2018 December

Limited vs. Premium

Forget “Medicare for All”.

The easiest way to think about fixing the healthcare system is to use the framework for reconstructive vs. cosmetic coverage.

Three words are used to evaluate whether something is covered or not: Bad – Good – Better. Here’s how it works:

1/ Reconstructive Services: [Bad to Good]

Reconstructive services focuses on health improvement from bad to good. [ie: reconstruction following mastectomy vs. breast augmentation.] The idea is that the service restores the body to “expected” function or appearance. The same concept can and is applied in coverage decisions for any body part or core function now in government programs. It’s limited coverage to keep people in good health.

2/ Cosmetic Services: [Good to Better]

Cosmetic services which focus on improving appearance or more broadly, services that improve quality of life aren’t covered. Anything that extends “expected function” isn’t necessary to sustain life. However, those services tend to enhance the quality of life. A good example is fertility services that are now an option for some commercial plans.

Of course, there would still need to be safeguards because some in the industry have a misguided understanding of capitalism.

Limited vs. Premium

It’s an easy concept for Americans to grasp limited vs premium coverage. And according to the Koch Brothers, there is more than enough money in the system now to provide limited coverage for all. While also giving Americans the option to purchase richer premium benefits.