Wednesday, September 23, 2009

A KISS to DRIVE Health Care Reform

My health care plan, a COBRA by default, is one of those Cadillacs that covers all sorts of things I know I will never use, and many I hope to avoid. Maternity care and family planning - I'm almost 55, and so far, childless... and not a man. Contraceptive drugs and devices - I'm post menopausal. Infertility services, double ditto. Smoking cessation - I've gone this far without a puff. A boatload of mental health and substance abuse benefits - the strongest thing I've ever imbibed is a couple of cups of morning joe and I'm probably one of the few Baby Boomers who's never inhaled. The plan is also light to non existent on services that I actually do use, such as dental care, acupuncture and massage therapy. For almost $500/mo, I get far more than I will ever utilize, yet to procure the most comprehensive coverage for my particular needs, I had no choice but to enroll in a program that covers infinitely more. To do otherwise would have left me with hefty out of pocket expenses far greater than any premium differential.
My health care plan is part of the current federal government "insurance exchange." Yes, there is an assortment, twenty one plans to be exact, with premiums varying from roughly $275 to about $550, with the lower cost options being the more restrictive HMOs. But even with such a panoply, my complaints highlight the problem, often overlooked and ignored, of fitting individual requirements, the proverbial "square peg," into the insurer provided "round holes."
The solution would be a cafeteria of choices within a plan, where one would be obliged to carry certain basic government mandated coverage which addresses common financial and social depletion risks, but could opt out of services that were clearly personally irrelevant to lower the premium. True consumer choice, not the current - and proposed - systems which offer one-size-fits-all products from an insurer determined menu. While this might have been difficult back in the day when record keeping was by hand, it could be easily implemented now in the age of computer technology - customized pricing - the way auto insurers do! Exactly the model the President proposes to mimic in requiring universality, taken one step further. It could be done with a minimum of additional bureaucracy and corporate inflation, utilizing the current infrastructure as a foundation. Medicare could expand to serve as the "public option," allowing for "buy-ins" that may perhaps save the program from projected future financial difficulty, and enrolling could be promoted as patriotic, to counter and reverse the current demonization. Not only would such a system lower my premiums, but it would force insurers to compete on price and appealability of product lines, and decrease and perhaps eliminate the need for government subsidies altogether. They shouldn't balk; in return for scant extra effort, they would have the opportunity to greatly increase their subscriber base and reap volume driven profits. The policies would be self limiting, cost containing and somewhat behavior modifying by their very nature, keeping overuse and abuse of the system in check. If you want more, you can always pay for it. Self, not government imposed, rationing through personal choice. This proposal, and the transition to its implementation, would be much less complicated and speedier than any idea in the current discourse and should appeal to everyone from the fiscally cautious, free market "pro-choicers" to the bleeding heart Robin Hoods and Crusader Rabbits. A great compromise. Keep It Simple, Stupid. Hint, Hint.
I'd also like to see some cash in the health care overhaul as a reward for not being a "clunker" - for not being a drain on the system, for watching diet and exercising regularly, for not being obese, for keeping blood pressure low, for not smoking or drinking, etc. - tantamount to a "good driving discount." This could easily be implemented via an age appropriate yearly checkup which would be optional and covered free of charge, with the results transmitted to an insurer to adjust a premium downward, adding an additional monetary incentive for health and wellness. I would gladly "tune-up," submit to an "inspection," downsize to a Chevy, and nibble at the "cafeteria." How about you?

Karen Ann DeLuca

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