Will Your Healthcare Reform do the Following...?

I want, for now at least, to avoid the single payer vs. building blocks (mandates and little public option, etc.) debate per se. Let us go back to first principles and determine what we want out of a system? I would suggest that we can evaluate the success of health reform proposals by asking what it will, or will not, accomplish:


  1. Will it cover everybody?  This is the universality question.  Does everybody have some sort of coverage, so that they can see a doctor or go to the hospital, and not be paying all out of pocket? 


  1. Will all necessary and useful treatments be covered?  This is the comprehensive question.  Is prevention and screening covered?  Do you have a medical home, a regular source of primary care?  Access to specialty care?  All appropriate medications?  Dental care?  Mental care?  Emergency care?  Acute care?  Hospitalizations?  Chronic disease? 


  1. How is long-term care, including in nursing home, covered?  Since in our current system, and in many proposals, this is handled (or ignored) separately, I too make it separate from item 2 above.   


  1. Can you afford to pay for the coverage?  This is the "affordable if not sick" question.  How much do you pay in taxes plus premiums?  Health care is too expensive for anybody to pay all out of pocket when they are sick.  So everybody has to pay something when they are healthy for the system to work.  Understanding this basic fact of modern health care is critical.  But it still has to be affordable even to those just starting out, to those who are poor, to those who are unemployed, etc. 


  1. Can you afford to get to sick?  In addition to the taxes plus premiums for coverage when healthy, how much will you pay in co-pays, deductibles, out-of-coverage, refusals, and all the other uncovered out-of-pocket expenses?  Will you or your family go bankrupt if you have an accident, need major surgery, get cancer, or some other chronic or expensive condition?  This of course is, or should be the point of insurance, to spread the risk.  In the EU and the rest of the OECD, medical bankruptcy does not happen.   


  1. As an employee, will you be able to change jobs without worrying about health benefits. 


  1. As an employer, will the specter of health benefits (again, whatever the combination is of taxes and premiums) keep you from hiring?  Will it keep you from a new start-up? 


  1. Does it control overall costs?  Items 4 and 5 have to do with the pinch you feel as an individual and family.  This is the system-wide cost question; the overall percent of GNP.  How are costs supposedly controlled, and what is the actual evidence (not just wishful thinking or say-so) that the proposed mechanisms actually control costs? 


  1.  Who pays and how?  Federal government via taxes?  State and Local government via taxes?  Employers?  Individuals in addition to taxes via premiums (plus additional out of pocket expenses if you get sick).  What is the distribution of which? 


That is my list of questions, so far.

What would you add?


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Can we add temporary disability to the list? Last I checked, only 5 states provided temporary disability benefits. A six month illness can bankrupt someone even if their medical care is provided. I see this as an important part of encouraging people to seek care when an illness first occurs as opposed to waiting.

I also know of people denied disability because their doctor's were unwilling to back a claim, in this case from someone with a number of interacting physical problems that had him s so fequently in and out of doctor's offices and that he was unable to get a job in the present market.