We are all tired of the health care debate and just want to get it done. There is little agreement on exactly what a good health care plan should look like, and everyone has an opinion.
Everyone believes change is coming regardless of what we call it. Most also agree change is very much needed. The original ACA plan was well intentioned, but fell short for many American’s while working well for some.
We believe a successful plan will contain several key elements. Here they are in no particular order:
Coverage: Plans must have the principle medical needs covered. Broadly speaking, these include hospitalization, reasonable deductibles for in office visits and preventive care. These key elements must be in each policy. And be realistic. Don’t force patients to seek minor care in the ER when a visit to a local clinic can be cost efficient and time saving.
Out of Pocket Expenses: High deductible plans can be offered, but we might want to “means test” their purchase. A person earning $100,000 per year might be very comfortable with a $7500 calendar year deductible, while a person earning $25,000 can ill afford that high a deductible. We constantly see patients in total shock when they find their deductible is far beyond their affordable means.
No limitations: We have really put the limitations issue behind us. There isn’t a lifetime benefit ceiling any longer and should not be. We use to see $1.0 million or $2.0 million limitations, but no longer.
Preventive Care: Basic preventive care is an absolute necessity. This should include a routine physical with frequency depending on the patient’s age, and cover other routine testing. This allows for early detection and treatment. Preventive care should not carry a deductible or copay to help insure a patient’s participation.
Pre-existing Conditions and Student Coverage
There must be a mechanism to cover patients for pre-existing conditions. This is probably the most diffiult problem to solve, but it must be done. We should also continue coverage for full-time students of insured parents.
Hopefully our politicians will offer American’s a viable and affordable health care plans with these important considerations.
Like everyone, we can only wait and hope.