Sunday, June 28, 2009

Access to a basic medical package

I was reading a summary report by a group of local doctors who had met to discuss how the proposed national health plan might be structured. It struck me as insightful that they came up with the mission statement or core purpose that any proposed health plan should provide, “ access to a basic medical package”.

I focused on the word “basic” as the bottom line of intent. They didn’t say access to equal care, or standard care, or quality care. They said “basic” care. So let’s for a moment assume any solution or implementation of a federal public plan accepts that some people will have to accept a “basic” level of care. There will be those who say there shouldn’t be varying levels of coverage as everyone deserves to receive the same quality and amount of health care. This,"basic" concept isn’t really as radical as it might seem.

I’m personally covered by the much referenced federal health program. But, I still have to decide among many programs and between high and standard options. The latter two are mainly a choice between higher co-pays or lower monthly premiums. Those with more money can easily opt for the high option. Those with less must make a cost decision.

As I chose a core (named) plan I also have to look at what’s covered and what’s not. The plans don’t provide the same medical options.

So here we have an existing federal precedent. All plans and all coverage doesn’t have to be equal.

Why then shouldn’t any public plan start off with the,"basic", package with an option to increase the package at additional out of pocket cost to the recipient? This would be a first step towards reducing any public costs.

Now on to cost reduction.

I’ve seen a hospital charge daily room rates in the $3000 range but accept Medicare reimbursement of a tenth that amount. And private health insurance reimbursement at much reduced levels. I can say the same for in home care for the elderly.

Emergency rooms staffed for 24 hours have the same total daily cost whether they see 5 patients or 50 patients as long as additional doctors aren’t required. Their monetary loss for caring for indigent patients is much less than we’ve been led to believe. Many of these costs are accounting gimmicks and tax dodges. Let’s review what a 24 hour emergency room actually costs to operate. If I’m going to be asked to pay for this plan, I want to be sure there’s no double counting or tax breaks being passed on to other players.

Reductions here would lessen the amount of public money paid out to this type of care. The cry of, “ Look at all we do for free in our emergency rooms”, might be silenced or at least muted.

The public sector shouldn’t EVER be billed for services at a rate higher than what the lowest private health insurance plan is billed. Nor should they be billed any lower as that becomes unfair competition.

I think it would be accepted as a national statement of intent that no one should starve in their homes, die in the streets or die from the lack of "basic" medical care. Let’s not let a search for perfection stop “access to a "basic" medical package” that is “good enough” .

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