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Solutions for sick system of health care

The problem of medical costs and the ability of our people to cope with them is a problem that is not going to go away and must be addressed.

The fact that medical costs are expensive should not be a surprise to anyone. Comparing today’s medical world with the one that existed when I was growing up in the ’50s reveals two significant differences.

First, there are far, far, far more illnesses and injuries these days. People just have more things going wrong with them. In the ’50s, the big problems were broken bones, polio, tuberculosis and nervous breakdowns. In the intervening years, we have discovered the many types of cancer, an unbelievable number of syndromes and allergies, the ability to replace practically every organ and bone in your body, and all sorts of mental conditions and phobias. In the ’50s, you had to really be sick to deserve a doctor’s visit and if you had to go to the hospital for any length of time that was a real problem. People today just have many more things to seek medical help for and they do.



Second, due to all these new medical problems, scientists and medical professionals have done an unbelievable job of inventing new machines and techniques to cure them, i.e., MRIs, chemotherapy, radiation treatment, brain surgery, organ and bone replacement, and, last but not least, efficient but very expensive drugs.

Putting these two things together, it is easy to see why medical costs are as high as they are, and even with the availability of “health insurance,” many people have a hard time coping with them, especially when one of the serious and costly (catastrophic) illnesses comes along. Now, what can we do about it?




For one thing, it is ridiculous to think that health insurance is the answer. The main reason is that this isn’t an “insurable” problem. Insurance is when a group of people pay a relatively small amount of money to a company to protect them from an “unprobable event.” For example, fire insurance is relatively cheap because not very many houses burn down. So, 10,000 people all give an insurance company a small amount of money because the insurance company knows that only about 10 of those people are going to have a fire and the cost can be covered by the premiums.

Now if those same 10,000 people tell a medical insurance company “We want insurance that will take care of all our medical costs this year,” do you think the premium is going to be expensive? Certainly, because the insurance company is going to have to collect enough money to cover the medical costs of all these 10,000 people. This means some people, those who have low medical costs, will be paying some of the costs for those people who have a lot of medical costs. Not even a “national health insurance plan” would solve this basic problem.

What is needed is a two-level program. To protect individuals and families from the catastrophic losses (which is the real problem today), the government would provide a “major medical insurance program.” This would cover the costs of cancer and major illness treatment, mandatory bone and organ replacement, major surgeries, and other medical costs above and beyond ordinary “repair and maintenance” expenses. The government could very easily integrate this into the Medicare program and premiums, based on income and size of family, could be collected through the income tax process.

The benefit of this is that these are the insurable types of events in that they are not “usual and ordinary” events and affect only a relatively small portion of the population. The cost, spread over the entire working population, would be relatively inexpensive on an individual or family basis.

The other part of the program, nonmajor medical costs, could then be covered by existing health insurance programs but at a significantly lower cost due to the elimination of having to cover the major and/or catastrophic losses.

As a fringe benefit, companies could still cover all or a portion of these costs for their employees.

I have purposely not mentioned the problem of health costs for those among us who are unable to pay for a variety of reasons because that is a separate problem. We must, of course, find a way to make sure that everyone who needs health care gets it, but we first must solve the basic problem with the existing health and medical cost situation.

ooo

Ron Avanzino lives in Penn Valley


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