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Universal health insurance vital but costly

Sat., July 11, 2009

DEAR DR. GOTT: All we seem to read about in our local newspaper is suggestions for health-insurance reform. Each person, from the man on the corner to the president of the United States, has opposing views. That’s not even taking into consideration the CEOs of countless large corporations who earn oodles of money while running the rest of us into the ground with their perks and golden parachutes.

Do you have any views you will consider sharing?

DEAR READER: Yes, I do. I feel health insurance should be a shared responsibility between each person and the federal government. While I can appreciate that some people may not have a source of income or might be existing on extremely limited funds, I am referring to the average Joe who has a means of supporting his family. Perhaps we can base it on individual earnings in excess of $50,000 annually. It goes something like this:

Working on a calendar year similar to Medicare, each individual will be out of pocket up to a check or money order for $2,000 for medical expenses incurred.

Beyond that, the individual will be required to hold private health insurance bridging the gap from the check or money order for $2,000 up to $5,000 should medical expenses be incurred. This coverage would be reasonably priced and universal throughout all 50 states.

Once that $5,000 limit has been met, the government steps in and pays expenses incurred for the balance of the year. The process then repeats itself in each subsequent year.

The advantages of my system are predictability, a limited liability on the part of each taxpayer and patients who actually participate in the financial aspect of their care. There are no hidden surprises, and this becomes a shared experience.

Before we proceed, I am acutely aware there are kinks that need to be resolved. An individual on welfare probably cannot participate at all without outside assistance. After all, to ask an out-of-work person to be out of pocket for $2,000 in every calendar year is ludicrous. Then there’s the issue of paying a health-insurance premium for what could be a good year without sickness when the money could have been spent paying for food, clothing, a mortgage and other tangible things. Perhaps this translates to each respective state picking up the tab for everything – the first check or money order for $2,000 worth of expenses in each calendar year and providing insurance coverage thereafter.

Residents of Japan have access to National Health Insurance. People are enrolled in the NHI based on the following criteria: They have resided in the country for one year or longer. They lack another form of government coverage. They are not full-time employees of a company that provides social health insurance. To be fair, the program is controversial. Many members feel trapped into paying more each year for coverage and find it’s an easy plan to join but difficult to withdraw from.

Private insurance generally covers 100 percent of costs in Japan, and the NHI only 70 percent. Age, general health and income sharply affect NHI premiums paid. People with many medical problems may actually profit by joining despite the fact that fees are not paid in full. Healthy individuals will fare better being on private insurance because the monthly insurance fees will likely be less than paying for the noncovered 30 percent.

One Canadian reader expressed some dissatisfaction with his universal plan. He claimed that because of his tax bracket, he had to pay 40 percent of his gross salary for taxes, a large portion of which covers his health insurance. The biggest problem is waiting to have surgical procedures done. While some procedures appear elective, others are more critical. Still, a wait is anticipated and often accepted as the price Canadians pay for having insurance.

Almost 40 other nations have some form of universal coverage for their citizens. Sri Lanka is included here, but that country may not have what we consider a complete plan in place. One of the things they do have, however, is a prescription plan that provides for all medications to originate from a government-owned drug manufacturer.

One of my pet peeves is the lack of limits placed on lawsuits. While I understand some claims are clearly justified, some people sue for millions of dollars based on what appears to be trivial complaints. Insurance companies aren’t fully prepared to handle such claims. This greed results in increased insurance rates across the board as an attempt to recover some of the outlay. There must be limits to help you, me and every other American. Boy, do we have our work cut out for us!

Dr. Peter Gott is a retired physician who writes for United Media.


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