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Health Care from the Ground Up

by Jean Hay Bright
October 2000

Health care and prescription drugs are topping the list of voter concerns this campaign season, as well they should. In the six years since Harry and Louise warned us about Clinton's national health care proposal, the privately-run HMOs have managed to deliver all the horrors they predicted -- no choice of doctors, bureaucratic bungling, rising costs, etc. At the same time, many businesses are reassessing their commitment to providing health care to their workers. And the number of uninsured Americans is increasing.

The time is ripe to look once again at a single-payer health care plan. I think the one I proposed during my race for U.S. Senate four years ago would work at the state level as well.

Mine is a three-tier plan.

The first tier would be a small amount ($500? $1,000? $2,000?) of up-front government money available to each person each year. This money would be enough to cover routine visits to the doctor and dentist, a few lab tests, some prescription drugs, as well as the occasional "I feel awful, what's wrong with me, Doc?" sessions. Eye and ear care, mental health services, and alternative medicine would be included. The choice of which services and providers would be left to the discretion of the patient, based on the patient's perceived need for those services.

The second tier of medical expenses would be a self-pay component, the responsibility of the patient, up to a set percentage of individual or family income. I chose 10 percent for my plan because I think even those in the lowest income brackets can handle 10 percent of their income for medical expenses in a given year.

When a patient graduates to the third tier, the government would step back in and cover all medical expenses, much like a catastrophic illness plan. Long-term health care coverage would come in here.

Funding for the first and third tiers would come from general income tax revenue, as well as a business tax on wages that would replace all the health care costs they now spend for their employees.

My plan I believe would encourage preventive care and less-expensive early intervention, while at the same time addressing one of the primary concerns expressed by opponents of a single-payer plan -- cost-overruns. I do this by making it in the patient's best interest to pay attention to the bottom line, and to shop for health care.

Having to fork over $50-$100 for an office visit is a real stopper for a lot of uninsured people, who often wait to see if they will get better spontaneously -- or until they think they are on death's door.

On the other hand, many people with insurance will insist on more expensive treatments or tests than they need, because they are not paying the bill. The tendency is to view insurance payments as free money, with a "heck, the insurance will cover it" attitude. Fraud and over-billing often run rampant in such an open-ended system.

If your health coverage is limited to a set amount of money, instead of based on the kinds of treatment listed in your insurance plan, it changes the whole dynamic between patient and health care provider.

I believe most people would be very prudent with their annual allotment. They would ask how much a doctor's visit or a lab test costs. They might shop around for a better deal on their regular prescription drugs. By the same token, allotment in hand, they would not delay seeing a doctor early when the need arose.

The same holds true for the second tier. People would spend their money wisely, since it would all be coming out-of-pocket. At the same time, with their own liability capped based on their income, they wouldn't turn down an expensive but essential test, treatment or surgery. But they would stop and think about it, which would be good.

With employee cost-sharing for health care now a major issue in union contracts, I believe business managers would relish my plan. Businesses would not have to drop coverage altogether, as many are doing, because of the dramatic increase in premiums. A set fee for medical care charged to all employers based on the wages paid would make health care costs equitable for all businesses. Instead of worrying about their employees' health care, business owners could concentrate on doing what they do best, whatever that is.

Workers, also, would have the freedom to job-hunt based on their own talents, interests and abilities, instead of worrying about finding a job, any job, with a decent health-care plan because someone in the family has asthma or diabetes. Smaller businesses, those that couldn't afford conventional insurance plans, would suddenly find themselves attracting a better, more focused, field of workers. I can't help but think that would have to be good for the economy.

This plan would eliminate much of the need for regulations about insurance portability, pre-existing conditions, coverage for family members or significant others, and a myriad of other details which now take up the time, energy, and attention of a whole lot of people.

It would also return personal responsibility to the health care scene, rewarding preventive medical care and good health, as well as vigilance toward the details in billings.

I'd like to think Harry and Louise would approve.

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