Wednesday, January 27, 2010

Incrementalism, Practicality and Health Care

Watching the health care reform fiasco in the last few months, it struck me that the Democrats and Republicans are wrong in equal measure. I don't think they asked the fundamental questions, and certainly haven't given any solid answers to the more tangential questions. Everyone feels this in their gut, regardless of where one stands on the political spectrum.

So, how about this? Learning from the travails of the original SCHIPs program introduced during the Clinton admin, and defeated once - finally passed in 1997, offer something small. And SCHIP is a good place to begin. Expand it. Start covering youths from 18 to 25, and have them pay a nominal premium on a mandatory basis if employed. What is nominal? $40 or $50 per month. Employers could contribute a similar or lesser amount. This could be marketed out to the public as a "Young American Worker Plan," or some such, that would help employees and employers alike.

On the older end, for people over 57, and not eligible for Medicare, something similar should be instituted, especially if those individuals are self-employed after being laid off, or taking early retirement. The cost of this should be about $100 per month.

This would help to take some burden off emergency room care issues, which have reached "critical" levels. The problem with emergency room care is that an ER is not a good substitute for primary care. The ER is just that - a place for emergencies. Emergency treatment is far more costly than simple preventative measures. Additionally, hospitals have no way to provide emergency care for free - it, like all other care, costs money. The cost of ER care for uninsured patients doesn't magically disappear. Uninsured patients often are billed directly for treatment but are unlikely to have the ability to pay. This cost strains hospital budgets and can be indirectly shifted onto families and individuals that do have insurance coverage in a "hidden tax" of higher premiums (Most estimates put the hidden tax somewhere between $1,000 and $1,300) Additionally, any hospital designated a "teaching hospital" and receiving Federal funding, seeks, and usually gets, otherwise un-reimbursed expenses from the Federal government. So, there is another hidden tax in there.

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