Legal & Policy Challenges

health care reform

Hello all,

 

Below are problems I have dealt with personally, and my proposed solutions:

 

1st, there is no real competition by insurance companies. Try to purchase insurance as an individual or small business - it's a nightmare. You can't see the rates, you can't understand the plans, and you never know for sure exactly what's covered.

 

So I propose a few things:

 

a: the fed create standards by which all policies must conform. This could be done by the new consumer protection board that will also regulate credit cards and mortgages, or an independent entity. This would ensure consumers that they will be receiving high quality insurance. It would also require companies to hew to coverage guidelines (no exceptions). A complaint system, outside the courts, would deal with any charges of malfeasance. There should be no such thing as "underinsured" anymore.

 

b: no more variable rates depending on your employer's negotiating power, etc. Companies would have to offer one rate, state-wide, regardless of whether the person is employed by a corporation or is purchasing the plan as an individual (I'm not suggesting one rate for all companies, just that each company decide on a rate, publish it, and allow consumers/employees to decide if that's a rate they want to pay or to purchase their insurance from someone else).

 

c: electronic, industry-wide standardized records. State to state, doctor to doctor, hospital to hospital, etc. This would accomplish not only better care, but a LOG of care, so any denial of care would be easy to reference, PLUS no more going to innumerable redundant xrays, blood tests, etc.

 

d: each state must set up (or pay the feds to set up for them if done improperly) a website listing the plans offered by insurance companies and the rates, along with clear explainations of deductibles. If you've seen a mortgage rate chart where they list the rates along with points, it could be done that easily.

 

e: create anti-trust provisions that determine what a competitive market is. If a state only has a few (or worse, a couple) of insurance companies the state MUST find a way to make the market more competitive or lose federal medicare dollars.

 

f: all health insurance payments (not including copayments) must be tax free. If employees get their health care tax free, everyone should, especially since as an individual you get no corporate benefits department to help or any other perks. Any individual who cannot get coverage through his/her job

 

g: I believe insurance companies should provide malpractice insurance. This would ensure the doctors in their networks are high quality, and the company would then have superior rate negotiating power with the malpractice insurance companies to lower rates, since they would have pools of doctors rather than each doctor paying individually.

 

h: coverage would be mandatory. For lower income people the fed could issue cards, similar to the cards used for food stamps, that carry a balance for what the lowest cost insurance available is, and that card could be used for payment. This would be better than a tax break since low income people may not have the capital available to sustain coverage until tax refunds are issued.

 

 

 

I believe if insurance companies were truly competing for our business our capitalist model would work, but the current system is not competitive at all - it's a racket, and insurance companies have been gouging consumers and companies the same way the financial sector misbehaved and made immense profits at the expense of all of us. With real, meaningful oversight and competition the health sector could be vibrant as companies tried to lower costs by offering competing models for prevention, overall health, and better, more concerned care for consumers.

 

I would say compare the cellphone industry to the cable tv providers. Where I live there are many cellular phone providers who compete vociferously with new products, new pricing, etc, while the cable companies have been raising prices (in NYC there are effectively 2 cable companies - time warner and cablevision - they even share a website and have identical pricing. The only other providers are dish network which is useless to most residents because building owners don't allow dishes on the roof. Comcast, Verizon, etc. aren't even in the market here).

 

The KEY though is to maintain standards - companies could lower rates by being more efficient, cutting administrative costs, reducing paper-pushers through electronic records, etc., but NOT through denial of service, since we all know Republicans are dead-set against "rationing". Otherwise the patient, once again, will be the one paying the price.

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