One of our thorniest health policy issues is whether or not healthcare coverage is a basic human right. Those who say “yes” feel that it’s immoral to deny anyone care. Those on the other side point to the economic challenges – including likely rationing – of providing expanded care for all. In this contentious, polarized political climate, it’s unlikely that either side will convince the other any time soon. But, if I may be so bold, there may be an acceptable compromise.
Before I present my idea, let’s consider three primary drivers that brought healthcare coverage into the public’s consciousness in recent decades.
· Charges of hospital emergency rooms “dumping” patients in the 1980s. Some highly publicized cases where hospitals allegedly dismissed uninsured patients from ERs without properly stabilizing and treating them caused understandable public outcries and played a major role in passing the Management and Treatment of Active Labor Act of 1986 (EMTALA).
· People being denied coverage or having extraordinarily high premiums because of pre-existing medical conditions.
· People literally being bankrupted by crushing medical bills triggered by catastrophic medical crises.
Here’s my proposal. What if we had a two-part hybrid system?
· Part 1 – A national public plan that provides emergency/preventive/primary care and catastrophic care for everyone. It would be backed by a combination of increased employer taxes and redeployment of some existing funding for Medicare, Medicaid and the Children’s Health Insurance Program.
· Part 2 – A reconfigured private insurance market that offers coverage to fill the gap between emergency/preventive/primary and catastrophic care. This supplemental insurance would be paid for either by individuals who wish to purchase it or employers who want to provide extra coverage for their employees. Additionally, state Medicaid programs could help fill the gap for Medicaid patients if they so chose.
This approach would address all three problems listed above. It would:
· Guarantee coverage for life-threatening situations
· Keep pre-existing conditions from freezing people out the insurance market
· Minimize bankruptcies caused by catastrophic medical bills.
Even though employers’ taxes would rise, their total healthcare spend probably would not. Their increased taxes would be offset by decreased insurance premiums since they would no longer have to pay for the emergency/preventive/primary and catastrophic care they pay for in their current policies.
Importantly, this concept also maintains a place for private insurance companies, who are understandably dead-set against a fully socialized program that would render them irrelevant.
The “healthcare is a right” group should be pleased that everyone has guaranteed access to basic care, and those on the other side should see this as a more affordable option than all-out, expensive full coverage for everyone.
Some might complain that this concept would establish a two-tiered system since not everyone would have the supplemental private coverage. But I would argue that in a free society, not everyone accesses the same products and services. That’s why we have both EconoLodge and Ritz-Carlton hotels. Furthermore, our current system does not adequately care for the needs of the “have nots.” This would at least be a good step toward more equity.
Let me know what you think.