We know that American have tried unsuccessfully for years to have a universal health plan.We have Medicare for (some) of those over 65.We have health plans for former members of the military.We have private insurers.The result of all of this is a rag-tag coverage system under which some members of the society can get partial or full coverage.And some get nothing.
What is a “universal health plan”?Health care is provided by doctors, dentists, hospitals, specialists who provide care as needed.It could include in-home nursing.It should include access to gymnasiums for exercise, which prevents illness.These are all providers.In the best of all worlds, the providers would give their services, and they would receive what they need as pay for their services.
Under the system I am suggesting, there is a single, universal health plan, which covers the users for everything.
Who provides the pay to the providers?In most countries (the wealthy ones, in any event) the providers’ pay comes from the government, through an agency.The patients, or users, may pay some amount, but basically the government pays all and derives most of its funds from taxes.If there is an argument about how much the provider should pay, the user is not involved.It is between the provider and the government.
But in the United States, most of the pay comes through private insurers, and the users pay fees to those insurers.There are all sorts of “coverage” disputes, which do not involve the providers.If the insurers do not pay, then the providers collect from the users.The insurers charge users under an assortment of plans, some of which only begin to cover the users’ costs after a certain annual level is reached, and some of which stop covering after a certain amount is paid out.This causes all sorts of havoc to the users and the providers.In fact, the administrative costs to the providers is far higher in the U.S. than it is in countries like Canada, where the government is the sole insurer.
The real difference in the United States is that there is a love of private economy, which in connection with health insurance makes for an extraordinary jumble.Joe Biden, for some reason, wants to maintain private insurers in the mix.Bernie Sanders would prefer to have a public insurer.What I am going to suggest here is a system which has both.If there is coverage conflict it is between the provider and the government, or the government and the insurer, but the user is never involved.
Under the system I am suggesting, there is a single, universal health plan, which covers the users for everything.Does that mean gymnasiums, too?If the country believes that gymnasium use should be part of the health plan, then so be it.But certainly anything involving a doctor or a hospital is covered.Under the universal health plan, the user goes out and buys a plan from a private insurer.There is only one plan in existence, and it covers all maladies and uses.The private insurers are free to accept or reject users for any reason or charge any price.The government also provides direct access to a policy, but at a reasonable price.This keeps the private insurers from trying to monopolize the market or bar users with pre-existing conditions from getting coverage.
Furthermore, the government will give reduced cost coverage to people who have low incomes.Therefore, wealthier users pay more, because the poorer users can always get a low cost policy.Providers can provide services to people who are not insured (like foreign clients), but they are not permitted to provide different or better services to those who pay cash instead of those who are insured.Moreover, they must accept insurance instead of money at the price worked out with the government.
When a person with insurance goes to a doctor, the doctor gets the patient’s universal insurance number and bills the government.If the patient has private insurance, the government bills his insurance company.If there is an argument over the amount of the bill, it lies between the provider and the government or the private insurer.The user doesn’t need to worry.
Of course, if the user doesn’t pay his insurance company, he gets cut off.But it’s a requirement that everyone be insured and pay for insurance.It’s a crime if you don’t.And if you cannot afford to pay, you go to the government for a lower price or even free insurance.
So the private insurers make money if they choose patients who don’t need much care, and who pay their bills.The government takes money from the private insurers or directly from patients to pay the providers.The government fights with the providers about costs and the users don’t need to be concerned about that.
Under this system, since the providers must accept insurance, the price paid is the one worked out between the government and the provider.If the provider doesn’t accept insurance, he loses his license.Period.Thus the price of healthcare is determined by negotiation between the providers and the government.
Under this system, there are no holes in the policies.The government fills holes that may turn up from taxes it collects and can raise and lower prices and make sure that everyone can afford health insurance.But at the same time, there is room for private insurers to try to make money even though there is a lot of government regulation of prices.
This sort of system would seem to provide the coverage that we need.There is room for private insurers to collect fees and try to make money.But at the same time the government, through negotiation with providers, can make sure that prices are fair and that the amount collected from users is fair.The system is universal and no one gets better service simply because they are wealthier.
Michael T. Hertz