Stuck Inside

I was standing, two Mondays ago, on the 16th fairway of Fowler’s Mill Golf Course. I was attending the annual American Jewish Committee / N.A.A.C.P. golf outing and had just had my best drive. As if G-d, Himself, had finally seen enough bad golf, an impressive lightning bolt lit the sky. We jumped into our carts and were among the first to arrive at the clubhouse. Torrential rain and heavy winds ended any chance for further athletic embarrassment.

It was too early for dinner, so the nearly one hundred golfers and staff simply hung around and kibitzed. We probably talked more at this outing than at all of the previous ones combined. With the Indians tanking, the Cavs on vacation, and the Browns a few weeks away, health care reform was a major topic of discussion in every group of golfers.

My friend Leo asked how I would solve the problem. “What is the Cunix plan?” Oddly enough, I hadn’t actually thought of one prior to his question. This is what I came up with that afternoon.

1. Health Insurance would be mandatory.
2. All preexisting conditions would be covered for anyone enrolling in the next year.
3. Medicaid is opened up to everyone earning up to 3 times the poverty rate, paid at a sliding scale.
4. The federal government would reinsure all shock claims in excess of $250,000.
5. All group and individual health policies would be revamped to reflect ten uniform options. All plans would include basic preventive care as well as dental and eye exams.
6. All medical providers would be required to update their record keeping in an effort to eliminate duplicate and wasteful testing and procedures.
7. Billing fraud would be aggressively prosecuted.
8. Hospital, doctor, and even prescription ratings would be independent and the results would be easily accessed by the public.

As I said, it was raining, we were stuck inside, and we had lots of time to kill.

I won’t claim that this is a solution to all of America’s health care woes. That would be impossible since we haven’t, as a country, defined the issues. My eight points are my off-the-cuff conversation starters. I am not qualified to advise doctors on cost containment, so you won’t see that here.

My suggestions only work as a whole, no picking and choosing. The insurers, the federal government, the states, and the providers all take a hit. Shared responsibility. Shared pain. Shared solution.

Warning: the following explains, with some detail, the above eight points. If you’re really not interested, it’s OK. Skip ahead to the last paragraph and we’ll see you again in two weeks.

There are supposedly 45 – 50 million uninsured in America. There will always be uninsured. It has been estimated that between 10 and 12 million are illegal aliens. Millions more, like the uninsured motorist who hit me in January, simply choose to not waste their money on insurance. Health insurance must be mandatory for the system to work. We won’t get everybody, but we’ll get most.

The insurers would be put at risk proportionate to their market share with the elimination of both underwriting and any exclusion for preexisting conditions. Of course, there has to be a window when any currently uninsured could acquire coverage regardless of health. After that open enrollment opportunity of six to twelve months ends, uninsureds seeking coverage would be subject to a preexisting condition exclusion.

Affordability would be addressed in several ways. Medicaid, the state run program, would be made available to the working poor – men, women and children. Premiums would be on a sliding scale. The federal government would serve as a universal reinsurer. All claims in excess of $250,000 would be shifted to Washington. Private insurance would be less expensive since the risk would be more manageable.

Product design must be improved. We currently have too many choices. The consumers are confused. The providers claim it is too complicated. And the insurers waste too much money on administration. We need to simplify the product offerings. The Medicare Supplement model is worth duplicating. With input from the state insurance commissioners and the major insurers, health insurance options could be pared down to a far more manageable ten individual plans and ten group plans. The plans would be numbered 1-10 thus eliminating the confusion caused by product names. Plan 5, for example, would offer the exact same benefits whether you purchased it from Anthem, Aetna, or even, G-d forbid, the U.S. government.

By the way, all ten plans would cover basic preventive care including annual eye and dental exams. If we’re going to do this, let’s make sure we do it right.

I covered the importance of modernizing our record keeping and information transmission back in February. This cost would be borne by the providers. Better information will save both money and lives.

Medicare and Medicaid fraud are rampant. The president may want to stop unnecessary tonsillectomies, but over-coding and ghost patients are far more serious issues. We can no longer afford to ignore white coat crime.

We can be better consumers if we have more information. Which hospitals are better for heart surgeries? When will the generic medication be perfectly fine? Independent, accessible studies should be available for all Americans. We need the opportunity to make informed decisions about doctors, hospitals, and therapies.

Our health care conversation came to a merciful end with the arrival of a fabulous dinner catered by Blue Canyon Restaurant. Lucky for me, my invitation to this charity event is not contingent on my golf game or my conversation skills, just my willingness to write a check for a good cause. With any luck, next year will have more golfing and less health care.

DAVE

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