Health Care: It's About Affordability

There has been all sorts of talk about making Vermont more affordable and about what to do about health care. For me they are intertwined, you can't talk about one without the other.

When I went to my first health care rally ten years ago (I hate writing that) someone had a sign that said,  "Make it better - not just different." I've remembered that sign as the various strategies have come up.  Up to now all we've done, by focusing on insurance companies, is make it different.

When did the discussion become about health insurance - it should be about affordable, quality health care for all.

Did you know that many people are just one accident or health care emergency away from bankruptcy? That's probably you or someone you know such as a brother, sister or neighbor. It's true, a large number of bankruptcies in this country are brought on by either large health care debt or the loss of one income in the household. Yes, I said one income. Frequently, the family still has money coming in, but just not enough. Combine the two situations, health debt plus loss of income, and you've got real problems.

I'll talk about Vermont incomes, debt and making Vermont more affordable in another posting. Right now I'll focus on health care.

As I said, for me it's about equal access to needed health care - not about providing "universal coverage." Words matter - thinking in terms of "coverage" makes this an insurance issue. When you think about it in terms of "access," it becomes a health care issue.

I think you and I both want access to the care we need - when we need it. But, we don't want to lose the house or our lifestyle getting it. We don't want adequate health care to be something only the rich can afford. If this involves insurance then let's make it better - not just different.

One approach that, I think, makes sense is declaring Vermonters one big insurance pool - excluding the Medicare and Medicaid recipients. The State then sets the rules for covering that pool - what's covered (yearly exams, preventative testing, etc.) and standardizes the reimbursements and codes . We then invite companies to put together insurance plans to cover us all.

You save a lot of money by standardizing the codes and reimbursements and the claims forms.  Hospitals and medical practices spend a lot of money and time on trying to figure out which insurance companies pay what for which procedures. Simplify it and you save a lot of money.

The proposals from the insurance companies are then reviewed and the most appropriate and affordable would become Vermont preferred providers. You would be able to choose which plan and which insurer you want to go with.

Funding This
Companies, including the State of Vermont and local governments, would pool what they now pay for health care as a base for funding this.

We, the insured, would each pay a modest premium, deductible and a co-pay on visits, all of which would cap at somewhere around $1,500 per year for individuals and $3,500 for families. With the employer contributions, this represents a multi-billion dollar market.

Other Solutions
This is just one idea; another is to learn from our neighbor to the north (Canada), take what works, improve what doesn't, discard what we don't like and have universal care. That's what I would prefer and it took one sentence to tell you about it.