As an employer and a health care provider I would like to discuss several things that are not being addressed in the debate between Obamacare and Trumpcare.
Firstly, though it is a dirty little secret, between 40 percent and 50 percent of the population in the U.S. is already on government-funded health care and mostly they are happy with it.
If you add up all the employees of the military and their families, those eligible for VA health care, Medicare, Medicaid, federal, state, county and city employees and their families, individuals in prison, companies that depend mostly on government-funded projects like highway construction companies and defense companies, and heath care providers treating mostly Medicare patients and the disabled, you have a large part of the population on government-funded health care.
Secondly, what both parties are trying to do in addressing only health insurance is like rearranging the deck chairs on the Titanic. The reason health insurance costs are so high is due to what it insures, health care. The cost of health care is high and getting more so. Neither party is addressing this. It is as if everyone drives a Rolls Royce and we are wondering why car insurance costs so much. As an employer, I saw the same double-digit increases to health insurance premiums before Obamacare as I do now afterward.
I have heard a lot of nonsense about allowing the free market to work here. Health care in the U.S. does not function on a free market basis. There is no way to choose one hospital over another as to quality and cost. When you go into an emergency room you have no idea what your costs will be. You just walk out of the hospital afterward and hope you can pay your share. Anyone who has ever examined a hospital bill will tell you it is beyond understanding.
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Allowing health insurance providers to sell stripped-down plans is the same as just increasing the deductible. It just allows the insurers to call it a non-covered procedure rather than tacking the charges on the deductible. Health care is a necessity. No one goes through their whole life and refuses to ever see a doctor. The federal government acknowledges this by requiring hospitals to treat anyone who walks into an emergency room whether they can pay or not. If health care was free market, hospitals could tell people "sorry you don't have insurance, so go die."
My proposal to both parties is to provide a federal re-insurance for the health insurance providers. Let's say an individual has more than $100,000 in a year in health insurance costs, then a type of Trumpcare along the lines of Medicare would step in and take over the costs. In addition, if an individual has more than $1 million in health insurance costs over their lifetime, what the old lifetime maximum was, then they would become instantly eligible for Medicare. Medicare is essentially a high-risk group insurance anyway and most people who need that much health care will end up disabled and soon on Medicare.
By limiting the losses to the insurers it should help to keep costs down. The costs of the program will only go to those we know are high risk and not individuals that insurers would perceive to be high risk. Medicare also approaches the costs of health care differently than most insurers by paying for the disease and not just procedures and supplies used. This is a real attempt to control costs. Medicare also has much lower administrative costs than private insurance.
Once we have addressed the costs of health insurance we need to take a good look at the cost of heath care. The answers to that puzzle are more complicated and require wiser men than me.
In addition, we should not switch regular Medicaid to block grants to the states. As most welfare payments go to support people in nursing homes and with us baby boomers reaching that age, going to block grants will put an incredible strain on state budgets. Remember Sens. John Hoeven, R-N.D., and Heidi Heitkamp, D-N.D., you were all once state officials and what it takes to balance a state budget.
Could Congress also reduce the reporting paperwork of Obamacare and simplify it? One of our office managers spent three full days this year just filling out the Obamacare forms that no one will ever look at. It was ridiculous.
Bradley King is a lifelong resident of Bismarck and founder and senior partner at Prairie Rose Family Dentists in Bismarck and Mandan.