A heated debate is on going in the press, radio, television, Congress about health care reform in our country.
All debates are leading, as usual, to the question of the necessity of additional spending of one trillion dollars in the course of ten years. Essentially very little was said about the reform itself. The whole point is that the country is in need of a real health care reform, which should meet the requirements of improving the health of all citizens, cutting down the cost of health care, putting in good order the work of hospitals, medical offices and many other things.
Surprisingly nobody mentioned the need of a health care insurance reform. Thoughts about this reform came to mind already a long ago.
There are two ways of financing medical care:
The first is a private method of financing, by means of using worker's and corporation's money as premiums for acquisition of private health care insurance, which provides medical care. The established order leaves far behind 47 million people without health insurance.
The second way, which is used by all developed countries of the world, is by taxing the workers for health care, which generates a pool of money, financing health care through the budgets of the countries.
From this summary we can draw a conclusion, that our people should clarify what kind of health care financing they prefer. However without any difficulty we can assume that our people would prefer private medical insurance and private health care.
Making such a choice, it seems to us advisable, to think about reforming the health care insurance industry.
However the medical insurance companies use as the basis of their operations an unfair practice. They select for medical insurance only relatively young, healthy, working people, which rarely are sick and they constantly increase the premium rates, excluding retirees who need substantially more health care.
Thus the health insurance companies established for themselves hot house conditions. They make billions of dollars in profits, which in essence is a simple misappropriation of unused funds of healthy people, that don't need medical services.
Justifiably these funds should be set aside in a special fund and used for health care when these workers retire.
We came to the point, that the health care insurance companies should insure every person from birth till death, collecting the same premiums independently of age.
That means, for example, that the insurance companies should collect the same amount of premiums from people at the age of 20, as well as at 80.
In that way, at retirement time, Medicare will deposit for every future year sums to the health insurance companies the amount of premiums that the workers were paying before retiring.
There needs to be no doubt, that such a system will unable Medicare to save billions of dollars and get rid of performing the duties of conducting the affairs of paying the bills for health care of retirees, which it is not able to cope with it satisfactorily.
The health care insurance companies should accelerate the reorganization of their whole system and top priority should be established for a computer system of documentation of data for every insured person (general
information of: all diagnoses, visitations to doctors, hospitals, tests, procedures, costs, etc).
Medical insurance should be for all people without limitation of age or state of health.
Giving some thought to the task of reform we can foresee that the health care insurance companies will oppose to the proposal, since to make a profit under the new circumstances will be difficult, without the application of supreme efforts.
Anticipating a rejection of such a reform, we shall think about the necessity to establish a system that allows health care providers to concentrate on care, not on profit margins.
It is advisable to set up a public non-profit organization for health care (National insurance company) for the population of the whole country, with branches in all states. The leadership of the National insurance company should be carried out preferably by the best experts in medicine, science, economics, finances and public representatives. They must take the full responsibility for the health care of the entire population and the means of financing it.
Reform must include effective mechanisms for controlling cost, requiring information on provider performance and enhancing efficiency.
This will be a managed care system. Managed care reflects the country's distinctive approach to universal human challenge.
The cost of health care must be contained. Containment requires limits and priorities. The rational for limit setting policies must be explicit and readily available to the public. The rational must show how the policy promotes good care for individuals and optimal use of available resources for the entire population.
A mechanism must be available for debates, appeals and learning from experience. We can call it having a health care system accountable for the reasonableness of the limit setting policies.
The program of medical care should be publicly financed at the national level, administered locally and privately delivered i.e. private physicians, hospitals and other health providers. All the means to finance health care should be directed to this system. The provision of funds for health care of working people can be carried out in a different way: through taxation of corporations, businesses and employees, defining more precisely the Percentage of payments. This should not lead to an increase of payments, but only to their redistribution (instead of premiums).
Thus all the means for financing health care will be received from one source-the federal and state budgets.
Having a more simplified (single payer) system of health care delivery would go a long way toward providing the resources needed to cover all the uninsured people.
Under a single-payer, all health care revenues go into one public administered pool of money that pays for all medically necessary services by doctors, hospitals and other providers. Of course, the payments of all the bills must be preceded by a careful control of the performance of medical care.
The suggested health care insurance reform is an important step in the interest of all participants, is likely to reduce the expenses on health care, to preserve and improve the quality in this field and provide the entire country's population with health care, without additional allocations.
Michael Zilbering
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