Brian Klepper
What Will It Take To Re-establish Stability and Sustainability to American Health Care? Will It Be Driven Through Policy or the Marketplace?
Problem
Social justice issues notwithstanding, the rapidly rising tide of uninsureds and underinsureds threatens to overwhelm and financially destabilize health care safety net professionals and institutions, and to precipitate significant turmoil throughout health care, the nation’s largest economic sector.
Actions
A. Establish Funding For Basic Care Services. Establish universal coverage for “basic” health services – basic must be defined – funded through taxes, for everyone in America. To define “basic,” establish an expert consensus process that recognizes:
• Optimal combinations of preventive, primary, chronic, acute and long term care.
• Individual variation and special need.
• The limits of public financing.
• Opportunities to access private supplemental coverage.
B. Establish A Basic Care Services Network Accessible By Everyone In America. Establish a limited national network of public and private health care providers that all residents can access for basic care services, with services reimbursed by the government or its intermediary. (A mandate requiring all individuals to purchase basic health coverage is an alternative solution, though this approach would likely be administratively complex and expensive.)
C. Leave Supplemental Private-Sector Health Coverage In Place. Individuals (or their employers) may purchase supplemental coverage for basic services delivered through a broader network of health care providers, and/or a more comprehensive range of health care services. Purchase of "private health care coverage" would not exempt individuals from contributing to the public health care financing system.
D. Eliminate State Benefit Mandates. State benefit mandates are influence-driven regulatory coverage rules that vary among states. They apply only to state-regulated insurance programs, but do not apply to the half of private sector enrollees in self-funded ERISA health plans. They amount to an inconsistently applied tax on health plan purchasers who do not have the scale to opt out by mounting an ERISA health plan. It can also be argued that the establishment of a universally available “basic” set of health services renders mandates superfluous.
E. Unify State Insurance Regulatory Guidelines. In an increasingly national health care marketplace, the differences in state regulatory guidelines infuse unnecessary complexity and cost that are antiquated and increasingly difficult to justify.
Principle 1: Establish Universal Coverage For Basic Health Services
Wednesday, October 24, 2007
