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Health care reform thoughts


[10/27/2011]

Dear Fellow Americans:

In the past few months, the one thing that has been in discussion the most is none other than Health Care Reform. For most of the United States residents, legal or illegal, the implementation of reform will have a profound effect for the many years to come.

Most of us will agree that the present system has not been satisfactory, regardless how we view it, be it medically, politically, or economically. Based on the projection, it is very clear that the present Medicare will go bankrupt in the near future unless the tax revenue is increased or the costs are cut. The President is right in saying that we need to reform the Health Care without increasing the burden of the tax payers. However, polling of the general public has shown that the majority of the respondents are uncomfortable with the bills that are being discussed by our elected officials. This is mainly because none of the bills have been able to show that they can provide any savings but in fact they may further burden our children or grandchildren with the increased expense. Partisan politics and philosophical differences have also created significant disagreements in how to shape the health care in this country. If we would only look at the concern of the general public, which is mainly the economy, are there no other alternatives that may be more acceptable to the majority of US citizens? I would like to share some of my thoughts with you and, if it seems reasonable, maybe you can help in communicating with the others in not only the medical fields but the general public. As the elected officials are shaping the bills already, time is running short.

The President stated that every person needs to have health insurance, just like automobile insurance, so other people do not have to be responsible for the expense incurred by the uninsured. This is not a logical comparison. There are people who do not have and are not required to have automobile insurance. The examples are plenty: children who have not reached the driving age, people who do not intend to drive and do not own a car, etc. Additionally, only liability insurance is mandatory in terms of automobile insurance. Therefore, if we require all people to have health insurance, it will be the same as asking every person to have automobile insurance. Another problem is: how much insurance coverage will be required? Should everyone have coverage for everything or just what is required to maintain survival? If only the bare minimum coverage is mandatory on the health insurance, other people still have to cover for the expense on the care not covered by one person’s bare minimum insurance. The spirit of helping the underprivileged is good, but to work out the details based on the concepts of expanding health insurances can be too complicated for different interest groups to reach a consensus.

A more appropriate analogy, if we are comparing automobiles and health care, should be to say that the health care expense is similar to the money we save to buy cars and the automobile liability insurance is more analogous to the liability insurance the health care providers carry. We have put our Medicare taxes in Medicare for our latter lives, just like putting money in our savings accounts so we have enough to buy cars. Automobile insurance is needed when a driver operates a vehicle, just like the malpractice insurance the health care providers carry, to pay for the expense from accidents. The total amount of money saved determines the quality of the cars, just like the quality of the health care.

We do not have unlimited resources for the things we want. For the average people, we can never save enough to buy a Rolls-Royce, therefore we will never even think about doing so. However, when health care expense is managed by the government mandate and the type of health insurance such as Medicare, every insured or uninsured expects to have the same best care that we can get although the contribution may not be the same by everybody. If everybody, including the ones who do not contribute, wants the same things as the contributors, there will never be enough for everybody. Taxes can be increased but sooner or later we will have to increase the taxes again in order to meet the entitlements, because if we are not responsible for ourselves individually, no one will be responsible for the society as a whole.

I think individual responsibility and self discipline are the keys to cost containment. As Medicare is reaching bankruptcy, we need to find simpler and more fiscally feasible alternatives to cover for both the contributors and non-contributors. One of these may be to convert Medicare to individual medical savings account using the existing Medicare tax that most of us are paying already and roll back the Medicare tax credit the individual already paid minus the expense already incurred. This will also include a big portion of the “uninsured” that are paying taxes, even some illegal residents. The account is only used for medical expense and maybe some funeral allowance. The health care providers are required to post their charges upfront in a transparent fashion, just like the honest car dealers. The patients determine how much they will spend based on how much is left in their account and the charges, just like buying cars. After a person dies, the money left in the account will be used by the government or a non-profit entity to administer high deductible catastrophic medical insurance and indigent (or basic) care for every legal resident. The children’s accounts can be initiated by the parents’ taxes or other provisions that can be further determined. The individuals are still free to purchase additional insurances with post-tax personal funds, just like what most of the people are doing already. By invoking individual responsibility and self-discipline this way, we can utilize the existing tax base to pay for more care, as long as we all are frugal to ourselves and save for the future. The more we save, the better the catastrophic insurance and indigent (or basic) care will be. There will be savings from the elimination of middleman in the administration of Medicare as well. The health care providers will have to compete for the patients as the reimbursements are now from the patients directly, not the insurance networks. A provider can spend less time or effort to see a patient, but the provider has to be prepared to charge less or risk losing patients to the ones who provide better quality of care. Perhaps fewer malpractice lawsuits will be initiated, when the patients and the providers together are the ones to determine how much care the patients are willing to accept, not how much they will receive by the administrators of the health care programs.

I have no political affiliation nor have I contributed to any political party. My thoughts are simply to provide a better alternative to the Health Care Reform, so the society can sustain the expense of health care and we do not lose the professions of health care providers.


Hue Shih



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