No on Medicare for All - for Now

I am not sure if I am in favor of “Medicare for All” and think that more investigation and thought needs to be given to the issue. On the flip side, however, I do not feel that the rendering of needed medical care should be based on the ability of the person/patient to pay. So, what is the solution? I have a couple of ideas. Granted I do not know the cost, but some bean counter probably can come up with something.

Emergency treatment for all. We have this already in the form of the Emergency Medical Treatment and Active Labor Act (EMTALA) which requires hospitals and emergency providers to evaluate and stabilize any patient that presents themselves for services. The pitfall of this program has been that less than 40% of it gets reimbursed for the services. This causes “cost-shifting” - -increasing the cost to those that can pay to pay for those that do not or cannot pay. This cost shifting on the part of the hospital includes increasing the cost of certain test or procedures or even hospital stays.

The other problem with this program is it invite abuse. Abuse of a segment of health care that is one of the costliest to maintain – emergency medical services – in the emergency room or on the part of ambulance services.

To address this issue, every U.S. Citizen, should be entitled to insurance that covers emergency treatment in an emergency or use of an ambulance in the event of an emergency. If it is abused by the patient, then the patient’s cost for the service, increases proportionally or the patient become financially responsible for the full amount of the bill. To help offset abuse, however, this insurance needs to include routine visits to a physician’s office or more urgent care centers.

Additional insurance coverage would be made available to cover the non-emergency or non-urgent treatment and care of a patient at the patient’s expense unless they otherwise qualify for state or federal health insurance programs.

This program would be limited to U.S. Citizens ONLY. Illegal or undocumented immigrants would or should NOT be covered under this program.

Of course, a lot of details would have to be worked out.  Our health care system is broken…no ifs, ands or buts about it. It is immoral and unconscionable for an insurance company to pay $500 dollars out of a $2000 bill while the patient without insurance is stuck with the $2000 bill that they likely cannot or will not be able to pay. Let’s face it, FOR THE MOST PART, if an insurance company is paying $500 that is probably about 90% of the real cost of providing that service.  The other $1500 charged the non-insured patient is shifting the cost (and profit) away from the insurance companies.

Another aspect of this program is insurance cost and premiums. An insurance company should have to go through a government review before they can increase insurance premiums much like a public utility. They must show their cost of providing insurance and allow for a profit margin equal to 1-3% over the inflation/deflation rate.