Monday, July 13, 2009

Health Care Reform - eliminate high deductibles!

I've been looking at various reform proposals. I got a look at the so-called Leaders' proposal, from a group headed by Bob Dole, Howard Baker, and Tom Daschle -- all former Senate Majority Leaders. Their proposal was written by Mark McClellan, former Bush Medicare head, and a guy named Jennings, a veteran of Clinton health care from 1993 on. Not much of a recommendation for any of them.

Anyway, I looked over this bureaucratic mess, with some good ideas and lots of real gook, and saw the levels they had set for the Health Insurance Exchange plans. The "basic" plan was, amazingly to me but then I tend to be very naive, high deductible plans! Plans the insurance companies devised that would charge people out of pocket money for basic care, but let the hospitals and specialists run wild! Plans that penalize the least fortunate economically! Plans invented so that employers could save money and pass on expenses to employees! Typical insurance company concoctions! It had made its way to the health reform platter!

Well, enough exclamation points. This is what some free marketers (and I like the free market) point to as the flexibility and inventiveness of the market that the government would not be capable of. Right. They have some standards.

I'm just thinking now more and more - what do we really need the health insurance companies for? Certainly we don't need them for what they do currently. Could they transform themselves into something useful? Usually, it takes a new kind of company to emerge that can do that, and the old horse and buggy companies just fade away. If their money doesn't purchase them artificial continued life.

Meanwhile, I've been thinking what details I would want to lobby on if I had the chance. One would be, the "basic" choice of health insurance on the HIE would not be high-deductible. It would be an HMO, like Kaiser, or like Hill Physicians, or like Geisinger. Anything less is unacceptable.

Budd Shenkin

Budd Shenkin

1 comment:

  1. Perhaps I am naive too, but I understand high deductibles to be capable of accomplishing something good for health care, namely that they shift some of the risk to the insured and inviting their participation in the negotiations of what is necessary. I understand that in health care there are many complicated decisions that must be made to get to the right prescription for any given malady, but I do believe that patients will get more and more informed over time and can participate more and more in such decisions. The high deductibles bring the customer into the negotiations. As for those who can't afford it, there should be subsidies, but for most people they should be invited to understand their health better and be participants in the decision.