State of the Union

President Obama said “There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

Since this is where I make my comments here we go.  First of all the reason that many doctors, nurses, and health care experts consider the approach in question to be a vast improvement is that anything would be a vast improvement.  Health insurance companies have taken over health care.  They deny coverage for people who are sick, charge unreasonable amounts for premiums, and then deny payments to the medical professionals who are actually treating the sick.  I submit that the health insurance companies themselves are the problem.  If you want to hear that from someone smarter than me I’ll refer you to Dr. Steffie Wollhandler.  I don’t happen to agree with her about the “Medicare for all” idea, but that’s simply because Medicare is insurance as well.  However, the “Medicare for all” plan would be a better approach that would meet your criteria above.

A more reasonable approach would be to hire the medical professionals on a salary basis to treat all the sick and injured.  You could give them more than they are making now, pay off their college loans and still save money since you are bypassing the health insurance company middle man.  This would cost less than the “Medicare for all” plan, and when it would cost less for the American people when you consider the increase in taxes would be offset by not having to pay an insurance premium.

I know that you aren’t going to do either of these because the health insurance lobby is too powerful.  You have explained that.  There have been times over the last year that it wasn’t clear what you wanted aside from health care reform that doesn't hurt the insurance companies.  Perhaps this will meet your criteria. 

• End the practice of denying coverage to people with pre-existing conditions.  This will enable people to get insurance. 
• Define health insurance packages.  I’ve seen negotiations for health insurance for a small business.  When you shop around you have to be really careful that the coverage is the same.  One company might sound good, but then somewhere in the policy you end up finding out about some piece of coverage that does not match.  The idea here is to have a few standardized labels so that anyone can compare prices apples to apples.  This will drive down premiums. 
• Make sure that the health insurance packages can not preclude supplemental insurance.  Maybe it’s just me but I would rather pay a premium for supplemental insurance that I know is coming than pay a deductable (or a bunch of co-pays) as a surprise.  On the face of it you might think that this would increase costs.  Over the longer term I would suspect that it would encourage people to get things looked at sooner which usually translates into cheaper.  The reason it works out the other way for insurance companies now is that they are considering the term of the policy.  If they were actually concerned with their customers well being the co-pays and deductibles would be lower.  Another way to handle this would be to drop co-pays across the board.  
• Define coverage criteria for everything across the board.  For each procedure that a provider performs there could be as many different forms, or steps to get paid as there are different plans.  Since one insurance company can have a multitude of plans it can get confusing really quick.  Set the coverage criteria for each procedure in law and make them as objective as possible.  I would suggest a group of providers and insurance company representatives get together and hammer this out.  This protects the American people from getting health insurance that isn’t worth anything.  If done well it will cut costs for both the provider and the insurance company since everybody would know the rules. Note: If the insurance companies object to this on the grounds that having to pay more claims will mean higher premiums (which they will) make sure to get a list of exactly who is objecting because they are basically saying that they had no intention of paying legitimate claims which might be grounds for criminal charges.
• Require everyone who can afford it to buy health insurance. This is mainly to placate the insurance lobby, but it could actually help providers as well.  Knowing that someone has health insurance and knowing the coverage criteria makes it a lot easier to get paid.  You then just have to find out who to send the bill to.  

So far this approach should reduce premiums, reduce cost, and cost very little to the government.  In fact it might come out as a gain for the government since the coverage criteria thing might best be enforced with fines. The following things might also save some money.

• Drop Medicaid and instead create a system of clinics and hospitals that uninsured people can use.   I'm sure that this would save money overall.  I'm not sure that it would save money for the federal government.  
• Set up a national health records database.  This will help with enforcing the uniform coverage criteria above.  This will help with diagnosing problems quickly.  The technology to do this is established.  I understand the privacy concerns, but this type of technology could save a life.  Privacy concerns should always be less important than saving a life.

This part will cost some money, but we just saved money while covering the uninsured.

• Expand Health Savings Accounts by allowing people to have them regardless of the type of insurance they carry.  
• Increase finding to Medicare.

I don't really think that this will get done.  I just thought I would let you know how.