Rescuing America's Economy -- III
Fixing the Health Care Mess
You may have noticed that every time politicians
talk about health care they talk about -- not health care, but health
insurance.
The two aren't the same thing.
Not only that, but some of our finest mythology
evolves around treating illnesses. For
instance, it's not true by at least a couple of measures that America has the
finest health-care system in the world.
Our average lifespan is declining, we pay more than anyone else in the
world and some significant groups don't have health insurance.
Still, going without health insurance is a
really dumb move. If one gets seriously
injured or sick, the bills are big enough to bankrupt almost everyone.
In fact, under our current system, if you get
seriously sick you may very well get bankrupted even if you have health
insurance. That's because most plans are
capped at $1 million.
And somewhere around 15-18% of every health care
dollar is absorbed by health insurance companies to the cost of what amounts to
money laundering -- they take your premium dollars in today and use them tomorrow
to pay for someone else's health care.
This is a bad system. It needs reform quickly. We have a plan. And that plan is not British-style socialized
medicine.
A Different System
First, recognize there are three different
levels of health care: Routine
preventive care (physician visits, well child care). There's major medical -- the sort of stuff
that lands you in the hospital overnight.
And finally, there's catastrophic medical, which is any care provided
once someone has reached the lifetime maximum (usually $1 million) on their
health insurance policy.
We think the folks at Monarch Beverage, the MillerCoors
distributor in Indianapolis,
have pointed us in the right direction. They've
got an in-house clinic. It's cut
Monarch's health benefits cost by hundreds of thousands a year.
Companies which are large enough -- Monarch has
600 employees -- can and should run their own on-site clinics for employees,
dependents and retirees. They don't have
to be staffed by physicians. A
physician's assistant should be more than enough. This retains the concept of employer-based
insurance.
Instead of paying premiums to an insurance
company to provide major medical, we would suggest paying "premiums" to the
place where major medical is almost certain to be provided -- local
hospitals. The hospital would then pay
the doctors, nurses, etc.
As for the catastrophic coverage, that would be
provided by the hospital with a government backup.
What's Not to Like?
We can think of several objections, but almost
all are easy to overcome.
What about those who are self-employed? Health savings accounts
should be able to accumulate enough money to cover routine medical needs. Self-employed persons would pay "premiums" to
the hospital of their choice for major medical.
What about
those who don't have a job? Those who are long-term
unemployed are already covered through Medicaid or Medicare. Medical needs of short-term unemployed should
be covered as part of unemployment insurance.
What
about companies with multiple locations,
especially those in multiple states? This
used to be a reason for national companies to pick a health insurer. After all, why write five checks when you can write just one.
But with the growth of large national and
regional hospital chains, we don't think this is so important anymore. Instead, a multi-location company should be
able to contract with one or a few hospital chains to provide major medical
coverage to their employees.
For example, Hospital
Corp. of America, for instance, operates 173 hospitals and 107 freestanding
surgery centers in 20 states. Bon Secours Health System operates 18
acute care hospitals in several states and one psychiatric hospital. In short, a company could contract with
hospital chains where it has a number of employees.
But what about
the single salesman operating out of his home office? We think there are two solutions. The first is similar to AAA, the automobile
club. If you're a member of AAA
Mid-Atlantic but break down in Napa
Valley, you can still get
roadside assistance, trip planning, etc.
The Napa Valley AAA club simply bills the Mid-Atlantic club.
Under this AAA-like plan, the single salesman would be
part of a group at whatever hospital the company does business with. But when or if he needs hospitalization
elsewhere, the hospital that provides the services simply bills the hospital to
which the company subscribes.
The alternative is to simply pay a hospital in the
salesman's hometown the "premium" needed to cover him each month.
We think a plan such as we've outlined -- one that cuts
out insurance companies -- would result in superior health care at a
substantially reduced cost. How
reduced? Consider this: Provena Health Systems in Joliet,
Ill., near Diageo's Plainfield,
Ill., plant provides a 30%
discount for uninsured persons plus a 10% prompt pay discount, again for
uninsured patients.
It's Already Here
Seven years ago, Johns Hopkins Health System,
which runs America's
top-ranked hospital, decided to use the millions of dollars it was spending to
purchase medical benefits for its employees to run its own health plan.
It now has nine clients, six of which are
related to Johns Hopkins. It covers
38,000 persons who can choose from a network of more than 8,400 providers in Maryland, Delaware,
Southern Pennsylvania and Washington,
D.C. Out of area medical emergencies are covered
at 100% of reasonable and necessary charges.
Monarch Beverage is saving hundreds of thousands
of dollars a year simply by providing an in-house clinic for employees and
dependents. Johns Hopkins Health Care is
saving millions. In both cases, they are
doing it by cutting out the insurance company's bureaucracy and money laundering.
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