Vera’s Similitude – Part II

Thank you for your patience (patients?). Let’s keep following Vera’s analysis – her similitude: First, understand that her vision provides coverage for all Americans, employed or not. Not sure where undocumented aliens fit into this mix. There is an underlying percentage of income charged against all earnings to fund the overall operation of the system not otherwise covered by big deductibles and co-pays described below. The precise number would be based on an analysis of the fully amortized cost of the system, and might have caps.

People would be provided with three alternatives, but as incomes escalate, the choices may become mandatory:

1. At the most basic level, where universal healthcare (with an emphasis on prevention) is given to all, participants are given “available” healthcare as appropriate. The system will provide them with doctors and hospitals, but the ultimate choice will be determined by the system and then-available care. For those with a taxable income above a designated threshold, they would be required to elect either choice 2 or 3 below.

2. At the next level, people may elect either to join a health maintenance organization (an HMO, against like Kaiser Permanente, where the doctors are actually employed by the HMO) or a network of preferred providers (PPO like Blue Cross, where you can choose from a list of private practitioners who have agreed to the PPO’s pricing and approval policies). The catch? The “co-pay” would be higher than what people pay now, maybe even $50 to $100 a visit for the PPO option. This choice would probably serve the vast middle class, government workers, union members, etc.

3. For those who want complete choice of doctors, an option that would be mandatory for those with taxable incomes above Mr. Obama’s magic $250,000 a year (presumably adjusted for cost of living increases or decreases), the structure would require the insured to contribute a huge annual deductible (pay as you go) before the healthcare plan picks up any costs – Vera suggests $10,000 for individuals, $15,000 for couples, $5,000 per child. These latter numbers could be rather staggering if the percentage of income charged across the board is not capped at some level.

Keep the private plans rolling, let the government support a large part of this private healthcare system, administrating primarily tier one safety net coverage, and let people have some choice. Does this fix the problem? Does this reduce administrative costs? Any side-bars on “malpractice-avoidance” over-testing? And what are a patient’s rights when they are placed into a system over which they have no or limited choice? How does Vera’s “take” compare with “prevailing” sentiments?

We’ve been waiting for a report, six months in the making, resulting from discussions (the “Health Reform Dialog”) among consumer groups, insurance companies, business representatives, unions, doctors and healthcare professionals. The five page document released on March 27^th was short of specifics, but the general tenor seems to parallel Vera’s template: “In their report, the groups said the uninsured should be covered through a mix of expanded government programs and subsidies to purchase private health coverage. They called for savings from making the health care system less wasteful and urged that prevention become the foundation for medical care. Many of their ideas are shared by President Barack Obama and influential lawmakers such as [Senate Finance Committee Chairman Max Baucus, D-Mont.].” Ricardo Alonso-Zaldivar writing for the Associated Press on March 27^th.

The floor is open for debate. But it isn’t evident that any meaningful healthcare reform can make its way into the next federal budget notwithstanding a friendly Congress. As our legislators examine Obama’s proposed budget with big deficits looming, even Democrats are skeptical. The March 25^th Washington Post: “Sen. Kent Conrad (D-N.D.), chairman of the Senate Budget Committee, said he would leave out new spending for Obama's proposed expansion of health care coverage, a program likely to cost in excess of $1 trillion over the next 10 years… Lawmakers would be free to adopt those policies as long as they did not increase the deficit, Conrad said. That means health care reform would have to be accompanied by tax increases or spending cuts equal to its entire cost, not just the $634 billion down payment Obama had proposed.”

Along with the meltdown itself, healthcare continues to be one of our nation’s most complex issues. President Obama believes that a commitment to universal healthcare will create new jobs and generally help in accelerating our economic recovery, though most Republicans and a few Democrats question that assumption. What do you think?

I’m Peter Dekom, and I’d like to know how you feel about all this.