The Steps to Fixing Our Healthcare

Opinion Article by Michael J. Zicolello, Esq.

As the folks in Washington DC wrestle with the notion of how to fulfill campaign promises to repeal and replace Obamacare, they never seem to examine how to really fix healthcare once and for all. All politicians ever do is fiddle with the current system and accuse each other of having un-American values.

So, I decided to fix healthcare. How hard could it be? All we need is a system that controls the skyrocketing costs, right?

The most obvious cost is insurance premiums. In the good old days many employers paid for insurance for an employee’s entire family. Those days are long gone. Now, most employees are required to contribute a portion of their pay toward their insurance with no coverage for their family.

Making matters worse, each year, employers overburdened by rising health insurance premiums, shift the burden more and more to their employees. Regardless of who may be paying the premium, we can safely say that the annual premium for a family of four is more than $10,000.

That’s not the only cost. No matter how good your insurance is, it does not pay 100% of every medical bill. There are deductibles, co-pays, and the dreaded “co-insurance” – which is insurance company lingo for “you really don’t expect us to pay more than 80% of that bill, do you?”

So, in addition to the hefty premiums, if you are unfortunate enough to actually need medical care, tests, or hospitalization, you’ve got to reach into your pocket to somehow find thousands of dollars to pay co-pays, deductibles, and co-insurance.

But wait, there’s more. We can’t forget the Obamacare subsidies. Subsidies is a fancy word for the government giving taxes collected from you to insurance companies. Why? Because the insurance companies can’t make money selling insurance families can actually afford.

Why are these costs so high? Profit motive. The health insurance company has to make money, and the medical provider has to make money. We are footing the bill to fund two separate industries. And what makes matters worse is that the two industries have two separate and opposing goals.

The medical providers want us to get medical care. That is very understandable, after all, that is their job – to provide medical care. The insurance companies, however, do not want us to get medical care. When we get medical care, they lose money. So, they have rules to prevent you from getting medical care. My favorite is that you can’t be hospitalized for the same condition during some random period of time seemingly picked out of a hat.

Traditionally, “insurance” is supposed to help the consumer by providing much needed money prompted by a catastrophic event. It is not intended to assist with payments for products or services we actually intend to use. An insurance company can only make money if it collects more money than it pays out. This principle works fine for car, home, disability, and life insurance, but not so good for healthcare.

How do we eliminate the cost to us all? Sadly, we can never eliminate the cost. We’re going to pay. The questions are to who and how much. We must change our system to be more reflective of the importance of healthcare to us all and eliminate the insurance companies’ profit motive from unduly influencing the costs to each of us.

Oddly, the answer came to me when playing a simulation game where you build a city. There were four structures that every neighborhood needed for progress to occur. A police station, fire station, school, and hospital. Only one of those is not government run. Think about it. If you were starting a country from scratch, wouldn’t you have the government provide healthcare? There are so many things the government is involved in that it shouldn’t be, but shouldn’t providing healthcare for its citizens be one of the few things it does do?

When I think about the future, it is impossible for me to imagine that 100 years from now healthcare will involve premiums, deductibles, co-pays, and co-insurance. In the name of progress shouldn’t we move on from our failing healthcare payment structure.

I know, I know. The government doesn’t do anything right. How can we trust them with healthcare? I was there once. I am, and have always been, a small government guy. The government ruins a lot of things.

But, of the four – Police, Fire, School, or Healthcare – which one is currently presenting the biggest problem for us throughout the entire nation; in every state, city and small town? Only one of the four gets worse on a nationwide basis because no one has been able to take any measure to control the costs.

We’re paying through the nose – each of us – for healthcare and it’s associated insurance industry anyway. If my choice is for companies and families to pay tens of thousands of dollars a year for health insurance premiums, subsidies, co-pays, deductibles, and co-insurance, or to have a healthcare tax in exchange for which a family would never have to pay for healthcare, I’ll take the tax. And I HATE taxes.

But, we are already paying the money anyway, and I’ve got far more control over a tax than I do health insurance premiums. I can’t vote the CEO of Aetna out office, and he’s never going to hold a town hall meeting because he is interested in my views. The reality is that government funded healthcare would give us far more power over our own healthcare than the current system.

But, you say, a single payer Medicare-for-all type system would be a disaster. I agree. Any system that allows private institutions to bill the government invariably leads to a “pigs at the trough” scenario where the private institutions figure out ways to suck every available dollar, and then some, from the government.

So, there should be no billing of the government involved. Nationally funded healthcare should be run like the interstate highway system with each State responsible for its public healthcare system. So, the healthcare workers will work for the State, not the Federal government.

The Federal government will merely set the baseline standards for the States to qualify for funds. If a State wants to do more than the Federal baseline standard – hello Massachusetts and California – they can do so and pay for it themselves.

But what about healthcare “choice” you say. What if you don’t want to use the public system and are willing to pay for your healthcare out of your pocket or buy insurance? No problem. There should always be private healthcare as an option. Remove the limitations on insurance companies.

Let them sell across state lines and give them the freedom to craft all manners of policies rather than what Obamacare dictates they cover. For example, you could buy a policy that only covers cancer treatment.

This was more words than I am usually permitted in a column, but when I said I’d fix healthcare, I didn’t say I’d do it in less than 1,000 words. Well that’s my solution.

The real question is whether we’ve elected politicians brave enough to act boldly and provide us with a healthcare system that works and that we can afford. Right now, I have my doubts.

Zicolello is a local attorney at Schemery Zicolello, PC.