Checkup

Vital Signs: Who's going to pay? Part III

Dr. George Bartley

Dear Reader:

In my last two columns, I tried to highlight some of the challenges facing our nation with regard to health care finance. Without getting into the interesting debate over whether medical care is a fundamental human "right," I suspect that virtually every American believes that each citizen should have affordable access to at least basic health care services. The big problem, of course, is paying for such care. Continuing to shift costs onto employer-sponsored insurance and providers is unsustainable, particularly as the baby boomers start retiring in huge numbers at the end of this decade. So what's a country to do?

Mayo Clinic supports reformation through market-based universal health care coverage. That's a mouthful, so let's walk through 10 principles on which our proposal is based.

First, every citizen should be individually responsible for obtaining his or her health care insurance, just as each is expected to obtain automobile insurance.

Second, universal coverage doesn't mean "socialized medicine." Rather, government's role should be to oversee a menu of options from private insurers, similar to the current Federal Employees Health Benefits Plan (FEHBP), ensuring that every option offers minimum required coverage.

Third, people should have the freedom to purchase additional coverage beyond the basic package.

Fourth, employers would have the option to pay part or all of the health care premium for their employees and their dependents. Employees, in turn, would be free to choose among any insurance plan on the national menu (as occurs today with the FEHBP).

Fifth, reimbursement would be negotiated between the insurance plans and the providers, without government price controls. This market-based approach will help to stimulate competition, innovation, and quality.

Sixth, unlike the current situation in which private insurers have incentives to delay treatment of chronic conditions until an employed patient can be "off-loaded" to Medicare at retirement, insurance companies would have a financial interest in encouraging prevention and appropriate early therapy.

Seventh, government financial assistance to purchase insurance should be available to those who cannot afford it. Such assistance could be in the form of cash, vouchers, tax credits, or other means and could be determined by income, age, disability, or whatever criteria the government chooses. Long-term care currently supported by Medicaid could be addressed separately by a government-supported program, if desired, exclusive of this model.

Eighth, the current Medicare and Medicaid programs would be transitioned into this new system to avoid disruption for current beneficiaries. Again, the government would get out of the insurance business and play a more natural, regulatory role as an overseer of fairness and availability.

Ninth, the government could and should continue supporting medical research and education, which provide major benefits to all of society. However, an all-payer mechanism from others who profit from this investment, such as insurance companies and the biomedical industry, should be considered.

Finally, reform must occur, and this proposal should be palatable to both major political parties. America currently spends about 14 percent of its Gross Domestic Product on health care, yet we still have millions without insurance, children who lack adequate vaccinations, seniors who cannot afford necessary medications, and fragmentation of care between "cottage industry" subspecialists. We can do better. Let's get on with it.

Sincerely,

George B. Bartley, M.D.
Chair, Board of Governors