Monday, April 28, 2008

Universal Health Coverage

I was thinking about the national health insurance crisis and the more I thought, the more questions I had. So rather than pontificating an answer, I just posted the questions.

60% of our population has medical insurance and are reasonably satisfied with it.

But upto 40% don't and this is an unacceptably high number.

What do we do to ensure everyone has coverage?

1) do we go wholesale into an universal government controlled program and its attendant ineffeciencies?

2) do we leave the 60% alone but provide some sort of government program for the 40%? If so, who will pay for it? Would it be a tax that even the 60% who have private insurance will need to pay? Can we consider this as one of the sacrifices we make as a nation for the common good?

3)If we adopt this idea of private insurance with a government safety net, what will prevent private insurance from promptly dumping all their unprofitable patients? Also, why would employers bear the expense of offering private health insurance if the government is doing so?

4)Can a public/private partnership work or should it only be one way or the other?

5)Should the private insurance industry be made non-profit? Would this be anyway better than government?

6) Can we reform laws to prevent denial of coverage or increase in premium for pre-existing conditions? Isn't it a travesty that you can be denied coverage because you have a disease or be charged outrageous premiums?

7) How do we ensure -in a private scenario - that health benefits are protected at low rates in the event of a loss of job or serious illness that necessitates stoppage of work?

8) Or do we just accept that you only have as much right to life and good health as you have money in your wallet? Is this an acceptable premise to our society and its values?

9) Do we accept that some aspects of the medical insurance business will be necesarily unprofitable - if they do accept everyone with lower premiums - and can we realistically expect a for profit company to allow certain segments of its business to be always unprofitable?

10)Can we put a cap on how much a family can spend on health insurance based on tax returns and the overage be picked up by the government? In effect, this means a catastropic coverage that is guaranteed by the government and would result in people getting the care they need.

11) Can we NOT replicate the British model of National Health Trusts? Keep the hospitals and the doctors who work in them in the private sector but have some sort of federal tax based guarantee on the bill payment.

12) How do we make medicines and lab tests more affordable?

13) What about the financial markets? What about all the traded stocks in health insurers, hospitals and labs? Can we afford to take this whole sector off the market?

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