Health Insurance

2020 Reform

Americans have a huge opportunity to get healthcare right in 2020.

The current system is broken. Access is limited by the lack of coverage and/or the cost of healthcare.

Medicare for All would make healthcare more accessible to all American even though access has yet to be defined in terms of who and what.

Getting who and what right is the first opportunity. If the benefits are too rich, the system will become unsustainable. Reportedly, Canada is spending 60% of all tax dollars on healthcare and have reached their maximum budget. They too are trying to address the rising cost with the triple aim.

The Republican concerns are real if other measures are not taken to curb the cost of healthcare.

Expanding access helps reduce the cost/person if people use the system to better manage their health and thereby reduce the need for expensive medical intervention.

For the theory to work:

1/ Self-Care: Americans need to take a more active role in managing their health and wellbeing.

2/ Primary Care: PCPs need to engage as health coaches rather than just as gatekeepers to specialists and pharmaceuticals.

3/ Coverage: Insurers need to cover self-care apps + devices.

The opportunity in 2020 is to present a new system that focuses on health and cares for the sick when needed.

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.