07 August 2009

Just One Guy's Opinion

My Dear Senators and Representative,

First of all, thanks for even trying to reform our health care system. I know it’s been hard because it sure has been difficult and confusing to watch from a distance, here in West Michigan. Certainly, it must be even harder for you, being up close with all the dickering and negotiating and disagreeing.

One thing being far away does for me, though, is that it allows for perspective. There is such a thing as being too close, right? Therefore, at the risk of sounding foolish but with a faint hope that I am not, I have a vision for health care reform and how to pay for it. And maybe because I am not an expert who is up close it has something to offer.

1) Basic Health Care Should Be Free

By basic I mean prenatal care and routine delivery, pediatric wellness, annual checkups and wellness, immunizations, even twice annual dental exams and cleaning. We hear that better preventative care would help. It’s also the least expensive. Make it free, free of user fees because it is not just our personal health, but essential to public health.

How To Pay For It? Make such ‘pro bono’ service a requirement for getting a medical license, dental license, nursing license, or other license (drugs, too!) Those who serve the public good owe the public something for the right to do that. This is the price.

2) Minor Medical Care Should Be Easily Affordable.

By minor medical I mean the next step beyond wellness care and advice, when you have call the doctor, like for broken limbs, injuries, and illnesses that require professional diagnosis and treatment – these are the sort of things that cannot be prevented and yet will happen to a significant portion of the population.

How To Pay For It? This is basic health care insurance, and would operate on the current basis of deductible, co-pay, and out of pocket. Like traditional insurance it is employer paid, or if you buy it directly, the cost is tax deductible. To make it clear what this does, let’s call it Minor Medical. Because it is not about major illness, it should not be all that expensive.

3) Major Medical Care Should Be Affordable, But Taxable.

A few people will need major medical help before retirement age, and most elders will require major medical help at some point. These are a combination of diseases that are unpreventable or undetectable and those that are the result of poor choices. They require extensive care and cost.

How To Pay For It? Everyone should be required to carry a minimum amount of “major medical” insurance tagged to a given dollar amount like life insurance, and risk assessed like life insurance. People may also elect more extensive coverage. But when they buy or get as a benefit more than is statistically required, you pay an incremental tax on it.

Those whose illness are statistically associated with life choices such as smoking, drug use, risky behaviors, obesity, etc, should have to buy additional coverage for their risk group and pay the additional tax it entails. Since people will be seeing doctors more regularly, this will be easier than it is now. And those diagnosed with lifestyle related diseases will have to take out larger policies to cover those illnesses, part of which price is the tax. Does this punish those who have some illnesses? Perhaps, but it may also give incentive not to take up smoking, drinking, drug abuse and other ‘voluntary’ risks in the first place.

Notice, now, that Minor Medical insurance is like Medicare except that it is more limited in what it covers. Note also that the Major Medical insurance is like Medicare supplements, except that it covers more. If you haven’t figured it out yet, a single payer system for the former (minor medical) makes great sense. The common illnesses and injuries make for less complexity, more continuity, greater efficiency and effectiveness overall.

Likewise, competition among private insurance is best suited for the Major Medical option. By focusing their work on the really sick, not the merely sick, private insurance can be more efficient. That’s also the time when individual attention is most needed and more suited. And this is what private insurance can do better than government. Just as we all should have a choice about what sort of car we drive or washing machines to use, but we do not want a free market in traffic laws or dueling sewer systems, so we all want to have both uniformity and individuality. This idea does both.

Do note that my ideas are different for one other important reason. They are user based not service based. I think you folks have been so absorbed in the economics of health care – the companies and industries and professionals involved, - that you overlooked the largest elephant in the room, patients. Think about health care from a user perspective and it comes down to “How can government provide a reliable structure people can use well.” You role in health care is like your role in building roads, sewers, water, power lines, etc. Do it like that and entrepreneurs will find ways to deliver those services in ways that are both medically sound and economically sensible.

Just one man’s idea here, and honestly I really have no expectation you will pay much attention. At least I told you about it, which is my responsibility. One thing is for sure. If our current health care system stays the same, the country may not survive. And that’s your res


Revwilly said...

Fred, as always your points of view cause me to think. I comment only on your first point. Are there enough doctors, dentist, etc. to do what you are suggesting and would such requirements cause those considering such careers to choose another? Like most things there could be some unintended consequences. Also, if there was such a law requiring free service, then there should be something in it for the practitioner such as a reduction or payoff of government funded student loans.

Thanks for taking your responsibility seriously. I agree completely that we need a fix. I wonder what role the church should be playing beyond the prophetic?

WFW said...


I am suggesting principles more than solutions - basic notions that do not in any way answer all the questions.

For example, you and I both retain a notion of vocation, calling. We do not calibrate our work to fees or billable hours. I would like to see that in all those whose professions are owed to the public, which is what a license or admission to the bar is. (Yes, I think all lawyers ought to do pro bonoe legal defense for the indigent.) Serving the greater good is inherent to the privilege of practicing medicine or law.

Whether it is adequate to the need is something I cannot gainsay. What I do want is to restore the sense of vocation to medicine. We have let it and every other profession become commodified - a means to make money more than a calling to serve a higher good. Maybe if physicians could regain that the system itself would be healthier.

Just One Guy's Opinion.

WFW said...

Oh, I do agree with you (and have written about it elsewhere) that medical school should be federally funded. Like going to West Point or Annapolis (and as it was for a while for those willing to service in the PHS) they would pay in return for active service, only in this case it would be a commitment to service throughout one's career. I think the dollars spent on medical school would be more than repaid in quality primary health care.

But in truth, I would prefer it if physicians just did it. Again, where is the sense of vocation as well as profession?

Revwilly said...

Fred, I think you are right on the vocation thing. I'd like to think that most doctors become so because they feel called. I do know that most hospitals came into being so that those who could not afford a personal physician. My how things have changed.