd go into Expected Care, as indigent.

If you chose not to get health insurance while healthy and got sick, you'd end up considered indigent by the system and the U.S. Treasury would pay for your care.

And the government might review your case and charge you later for your entire cost of care.

You had a chance to get insurance, so why didn't you?  If you screwed up, you pay.

So if you screwed up by not getting health insurance when you could, it was your choice.  But the consequences are up to legislators.

So what's the problem with other approaches?

Well let's say that a person under a system without mandated insurance decides to screw the system and not get health insurance until he is sick.  Then the health insurance company is not then a business if it has to take him on--it becomes a charity.

Worse that person could be then rewarded for being irresponsible, and other people would pay for it.

Punishing them at that point could be more difficult for a private company as it's politically a hot issue.  So it is an area for politicians.

In contrast, by allowing people to choose health insurance companies they can pick the ones who give the best service, without refusal being possible for those companies.  While the health insurance companies have an incentive to keep people healthy, so that they pay premiums.

While for those who are beyond the realm of profit for private companies, our nation does the right thing and takes care of them, but doesn't administer so the private companies can help in catching fraud, waste and abuse.

I like this plan.  To see my original presentation with all the 4 tiers including Core Care and Expected Care explained, you can look at a previous post on this blog.

How hard would it be to try it out?

Our government could means test by taking some people from Medicare and Medicaid and having them pick insurance companies who would third party administer, and we could see if it could work or not.

Those people would just get an insurance card like anyone for, say, United Healthcare, and I don't have any affiliation with them, as I lost my health insurance when I was laid off.  For me, being covered by them is just a memory.  Yes, I could have done the COBRA thing.  No, have never done it as it's too damn expensive I think.

I've sent this plan to my congresswoman Nancy Pelosi, but more of you need to ask for it as well, as one person is not enough, and should not be enough.  I like my ideas, as I should, they're mine.  But can they really work?  Not sure.  But if other people think they might and ask for them, then our government might try.

Health insurance companies should not be considered enemies.  Smart solutions can turn business strength into an asset for our entire country, bring down healthcare costs, and give people choice without a health insurance mandate.

But still allow accountability for those people who foolishly choose not to get health insurance anyway, when it becomes, universal.


James Harris
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