Getting businesses out of the business of health care

The top reason that someone accepts or stays with a job they hate is that they need the health benefits.

This attitude is part the reason why Danes were recently voted as the happiest people in the world. They are free to do what they love and focus the family without worrying about being covered in case they get sick.

Now, I'm not advocating a socialist-style national health plan like Denmark's health coverage. At a recent discussion in Montreal, Canada, about nationalized health plans, even our presenter, a health care professor who has practiced medicine on both sides of the border, concurred with Niall Ferguson's assessment that socialized systems are not fiscally sustainable.

So what do the Danes and other socialized nations have that we don't?

They have portable health care coverage that goes with them, whatever they choose to pursue in life. They don't have to take on a crappy job that's a 90-minute drive from home (each way) just for the benefits.

We need health care reform. I'm not necessarily on board with the current Administration's approach. The key change that we need is to get businesses out of the business of health care management and administration.

I'm not sure that this is a job for government either. I have the following recommendations on the White House's guiding principles for comprehensive health care reform (the verbatim principles are italicized):

The Administration believes that comprehensive health reform should:

• Reduce long-term growth of health care costs for businesses and government.
  I recommend that we take the responsibility for costs out of the hands of government and businesses and put it into the hands of the people. If individuals receive their premium bills each month and regular reminders regarding coverage, they will be more aware of costs, coverage, and benefits. Businesses can then choose to contribute to an individual's privately selected health care plan. As a result, the business does not have to manage a pool of benefits and coverages. They can also elect to provide access to insurance consultants to help employees review and select the right personal coverage, but the management of the benefits and costs should be an individual choice that moves with you from job to job.
  
• Protect families from bankruptcy or debt because of health care costs. Health insurers should stop penalizing the insured for cost overruns by health care providers and make doctors accountable if they order unnecessary procedures. The standards for procedures and allowables should be made public so that if the insured has time to review the procedures, they can do so before and be aware of what the doctor should be including and what would be considered exclusions. This "magic formula" has always been a mystery. This might require insurers setting standards for procedures and new technologies and experimental procedures to be approved by feds and insurers. Insurers should also allow the insured to get second and third opinions. With more choice, better information, and the ability to research their choices, both the insurer and the insured won't be stuck with surprise bills and unnecessary debts.
  
• Guarantee choice of doctors and health plans. It would really help if all doctors could honor all major health plans. Health plans would benefit the public more if they have minimum guidelines in place that carry throughout the nation, not just in your home state. That way, if you travel, get a job in a new state, or find a specialist across the country whose services are the most beneficial and cost-effective, you don't have to fret about "networks" and exclusions. This would mean that insurers would have to work with doctors to ensure that they are properly compensated for the services they provide.
  
• Invest in prevention and wellness. This is a "duh" statement. I love my HSA (Health Savings Account) which automatically includes the cost of the annual physical in my insurance coverage (no copay, no application to the deductible). Health education with prevention and wellness should be a public school education requirement as part of mandatory ANNUAL physical education. Community classes should be easily accessible to adults for continued education through community colleges and community (even religious) institutions.
  
• Improve patient safety and quality of care. I echo a few points above. Just keep it competitive and keep the consumer/insured informed. Doctors must allow time for patients to consult advisors and family members before procedures can be done. The pressure to have procedures done can be overwhelming.
  
• Assure affordable, quality health coverage for all Americans. Affordable and quality can be relative. The first step is to set some minimum requirements for affordability that adjusts for inflation/deflation and for quality so that it meets acceptable health guidelines. A government plan is not the answer, though basic catastrophic care and annual physicals would lead to more prevention and lower costs. Our GDP is too closely tied to our being sick. More choices in catastrophic, preventative, and supplemental care plans with nationwide competition would drive up quality and down prices through increased competition.
  
• Maintain coverage when you change or lose your job. I cannot believe that they went after Microsoft for bundling IE with Windows, but we still associate health care options with our employers. The average employee today sticks with a job an average of 4 years, which is a drastic change from the Baby Boomer era (job tenure of 10+ years). Increasingly, more and more people are working as free agents and are responsible for choosing their own health care. Removing health care from compensation packages will allow people to focus on meaningful careers and not sacrifice quality of life. Employers can focus on innovation and job-growth, not plan management and escalating health care costs. The result would be fewer layoffs and more job satisfaction. It's criminal to think we're sacrificing quality of life (which ironically impacts wellness) just for benefits. All plans should be portable nationwide with international care coverage options.
• End barriers to coverage for people with pre-existing medical conditions. Coverage should truly be accessible to all. If the health care industry is doing its job with education, some preexisting medical conditions can be prevented. For those that aren't, patients should never be denied coverage. All patients should have the option to review less expensive, experimental treatments when feasible. Some standardization or approval methods might be needed, but it will continue to drive innovation.
  

I would also like to propose a couple of other ideas:

• Make tax-free savings plans available (like HSAs) to cover cost of premiums in case a person loses their job or to cover gaps in premiums provided by employers. These should be available independent of the insurance plan you choose (unlike HSAs).
  
• Incentivize individuals with tax credits for maintaining healthy lifestyles and reducing health care costs. Who says that we're too old to participate in the President's Physical Fitness Test once we graduate from high school?
  
• Keep insurers, businesses, and governments out of health care decisions. If a patient gets a variety of opinions and finds the procedure that will best help him, it should be covered without going through a series of approvals and reviews. The decision should be made between the doctor, patient, and the patient's family.
  
• Provide more incentives to businesses and communities to provide wellness and preventative care programs to their employees and to the public. Tax credits, stimulus funds, and other programs can be designed to reward businesses and organizations for making education available. They would also be required to demonstrate a measureable decline in health care costs and an increase in health and well-being.

Even with our private health care system, the insured subsidize the uninsured. The uninsured use the most expensive care service - the emergency room - for routine check ups and colds. We all pay for that through the rising cost of medical services and health insurance premiums.

It's time we stop kidding ourselves and realize that we're already paying for a socialized system that's putting the management burden on employers. A complete revamp of our medical system should allow for national (if not international) portability, put individuals in charge of their health care, stop penalizing patients due to inaccessible information and guidelines, release businesses from health care management, and create an economy that rewards health instead of illness.

I could go on, but I would prefer to hear from you. I'll keep you posted on future discussions on this and other topics affecting employers and employees alike.