Health care reform: complex problem with a simple fix

Have you ever asked someone what time it was and had them tell you how to build a watch?

This is the surreal environment we find ourselves in today. Shell shocked by a new administration and massive spending on a scale never before seen, citizens of all classes are asking for concise and precise answers that are not coming.

Our political system has broken down in fundamental ways and appears incapable of working in a constructive manner to arrive at effective solutions. Unfortunately, “the chum is in the water” and there is nothing that resembles anything like a “fair and balanced” debate — to have one you must have factual information and that is secondary to the posturing to gain political advantage. Indeed, when you ask you find one party with power and one that is in exile and wants power back — sadly all we have are “Republicans” and “Democrats.” It is pretty obvious that our choice is to be “burned at the stake or torn apart by wild animals.” Hyperbole aside, the politicians don’t get it and the media that feeds on a 24-hour news cycle believes the “food fight” is more interesting than responsible journalism.

Let me offer what I think are a few “common sense” observations and recommendations. First, let me assemble 435 lawyers and ask them in their spare time to write a “how to deliver health care” manual that will meet the needs of 300 million people. In another room, let me put another 100 people and ask them to do the same thing. Then let me bring the representatives of the two groups together and ask them to harmonize their different solutions — telling them that anything they come up with must be paid for by a new line item in the federal budget.

It can’t be done because there is no consensus that would guarantee its success nor, and more importantly, they don’t have the necessary expertise in the sophisticated nuances of a free market-based health care system. That is the most important point to make — no expertise. This is not Holiday Inn Express — and there is a need to know of what one speaks.

Government has again lost sight of the objective. At the risk of being too simple, let me make a couple of direct points without spinning off into side issues.

The problem, as I understand it, is two-fold: To make health care available and affordable for every American. The uninsured constitute an estimated 16 percent of all Americans — about 45 million people. That means 84 percent, or 255 million, have health care. If surveys are to be believed, most people are happy with their health care, albeit that most would like to see the premiums controlled.

The objective of the government is to establish achievable and broad-based guidance that helps Americans in their pursuit of happiness without taking away their most fundamental rights to freedom and privacy. The health care reform bill should be five pages or less to “tell us the time rather than build us a watch” and it should say, in so many words, the following:

It is the right of every American to have access to affordable health care throughout their lives. Participation is optional, but a declaration must be made on or before an individual’s 25th birthday. Initial registration is open and exempt from penalty for preexisting conditions.

If the taxpayer works for a company without an insurance program, they will be able to choose from any existing insurance company and will be guaranteed a basic set of health care services regardless of pre-existing conditions provided they sign up before their 26th birthday.

Premiums for private or group health care costs cannot exceed 7 percent of a household’s adjusted gross income. Annual co-pay limits cannot exceed 13 percent of the household’s AGI. A catastrophic cap takes effect when combined household medical expenses reach 20 percent of the past year’s household AGI. Private insurance may be acquired, at additional expense, to bridge the gap between 7 percent and 20 percent.

Long-term health care coverage will be guaranteed on open enrollment provided the taxpayer opts for such arrangements by their 30th birthday — and pays premiums equal to the desired coverage. Such premiums will not exceed 1 percent of household AGI for the first 10 years, 2 percent for the next 10 years, 3 percent for the third decade and so forth — not to exceed 5 percent.

An American citizen who has opted for health insurance is guaranteed the right to continuous insurance until Medicare takes effect at age 66. Employees transferring or changing jobs must be insured without an increase in premiums for preexisting conditions. If an employee leaves a position voluntarily after 12 months service or is dismissed in good standing, regardless of tenure, and moves to another position without a health care plan they must be allowed to retain coverage with the previous company at no more than the combined total of the company group rate plus the employee’s cost share subject to the same out of pocket ceilings previously described. A dollar-for-dollar tax credit may be taken if such premiums exceed the 7 percent ceiling.

Board certified physicians and health care providers will be protected from frivolous torts, provided they have followed the standards for diagnosis of disease or treatment. In as much as health care providers cannot guarantee a medical outcome, such malpractice shall be limited to actual damages from loss of income while the patient is unable to resume full employment. An exception may be made for lawsuits involving gross neglect in which standards of diagnosis and treatment were not followed. Health care providers’ malpractice insurance premiums may not exceed 15 percent of past year’s business income. Legal fees for attorneys litigating such doctors shall be limited to 15 percent of the monetary award or actual costs, whichever is less.

Clearly, there would be several other broad policy mandates within the legislation, but my point is that the role of government is to set policy guidelines that prevent discriminatory actions that set in place the conditions for catastrophic health care costs. It also removes the incentive for the legal profession to “ambulance chase.” The devil is in the details, but they need not be complicated — the biggest concern is transitioning to implementation and how it will affect the current system. That is deserving of a Blue Ribbon Panel — co-chaired by the Surgeon General and the Secretary of Health and Human Services with a mandate to provide the guidance in 10 pages or less.

In the 10 minutes it takes to read and digest this column, you have all the involvement that government should undertake in the health system. It protects the least fortunate among us and provides a reasonable “social compact” that a young adult must consider at the time when they are least likely to need services. As they progress further in their work life they apportion a reasonable percentage of their income to health services confident that they will have a safety net.

I fear this current effort is too far down the tracks to not have a showdown that is coming in September. I think it is unreasonable to have a 1,000-page bill that our congressional representatives can neither read nor explain to their constituents in a reasonable and easily understood manner. That’s what happens when they think they have to build a watch. However, I do think that setting the policy and federal mandates for the future will give the health industry and everyone effected by it confidence that this is the system that we want.

* Riedel lives in Danville and is the executive director of the Blue and Gray Education Society.