Last month my son had a major operation. As we checked him in, I asked the person processing the paperwork for an estimate of how much this would cost. She replied, “I don’t know, but don’t worry your insurance covers it.” We are now receiving a steady stream of bills from each different doctor, the anesthesiologists, the hospital, and on and on. There are currently 29 separate insurance claims related to this visit. Naturally, most show up as fully covered but others do not. This is a crazy system.
I’m lucky. I have good health insurance. I understand enough about the system to know that if a charge isn’t covered by my insurance it is likely due to a mistake. I am fluent enough in English and bureaucracy fighting that I am confident that I will get it resolved.
I would like to suggest three different reforms that we could do to our health insurance system that would not involve doing away with all private insurance but could make things better:
- Require health care providers to offer the same price to everyone: One of the biggest benefits of insurance is that it is a discount club. Each of the hospital or doctor’s bill comes initially with a very high amount which is then marked down to the insurer’s negotiated rate. An initial bill might be $1500 that is marked down to $500. So who has to pay the higher amount? The uninsured—the people least able to pay. How does this make sense? Do we really expect the uninsured to subsidize the cost of healthcare for the rest of us? Instead, why not require hospitals to fix their prices and publish them. Everyone pays the same price for the same service.
- Require all insurance companies who sell insurance to the federal government to offer the same plans to everyone: We get our health insurance through our employers since that is an easy way to lump a lot of people together. Some companies have given me good insurance and others have given me poor insurance. I do not like being dependent on my employer for this choice. Since, the federal government is one of the largest purchasers of health insurance. Why not make this same insurance available to anyone who wants it? Small businesses would not need to negotiate their own deal. Individual employees could opt to buy from the government list instead of from their employer. This would give us many more options than we got from the Affordable Care Act and would not require any extra government funding.
- Offer Medicare to anyone who wants to buy it: Medicare is supposedly the least expensive health coverage. Why not offer this bare bone insurance to anyone who would settle for it? It should be priced to fully cover its cost. If it works as well as some of the democratic candidates think it will, then people will switch to it. But no one will be forced to switch.
I’ve always suspected that the most vocal defenders of our current system are those who either don’t use it or profit from it. Reform is hard but if we can continue to make incremental progress we can slowly make this work better without risking breaking it all.