Requirements for Health Care Reform

Politicians Have Started Claiming They Are Reforming Health Care in the US, But What Are the Requirements?

March 13, 2010

The US Senate and House of Representatives are discussing reforming health care in the United States. President Obama is speaking at great length that this is a critical issue and must be addressed right now. However, Congress doesn't seem to be even thinking about the issues related to health care reform, or how those issues can be addressed.

Reading the various bills, it is clear that what is passing Congress has nothing to do with making health care affordable for Americans, nor with making health care available to Americans.

While a great deal of lip service is is being given to making health care available and making health care affordable, and lip service is definitely being given to stopping unfair business practices by health insurance providers or health care providers, the actual bills contradict this position.

Lamar Alexander has suggested that Congress needs to start over. A statement that is probably the most logical suggestion to hit the senate floor since this debate started nearly a year ago. Pushing a big bill like this through willy-nilly (and this bill is big, which, in law is synonymous with bad) can only have bad results. There are only a couple reasons to have a bill this big - and they're both bad for the population.

Mitch McConnell and others have backed Mr. Alexander's statement. Mr. Mitchell also suggests that Congress should start by setting specific obtainable goals and addressing those individually, with simple pieces of legislation. This will probably be able to move faster and will almost definitely have better results that what Congress is currently considering.

What Is Needed in Health Care Reform?

There are several things that are absolutely necessary to achieve any form of reform in health insurance processes - which seem to be most of what Congress is currently considering. Of course, the current bills don't address these primary issues - they only address secondary issues (and then only with more loopholes than there are issues).

No Networks

The first thing that needs to happen is that medical care providers need to be prohibited from joining networks with insurance providers.

Part of the problem currently is that insurance providers require caregivers on their networks to lock in at specific prices for some services. This means that the uninsured patients are supplementing the discounts of the insured. This drives the cost of care up. For everyone.

So, stop the caregivers from joining networks in the first place. In many places this is illegal for insurance companies, but either health insurance companies are exempt or they ignore this law.

No Submission of Insurance Claims by Caregivers

By prohibiting the caregiver from submitting insurance claims for patients, two things will be accomplished.

First, health insurance forms will have to be simplified, or health insurance companies will have to have a lot more people to answer questions and help their insured. The health insurance industry in the U.S. is one of the few places where the business in in the business of giving bad service to increase profits. This may change with this simple alteration in process.

Second, by prohibiting the caregiver from submitting insurance on behalf of the insured, it also requires the patient to look at their bill. This gives an opportunity to first question any charges on the bill and confirm what has and has not been done. It also lets the patient see what they are being charged. This, for insured individuals, should give the patient a better idea up front of what they should be getting back from the insurance company.

This is also the first step in moving decisions about health and health care to being a decision made between the patient and their doctor. Currently, this is a nightmarish process handled exclusively by insurance company bureaucrats.

Prohibition of Group Plans

This also seems like a no-brainer. Put everyone on a level playing field. Remove health insurance plans from compensation packages making it easier for small businesses to compete with large businesses for good employees. This will also make the insurance companies compete for the business of the insured, rather than having insurance plans forced on employees in a take-it-or-leave-it fasion.

No Exclusions

In order for any kind of health insurance reform to occur, there must not be any exclusions. If there are any procedures, no matter how offensive they may be to some portion of the population that are excluded from coverage, or that insurance companies can choose not to cover, that opens the door for all procedures to be excluded.

There is a debate about some kind of exclusion for abortion in the 2009 bills. If this is allowed, it opens the door for all the "preexisting condition" cop-outs the insurance companies use now, as well as setting precedent for exclusion of other procedures, such as cancer treatments, heart surgery, or coverage for prescription medication.

This is the second piece required to make health care decisions stay between those involved in the decision - namely the patient and the caregiver.

No Requirement without Option

Some versions of some of the reform bills have a clause requiring all Americans to purchase insurance. Without a viable, public option that is completely covered without additional expense to any citizen, this requirement is unethical and non-viable.

Some people pose the argument that as car insurance is required if you want to drive a car, you should be required to get health insurance. The fundamental difference here is the basis for the requirement. Yes, car insurance is required if you want to drive a car. If you don't want to get health insurance, don't get a car. You do have a choice. Some people say it isn't much of one - and if you live in Montana where it may be over 100 miles to the next grocery store it may not be - but it is still a choice. What's the option to not wanting health insurance (or not being able to afford health insurance)? Suicide? Would that be covered under this plan?

No. If there is a requirement to get health insurance, there needs to be an option that is available (call it the "pubic option" or whatever you want to call it) at no additional cost.

No Exemptions from Other Laws for Health Insurance Companies

For some unfathomable reason, health insurance companies have been given exemptions from various antitrust regulations and other business regulations. Other than to give more money to these companies by driving up costs of insurance while reducing coverage, there doesn't seem to be any rationalization for this.

OK, there is one rationalization for these exemptions. The insurance companies pay our congress-critters more than we do. Or being elected to office drops your I.Q. by at least 100 points.