Health Care--What can we expect?

Once again, Health Care rules the agenda in Washington. It's been a long time coming (16 years!), to say the least. I am sure that, with the resurfacing of the health care debate, will come all of the usual crap (the "Harry and Louise" ads, Betsy McCaughey will start popping up on every news outlet as the "expert" on why single payer is the worst idea ever, the cries that we can't be like Canada, or France, etc).

Perhaps I am too naive to think that this time...it will be different. But I think that there is a chance for real health care reform.

So...what IS real health care reform? That is truly the million dollar question. Unfortunately, we now understand why some of these questions have been put off for so long. It is partially a function of how difficult and challenging the existing system is to understand, and how messing with any part of it can have tremendous unintended consequences. It is also the concerns about how much control really can be ceded to a federal bureaucracy, and whether there are costs and efficiencies that can be gained by either moving to a Medicare Expansion (ie. Single Payor option), a federal mandate for coverage, or even a mix of the two (multi-option, with a public option choice).

We will hear a lot about how Canada's system is all fouled up, and we will hear about why it is nirvana. We will hear about waiting in lines, rationing, tax increases, federal control, and we will hear about insurance lobbyists, 47 million uninsured, and the rights of all to access to health care. In the end, though, I think everyone can agree that we want more affordable health care, and appropriate coverage for all who desire it.

I figured I'd check on some of the basics of how other countries do it. The French have a popular program, but is it workable here? Some of the other European countries have wonderful care, but their populations are either too small, or too homogeneous to necessarily be transferrable to our society.

So far, the best model, in my opinion, has been the Swiss Option. Not that it is the most populous, or heterogeneous society. Rather, that it is the one option that we can actually get to from where we are, that has a shot at passing Congress, and actually doing something about our health safety net, our health costs, and our health care industry prosperity.

So what does the model look like?

According to the NBER Working Paper No. 13817Issued in February 2008

"In the Swiss healthcare system:

• there is an insurance mandate for all individuals [to have coverage],
• the government defines a what the insurance benefit will be for all standard health insurers,
• insurance companies are not allowed to deny coverage to any individual,
• health insurance and medical procedure prices are made publicly available,
• in exchange for providing health insurance to consumers, insurance companies receive premiums from consumers and risk-adjustment payments from the government in order that insurance companies are not punished if they decide to insure a sicker population,
• premiums are community rated, meaning that sick and healthy individuals pay the same price within each age group (the age groupings are 0-18, 19-25, >25 years old).
• individuals are allowed to purchase supplement insurance as well (there is no regulated benefit for supplemental insurance),
• there is significant cost sharing in all insurance plans (i.e.: deductibles, 10% coinsurance rates up to an annual ceiling),
• open enrollment occurs twice per year (June and Ddecember).

In 2003, 49.7% of Swiss individuals choose ordinary deductible health insurance, 42.0% choose higher deductible health insurance, and 8.2% chose insurance with limited choice of provider networks (HMO-style contracts). Since only 8% of individuals are in managed care insurance firms, quality is fairly homogeneous across insurance companies."

This model may not be ideal, but it would help in a number of areas, and could always be tweaked to handle a US population demography much different from the Helveticas. It would provide Private Insurers with the right to continue to practice competition, and at the same time, provide options for all individuals to receive health care coverage. From a service standpoint, it appears on par with the US in terms of wait times, and service (ranking second behind the USA).

What we can't see here, though, is the cost of the overall program. And, as with each of these plans, this is the rub. No one is going to be willing to put a plan into action unless it can be determined, with even some opaqueness, that it wouldn't be more costly, and less beneficial to the society at large.

But I think, over the course of the next few months, the Swiss model will be one that is at least debated, and could pose a real option for developing a plan to improve the future health care of America.

We shall see if the defection of Arlen Specter proves to be the difference in the Senate math that leads to a deal of some sort. We'll revisit this topic from time to time here, to see where the debate leads.