The Obama Plan – What’s In It For Me?

It is now well over the First 100 Days of President Obama’s first term in the Oval Office, yet we have precious little information about what the President is likely to lead us towards, what sorts of changes the Medical industry and patients can expect.  While many are excited to see some sort of healthcare reform, some sort of game plan to ensure that all who need care have access to it, the fact is that a large portion of the country already has affordable access via their health insurance.  Or do they?

The fact is that most traditional coverage requires a 20% co-pay by the patient for hospital stays.  When one has a major illness or trauma, that 20 percent becomes enormous and financially catastrophic to the individual’s budget.  If the bill is $200,000 then the patient still has to pay $40,000 of it… and while the insurance companies may have the clout to renegotiate the costs with the hospital and other providers, the individual does not have that ability, as few have the funds available to pay even a reduced portion of forty grand.

Another way in which the insured don’t really have coverage is exclusions from the health insurance companies.  We’ll examine this in greater detail in an upcoming post, but suffice it to say that just because your doctor prescribes a medication or procedure doesn’t mean that the insurance company is going to pay for that treatment.  This isn’t the difference between a drug and its generic equivalent either.  There are times when the insurance companies are effectively prescribing treatment by holding the purse strings.

Would a law which forces the insurance companies to pay for prescribed treatments raise the costs?  What about a low or zero deductible policy?  Surely those will raise the costs, won’t they?  The answer is split.  Yes, it would raise the costs to the health insurance company, but that company is going to split the costs amongst all of their clients.  In the final analysis, it will cost each of us a little bit more, but ensure that none of us is facing tens of thousands of dollars in debt — even when we have well-rated coverage — when we get out of the hospital.  It will protect us from having insurance companies practicing medicine by deciding not to pay for a medication or treatment.  Since any form of insurance is an attempt to spread the costs out across a larger number of people, it stands to reason that all-inclusive coverage for non-elective cosmetic care is a part of making existing healthcare functional.

Medical Malpractice insurance is often scapegoated as the cause of the high costs of medicine.  To be sure, the cost of protection is a factor, but defending against inappropriate law suits is expensive and creates a huge burden.  Get rid of that aspect, the costs go down dramatically.  Physicians do not want to harm their patients.  They became doctors to help people, to heal them.  Accusing them of intentionally or negligently harming a patient can be devastating, when the physician most likely never had any but the best of intentions!

Like any other form of abuse, frivolous malpractice suits are a form of insurance fraud which everyone pays for.  Tort reforms have helped a lot, but further protections mandated by legislation, protections for the physicians (except in cases of blatant malpractice, of course) could go a long way towards reducing both costs of premiums and losses. Meanwhile, getting more physicians to sign on with Medical Justice (and take other steps to reduce risk) is a large step in the right direction.

Whatever form the Obama Administration’s plan takes, if if it doesn’t address these concerns and issues, it’s going to be met with indifference by those who have healthcare, and prove ineffective overall.  Certainly, the entire system would gain from restructuring, but the working public must stand to benefit from these changes as well, it is to receive bipartisan support.

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