Expand Health Care Coverage the Sensible Way

            Health insurance funding is in and out of the news continually. The current proposals don’t seem to make anyone happy…. Not only are many uninsured, or paying high premiums, but Medicare is currently headed for ruinous expenses.
            I have worked in many roles and areas of health care over a 40 year career and believe in the benefits of access to primary care.
            Here’s a different idea that should be considered. It would allow market capitalism to work in a way that would increase patient choice, promote preventive care, spur innovation and hold down costs, and it could provide really affordable care and security for all Americans. Ours is a wealthy country and some benefits should go to all our citizens - the whole community loses when people fall through the cracks in the system and develop serious and chronic illness… but when everything is provided by government, everything is controlled by the government. Here are my proposed A B C’s of health coverage.
 

1. Medicare A for All- Acute care This is the branch of Medicare that pays for hospital care and some rehabilitation and home care. This is currently provided to all US citizens age 65 and over or disabled. We should provide this for all citizens, as it would: 1) Reduce costs for outpatient insurance coverage to manageable levels 2) Make it easier for hospitals to manage costs. 3) Provide security to US citizens.  Costs for uninsured patients are currently covered by Medicaid or “cost shifted” to insured patients AFTER the patient has become seriously ill and has a large hospital bill, so the public is already paying these costs.
2. Better Care in Basic Primary Care and Outpatients This insurance would cover all office visits to primary care and specialists, emergency care and outpatient testing and surgeries. It would be purchased by individuals or employers.  Potential advantages: 1) Security of affordable coverage - people would be free to change jobs, start a new enterprise, etc. 2) American business would have more options and manageable costs in helping employees with coverage. 3) Flexibility - it could include a health savings account to allow more flexible spending on non-standard care such as nutrition counseling, chiropractic care, acupuncture, etc. Each citizen would be required to purchase some type of coverage OR have a sum set aside to cover costs. Policies could be in the form of an HMO, group coverage or individual. Current Medicare recipients would be partly funded to buy this outpatient coverage - as they are now. Medicaid recipients could receive a voucher to purchase a basic plan, providing them more choice.
3. Cost saving measures - Other measures to save costs are also needed. Some may include: 1) Reducing pharmaceutical prices by allowing more competition 2) Hospital cost controls using established international standards for effective care, 3) Require a small co-pay for all Medicare outpatient services to reduce excessive tests and doctor visits, and 4) Allow establishment of infirmaries with excellent nursing care for simpler acute / hospital care. This could reduce Medicare payments in the last year of life - currently 1/4 of all Medicare payments. 5) Allow experienced nurse practitioners to practice within their scope without formal supervision requirements in all states as 18 states already do.

            Our current “system” is causing a huge amount of stress for Americans and many people neglect treating disease at an early stage, leading to higher overall costs, worse outcomes and many bad effects on the health of the community at large. Americans need a platform of security in health coverage to free them to innovate and live their lives with greater peace of mind.
Elizabeth Markovich,
Nurse practitioner, Integrative Healthcare.