The whole insurance issue is complicated. It is also inflammatory. The country is divided on whether we should develop some form of socialized medicine, whether it should be completely free market, and how much help people should get with their medical expenses.
Right now, the US medical system is run on insurance, with support from Medicare for those who are elderly or disabled, and Medicaid for others with severe medical conditions, or for those who are very young. It is an unstable, expensive system.
Someone once said (I am sorry, I forget who it was) that we usually insure against low frequency events: like floods, like fires to our homes.
Health insurance does not work that way, or at least it doesn’t appear to work that way. If someone just has health insurance for catastrophic events, it is similar to fire or flood insurance. However, our medical clinics do not work that way. Instead, we use health insurance for illnesses and procedures and preventive medicine. As long as the US medical system is run on insurance, then everybody should have access to it.
If we don’t call it insurance, we may be able to see the problem in a different light.
Let’s call it granite account.
Everybody needs to have access to medical care, and that care is charged to a granite account. You pay a monthly fee into your granite account. The amount you pay is based on your income. You pay over your lifetime. If you cannot pay anything your payment is covered by either your parents, depending on their income, a youth grant to your granite account, or by a disability or unemployment grant. For retirees, a portion of the social security payment is made to the granite account. For the elderly, the amount that they pay can be modifiable according to retirement income.
The cost of medical care is paid by the granite account, with medicare available for the elderly population, the disabled, and the people with difficult to manage or catastrophic chronic conditions.
This system would work something like the way we currently manage our exercise and entertainment. We pay a monthly fee to the exercise club, whether we use it or not, and we pay a fee to Netflix, whether we watch 10 videos a month or only 1, and we pay monthly fees to our cable and/or telephone company.
What I have described would cover a basic system of care, and I know that there are many people who would want more: Therefore we should be able to choose to have a tiered system if people want more tests than those that are required, or who have some problems with adjusting to a new medication and want more attention. To save money some of the changes that are already under way in medical care can be used: case managers for people with chronic illnesses, follow up contacts with nurses, education and encouragement for healthier life styles.
Some services, like vaccinations, are required because they are essential for public health, other services are used to increase personal health and safety. We pay for these services over a lifetime by our payments into the granite account. Once these changes are made, and people have accepted the fact that they are paying over a lifetime for services that they will use sometimes rarely, sometimes often, we can, if we would like, stop calling it granite accounts and go back to calling it health insurance. We just need to recognize that we are paying for a service that we choose to use, some more than others, and that we will almost certainly use at times.
Now Governor Romney is saying that he likes many aspects of the Affordable Care Act, and that he will replace it with something that he likes better but that will look a lot like the Affordable Care Act. This is confusing but not surprising, since he has helped to pass a similar plan in Massachusetts. Although he has not said specifically what he wants to eliminate from the Affordable Care Act many people suspect that he wants to eliminate the mandate: that requirement that everybody obtain insurance. However he has said that insurance companies will not be allowed to deny insurance for people with pre-existing conditions. It is difficult to see how this would work, but I will say more about this tomorrow. Meanwhile I would love to hear your comments and suggestions.