Why is it so difficult to come up with a health care plan that provides reasonable universal coverage along with the benefits of private enterprise and freedom of choice? I’m certainly no expert in this area, but I think all we need is something along the following lines.
Insurance companies can offer any health insurance plans they choose, but in order to provide nationwide (rather than state-by-state) plans, they must agree to the following stipulations:
- They must offer a BASIC MINIMUM PLAN (BMP) that meets requirements defined (and updated every 2 years) by an oversight coalition of bipartisan-appointed experts, insurance industry representatives, and consumer advocates, all reporting to the Surgeon General’s office.
- They must contribute (through a new tax on insurance providers?) to a fund for citizens who cannot afford to pay for health insurance. This fund will also receive revenue from other tax sources.
- Any citizen who meets federally-defined “unable to pay” requirements will be assigned to a BMP the first time they seek health care or apply for “unable to pay” status. These assignments will be distributed so as to balance the load between all nationwide health insurance providers. Coverage for the plan will be paid to the designated insurance provider from the above federal fund. “Unable to pay” status might actually be a graduated scale that determines the percentage the citizen must pay.
- Any citizen who has not yet chosen a health insurance plan will be assigned to a BMP when they seek health care. Coverage under the BMP begins immediately. No payment from the consumer will be required until they have had sufficient time to apply for “unable to pay” status and receive a determination.
- Any citizen can keep or change the plan they have at any time if they pay the plan’s fees themselves. Plans other than BMPs can attach conditions to entering and leaving the plan, so that consumers can’t just switch to a high-coverage plan for one procedure, then switch back.
- In order to drive down the cost of health care, all nationwide health insurance plans must pay the provider immediately when services are provided (in exchange for negotiated service rates.) These payments will be treated like credit card accounts. Once the provider determines the charges that must be paid by the consumer (e.g. deductibles, co-pays, uncovered costs), that amount is added to the consumer’s account balance. The consumer can pay the balance in their account immediately or over time (at interest rates set by the oversight coalition.)
- The oversight coalition will provide a process for consumers to appeal coverage decisions by their insurance provider. This will not affect or delay payment to health care providers for services rendered.
- All health care payments, including premiums, are deductible from consumers’ pre-tax gross income.
The requirements for a Basic Minimum PLAN should specify at least these attributes:
- No restrictions on pre-existing conditions.
- No vesting period.
- Minimum required coverage levels.
- Limits on premiums.
- Limits on deductibles and co-pays.
- Limits on maximum out-of-pocket costs.
- Limits on the age and status of children and other dependents who can be covered by a consumer’s plan.