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Editor’s note: The Denver Post asked readers to submit ideas about how America’s broken health insurance system could better serve the nation and what Congress should do to fix it. Here is a sampling of the letters we received.
Health care is a basic human right. The U.S. spends more on health care than any other industrialized country, yet we have poorer outcomes. We are sicker and are more likely to die from preventable causes than citizens of other countries. Our health care costs add substantially to the national debt.
Americans say we have the best health care in the world. That may be true if one can afford a concierge physician or have a specific disease that is treated better here than elsewhere. But due to high costs, difficulty accessing primary care and disparities like income or race, millions of Americans are still without coverage.
The answer is universal health care. Unfortunately, with the president’s recent executive order on health care, we are heading in the absolute wrong direction. More people will lose coverage and die unnecessarily.
Carol Goldstein, Englewood
The writer is a registered nurse.
Fixing America’s broken health insurance system is simple. Medicare and Medicare Advantage are a single-payer system that seems to be functioning well for our senior citizens and for those with disabilities. It would not take much tweaking to extend coverage to pre-retirement-age Americans. Medicare adjusts premiums based upon income, and Medicare Advantage already utilizes private insurance companies to sell plans to individuals. A less costly pre-retirement plan with fewer benefits may be offered as an option. No one would be forced to enroll, but perhaps some tax incentives might encourage participation. Premiums would have to be paid directly by those covered individuals instead of being deducted from Social Security. Private insurance companies would still be free to offer more comprehensive plans and compete with each other, but at least we could offer all Americans basic safety-net of coverage.
Edward Rosenfeld, Greenwood Village
As a small-business owner, providing adequate health coverage to our employees has been a major management focus. We have watched political posturing erode any ability of Congress to reach rational compromises. For 25 years, presidential leadership has not resulted in a national consensus. We need an alternative approach to halt the rhetoric and commit to rational evaluation. I suggest a large, high-level panel of experts from all persuasions to address the basics:
Who should be covered and to what extent? What should be the role of insurance and corporate profits? What should be the respective roles of the federal government and states? How can we find efficiencies to reduce overall health care costs? Can we solve the difference between urban and rural needs?
We can no longer trust the political system to craft reasonable health care compromises.
J. Kemper Will, Denver
It does not take a brain surgeon to understand that for-profit insurance companies exist to maximize profits. The best way to maximize profits is to only insure the healthy. Since that goal is unrealistic, the second-best alternative is to avoid insuring the sick. The only way insurance companies can truly avoid insuring just the sick is to insure everybody. Participation has to be compulsory. Our increasingly larger and fewer remaining insurance companies need to be treated and regulated like the utility companies they are becoming.
As a nation, we pay in excess of 17 percent of our GDP towards health care, and for that large sum we do not insure everyone. The United Kingdom pays just over 9 percent and insures everyone. As a mild-mannered, bald-headed accountant, I would like to tell my senators and representatives the obvious, it is better to pay less and insure more than it is to pay more and insure less.
Rick I. Kerr, Denver
The key to sustainable and accessible health care is affordability. Not only will affordability benefit those who are healthy, it will especially benefit those who are unhealthy. Because of health insurance companies who were exempt from antitrust laws, personal injury lawyers run amok, etc., we were already on an unsustainable cost trajectory before Obamacare ever came along. Not only did Obamacare fail to address these underlying issues, the subsequent skyrocketing cost of premiums and deductibles proved yet again that the federal government is the worst possible choice for reducing the cost of nearly anything, especially when money-laden lobbyists are involved. It also helps make the case for why, going forward, the solution to affordable health care is a combination of competition in the private sector, a level playing field (by getting rid of antitrust exemptions), tort reform and implementation of health care by the states, rather than Washington, D.C.
Douglas Fleecs, Greeley
When someone gets badly hurt or very sick, they don’t go shopping. They get it fixed, whatever the cost, and worry about paying for it later. Getting it fixed is not optional. Therefore, health care does not respond to normal market forces, and so should be in the public sector.
I’m an old guy and I’ve been well-served by Medicare. Medicare deductions from paychecks throughout my career were a good investment. I think that universal Medicare should be the way to go. A lot would have to be worked out as far as setting reasonable tax rates and fees paid to health care providers and the pharmaceutical industry. Eliminating third-party insurance companies should produce some savings. Maybe those people could be re-trained to do something useful, like administering Medicare or installing drywall.
Bob Wood, Monument
Let’s stop pretending that health is amenable to the actuarial models of home, car and life insurance, which we buy hoping we will rarely, if ever, need. Instead, we should be actively promoting primary and preventive care. Let’s pool all the state and federal subsidy money and a share of money from the public programs to create a concierge-style system of primary care in which primary care providers are paid a healthy monthly or quarterly fee per head to provide primary, preventive and urgent care to keep people out of ERs and hospital beds. Encourage competition, based not on price but on access and quality of care, by allowing people to change providers at open enrollments twice a year. Remove all such services from private and public health plans, compelling them to reduce their premiums to cover untoward health care needs like other insurance models are intended to do.
Deb Bennett-Woods, Greeley
The writer is a professor emerita at Regis University.
The basic problem is with the word “insurance.” Insurance is designed to accept money from many and to pay out money to only the few who have the problem being insured against — house disasters, car accidents, etc. Health does not work that way. We will all die someday and, along the way, most will have various health issues. Get rid of the profit-oriented health insurance companies and have each of us pay all our lives for health coverage. As an 81-year-old, I have enjoyed health “insurance” most of my life, and my healthy early years only gave profits to some company. Instead we should have a single-payer program that funnels the money to the medical world of workers.
