OPINION – May 13, 2013 -- The rise in healthcare costs has inflamed our public policy debate for decades, leaving a trash heap of unsuccessful pursuits and discredited experts. The cost of a robust health insurance policy, left unsubsidized is hard to justify for most sensible individuals. And subsidies in all forms are inflationary. Isn't it essential that we break this behavior of pursuing unproven policies merely because we believe in their likely merit? We do not even have consensus that the cost of healthcare should have influence on our personal demand for services. How do we possibly control costs when so many believe costs to be an offensive consideration? So what is the right path forward? What health plan constraints would you accept?
Perhaps we need to abandon the requirement of consensus, and focus on the development of alternative initiatives with differing appeal to different market segments. A plan(s) that would be so outside the box, it may be unacceptable to many.
I, for one, would prefer a health plan that:
-
Encouraged catastrophic insurance and the responsible reduction of member dependency on insurance to pay all healthcare costs.
-
Promoted personal savings to help soften future healthcare costs. Favorable plan performance rebated to member savings accounts.
-
Favored the migration by all sources of financing from a "defined benefit" structure to "defined contribution."
-
Required all members to complete an end-of-life directive with the intent of forestalling hopeless heroic measures.
-
Varied my premium to some degree, based upon personal risk profile and historical claims.
-
Embraced prospective estimates and comparative cost analysis as a legitimate requirement to consider before engaging in expensive non-emergent care.
-
Promoted access to the "best" sources of health care regionally and nationally. If the plan and member had different preferences for providers, the plan would be obligated to honoring the member's choice and pay as it would have to its preference.
-
Joined with government regulators to enable "guaranteed issue."
-
Had a methodology for independent and impartial performance evaluation, and
-
Used Medicare and Medicaid provider pricing as benchmarks for what it pays providers. The member would be responsible for any shortfall to provider expectations and possibly pay for a supplemental policy to cover the difference. Providers would be permitted to charge overrides to a blended Medicare / Medicaid fee schedule, expressed as a percentage across all fees. (Patients would shop providers in part based on published overrides.)
Got me!!! What would you do?
Stephen A. Gregg is ADD INFO FROM PREVIOUS COMMENTARIES HERE and can be reached at [email protected].
