May 2017
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The Health Care Debate

#1 Everyone has access to healthcare.

Some have access to better healthcare than others. Some can pay for better healthcare than others. This has been truth for always and forever. Even with social medicine. Even with single payer.

#2 Everyone will die regardless of the quality or quantity of healthcare one can obtain. This is also truth. We all die. Every one of us.

Science has not solved this problem yet and we aren’t yet sure that this something we all might want.

Longer or endless life with illness isn’t a pleasant future. Being tied to an oxygen tank, or in a bed with a feeding tube… That might not be such an attractive prospect.

#3 The issue isn’t access to health care. Everyone has access. The issue is who pays for that health care.

Actual Insurance got tied to employment in 1943 when the War Labor Board ruled that the wage freezes didn’t apply to fringe benefits. So employers, in order to attract and retain quality employees, offered health insurance policies. These were real insurance. Hospitalization, catastrophic care policies. People still paid the doctor for regular office visits.

In 1973 the HMO Act (It was a “trial”) was passed to require employers who offered traditional health plans to offer at least one HMO plan as well.

The HMO has morphed into what people now call “health insurance.” But what it is is pre-paid health but made into a monster.

Instead of actually getting so many visits for a set annual fee (plus premiums for real insurance for the big stuff) with small co-pays per visit like HMOs were initially set up to be, we now pay big premiums for both big stuff and small stuff and have huge deductibles to meet, we may or may not have a co-pay, and we still have to pay a percentage of the bill.

What most of us are getting for our huge premiums and deductibles is a “discount” from the artificially high regular price charged for the services.

That artificially high price charged because the doctor has to “negotiate” +/-27 different “discounted” insurer/plan prices and also take into account the abysmally small reimbursement rates of Medicaid and Medicare and the receivables that just have to be written off.

The artificially high price the doctor has to charge because he/she has to hire people **just** to deal with compliance with the insurance companies and the government.

You know that “free” physical you get? If you bring up that you’re having an issue with this or that at your annual physical, a place and time that you think is correct to bring up a new issue, you have to pay extra.

I brought my son in for a “free” annual physical and we left $250 poorer because we brought up a lower GI issue he’d been having and we hadn’t reached our deductible. We never reach our deductible.

If you go in for a follow-up visit to check on your ear infection and bring up the fact that you’ve been experiencing some issues with plantar fasciitis, you’ll have to pay extra for the foot exam because you’ve gone in for the ear exam.

Even though you’re in the same office at the same time seeing the same provider.

Let’s have REAL insurance back. Hospitalization, catastrophic insurance. For when you break your leg (or bad sprain – you don’t know x-rays will tell!), get into an accident, fall off the roof, heart attack, stroke, the big C, the bad stuff. This is what INSURANCE is for. Hedging against that bad stuff.

Part of the issue is those without employer-based insurance are relegated to “individual” plans. Employer-based “groups” are completely arbitrary. Why not make regional groups? They’re just as arbitrary and don’t have to be put together by any particular employer or association.

Let’s have pre-tax Health Savings Accounts accessed by debit cards or reimbursement like Flexible Spending Accounts are — BUT they roll over year over year.

Let’s be able to purchase HMO type plans that suit ours and our family’s needs. Maybe a plan that includes well baby/well child visits. Maybe we want a plan that will include maternity. Maybe we want a plastic surgery plan for bigger boobs or a bigger butt or a smaller nose.

We shouldn’t HAVE to have any particular kind of coverage. We should have the coverage we want to have. If we want a higher deductible hospitalization/catastrophic care insurance policy and pay the doctor when we see him/her we should be able to.

Divorce health care from employment and the employer doesn’t have to pay for premiums anymore. That money **could** be paid to the employee as higher wages or go towards the pre-tax Health Savings Account, to which the employee can also contribute.

Premiums for Real insurance will be lower than the current premiums for the “all-in-one” stuff we have now.

Doctors won’t have to charge 27 (+/-) prices for the same office visit.

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