Barbara B. Bond, Dillon
Current health care proposals add more complexity to a very complex system. This is not the answer. Simplicity is. Start by recognizing the two primary issues. First: What should be the minimum coverage offered by insurance companies? Second: How can health insurance and care become less expensive?
The government would have two simple and relatively small functions to address these two issues. First: Setting the requirements of a basic plan. Second: A tax credit would be given upon proof of insurance. Of course, Medicaid would continue to cover low-income folks.
Then, let the free market work. Everyone shops for himself or herself, just like any other purchase. Competition will keep costs down and quality up.
There will always be the “What about this, what about that.” Trying to “fix” everything is the cause of the chaos.
Fred Degiorgio, Lakewood
By focusing on health insurance, you are looking at the wrong issue. Health insurance is just a way of paying for health care. The inexorable rise in the cost of health care is the fundamental issue. Since 1960, median family income has increased 78 percent, GDP has grown by 447 percent and health care costs have increased by 873 percent. These percentages have been adjusted to eliminate the impact of inflation. Unless we limit the growth in health care costs, the vast majority of Americans will soon be unable to afford health insurance — or the array of health care it pays for.
Allen Lindeman, Aurora
If I go into a business — a car dealership, a clothing store, a restaurant — I expect to look at a price tag and see what the product or service is going to cost before I buy. Try doing that with medical care. It is difficult or impossible because a medical procedure may cost different amounts even at the same provider.
Medical providers should post their prices like any business. Call it a medical menu that you can pick up at any medical business or access online. Now you can make choices about the services you need and have an idea of up-front costs. That should promote more choice and more competition. Isn’t freedom of choice what we want in a free-market system? Wouldn’t that start medical providers competing for us as customers, and isn’t that how we expect other businesses to function?
Deborah Ross, Colorado Springs
We have been purchasing individual health insurance for 13 years. Our premiums have gone from $516 a month (with a $500 deductible) to $2,007 a month (with a $5,300 deductible) for 2018. We are a 61- and 62-year-old couple (no children). We have gone through the stress of underwriting several times.
We are strong supporters of the Affordable Care Act and believe it is a big step forward, especially guaranteed issue (no penalty for pre-existing conditions and no lifetime caps).
What Congress can do to improve a good start:
1) Require everyone to be covered from a certain age.
2) Consider an early buy-in to Medicare (age 50 or 55). Throughout the discussion, I have never been told what my cost would be to pay the full cost of Medicare.
3) Consider having the government bear the risk and expense of lifetime costs exceeding a certain amount ($2 million or $3 million).
4) Consider requiring a set number of standard plans to be offered by all carriers like Medicare supplemental plans. This would allow carriers to sell plans across state lines without mass confusion.
5) Consider a public option as originally envisioned with basic coverage affordable to all (with some help required).
6) Continue to include preventive care at low or no additional cost. This will lower the incidence and cost of chronic disease.
Mitchell Imber, Boulder
Thanks to Obamacare and Medicaid expansion, I was able to obtain health insurance for the first time in five years. However, what I most regret about health care is Obamacare’s mandate or tax penalty. I struggle to pay my insurance premium every month, even with a high-deductible plan that covers little. If I incur a gap in my coverage, then there is tax charge but no health benefit is provided. I do not understand why the richest nation in the world cannot provide universal health care for every citizen. Congress has it. Why can’t the people have it, too?
Jeffery Moser, Aurora
My take on health insurance is pretty short and not so sweet. If I lose my Affordable Care Act coverage purchased through the Connect for Health Colorado exchange, I will I will not survive. My family does not have the resources to afford my care, and as a 62-year-old, three-time cancer survivor with COPD, there will be no coverage available to me that we can afford. I do not intend to burden them with my costs. My grandchildren do not deserve that. If it becomes clear that my health care has become a liability to those I love, I will end my life rather than see that happen. We need Medicare for all of us. This should not be happening here or anywhere.
Donna S. Smith, Denver
Here are a few simple steps to improving our nation’s health care system.
First, we eliminate gerrymandering so that there is no longer any such thing as a safe seat in Congress. With true competition for congressional seats, we will fill Congress with people who actually care more about their constituents than the party bosses who put them in power.
Second, we remove money from politics. Money is not free speech and the rich are not entitled to more of it than the least of us. Freed from the burden of fundraising and the inherent quid pro quo that accompanies the acceptance of large amounts of cash, Congress can focus on doing its job.
Third, we eliminate barriers to third-party candidates so that we have more than the two limited visions of America provided by the inept and self-serving Democrats and Republicans currently running our country.
Lawrence Jones, Conifer
There’s no shortage of policy proposals for health care. But I don’t believe we will agree on one (or a combination) of them until we have a national consensus on these questions:
1. Should every American be guaranteed some reasonable level of health care?
2. Should we continue to spend 18 percent of GDP (and probably more as time goes on) on health care?
If we are not willing to spend so much, are we -– doctors, hospitals, pharma, patients -– all prepared to accept our share of the sacrifice required to control health care costs?
With agreement on these points, it should be relatively easy to craft policy from the many options available. But until we agree, the health care policy debate will continue to be based ideology, self-interested advertising, and sound bites.
Victor von Schlegell, Denver
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