Health Insurance Reform

Health care reform seems to be on the horizon, and I think like many, I would say it's hard to be optimistic. Doctors are perceived to be the source of a lot of problems, even though we're just out here trying to follow the rules we are compelled to accept, meanwhile the primary ones liable when something goes wrong.

Health care reform needs to begin with health insurance reform. As I look at various other ways countries around the world manage or try to, I think we don't necessarily have to adopt anyone else's method, but perhaps some modification of the German system is worth a serious look.

Here are the features of reform as I see it should happen:

• Everyone must have health insurance, regardless of age, health status, employment or lack thereof. This encompasses a responsibility of the insured to obtain it, and to insurance companies, who cannot deny coverage to anyone.
• There needs to be free access to whatever plan you choose, and it shouldn't be any more guaranteed if you are working for a major corporation than if you are self-employed or unemployed. There will likely be a need for government subsidy of those in lower economic brackets. You should be allowed to switch insurance companies at least quarterly, if not more often.
  
• Private insurance companies should be the main source of health insurance. This allows for competition, and helps prevent some massive bureaucracy from eating up health care dollars.
  
• There needs to be tight regulation of insurance company profits. When profits increase, they need be reflected in lower premiums to policyholders. Bonuses to health insurance executives for increased profits are forbidden. This is a conflict of interest. Similarly, doctors and other providers should not make more money by denying care.
• In general, the goal of the system should be to ensure that a high percentage of health care premiums are spent on health care, not administration of benefits, not to shareholders. This will require a simplified process for reimbursement.
• There should be a level playing field for reimbursement. This may or may not necessarily involve identical fees countrywide, but there should be little or no variation in fees paid by one insurance company versus another for a given region or to one provider versus another. This simplified billing and payment process by itself will save a very large amount of money. Thus you can also eliminate the possibility that a given provider may or may not accept your insurance.
  
• When healthcare is delivered, fees are paid, and in a timely manner. There can be room for questioning the legitimacy or necessity of care which is delivered, but this occurs after the fees are paid, with any decision affecting future billing, not already paid fees.

Regarding this last point, if there are questions regarding the care that a doctor delivers, regarding necessity and other questions that we now face from health insurance companies, these should be handled by licensing boards and other standards of care organizations. We don't need to try to affect the quality of care by the way reimbursements are paid, since too many times we see that withholding payment is more about profit than it is about the needs of the patients.