It is apparent that meaningful health care reform cannot be achieved in Washington. There are simply too many factions pulling in too many directions to have federal legislation that will address the continuing escalation of cost, rationing, access, end of life care, single payer, public option, and on and on. It is probably too much to expect that any one of these issues can be addressed in the present political climate.

I offer the following common sense approach for health care reform that takes the problems out of Washington and puts them in the hands of each individual. The idea requires that state insurance agencies mandate that medical insurance be sold with choices such as found with auto insurance policies.

Medical insurance is typically sold with 4 categories: Self or Self and Family with a High or Low option for each. Not quite a one-size-fits-all but just about. To these categories I would add the ability to choose from a menu of options that include the following:

  1. The de facto tort reform option—To combat the rising costs of litigation, (awards, malpractice insurance, unwarranted testing, etc.) one could, with a simple check mark, select an option that puts all malpractice under binding arbitration with specified caps on awards. If you want to retain the right to sue someone for malpractice, don’t select this option but be prepared to pay the premium that reflects the actual cost of malpractice and all that it entails.
  2. The death panel option—To address the issue of costs, particularly in the last year of life, each person could elect to be their own one-person death panel and select the procedures that are not covered. (organ transplants, feeding tubes, long term life support, resuscitation, etc.) If you want to be kept alive as long as possible using every medical device, don’t select this option but be prepared to pay the premium that reflects the actual costs. (Some may say that ability to pay will determine the care one selects. So what else is new? —I drive an old Camry, not the new Lexus I would like to drive.)
  3. The uninsured “option”—Just as I am required to carry coverage for uninsured motorists, require that I help pay for the medically uninsured. That doesn’t bother me because I know I am already paying, but instead of it being a hidden cost, the actual cost will be spelled out. As for health care for the uninsured, they are automatically selecting both options A and B whenever they receive care. Routine care would be available in subsidized clinics supervised by regular doctors and staffed by health care professionals serving internships or repaying loans. Urgent care would be provided as at present, but only for actual emergencies; hospital emergency rooms would not be reimbursed for treating hang nails or runny noses.

Insurance companies wanting to make profits should have people clever enough to modify and add to this framework. I don’t think it would require 1023 pages of fine print.

Please hold the applause.

Richard Strauch

Boulder

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