Morphing Towards Universal Health Insurance

01/04/2006

A four tier national health system is evolving and we are close to major change-over

By Paul Munnis
January 5, 2006

Americans will not quickly recognize it. The Bush Administration and the GOP will totally disagree and be in full denial. The Insurance Industry will shake their heads in disagreement. The medical community is staying pretty mum on the subject. Yet America is slowly but surely morphing its way toward a de-facto national healthcare system. It’s happening at a fast pace too.

All such systems are phased in. They do not happen in one giant leap for mankind. That is because they are very expensive. Instead, a piece falls in here that covers one section of society. Another falls in there that covers a different section of society. One day the pieces all fit together pretty good and then you have a system with all of society covered.

It’s happening right now and the change-over is just about done. A hurricane blew it along and accelerated events.

When the victims of hurricane Katrina fled to makeshift shelters in New Orleans, Houston and elsewhere, they were tired, broke, sick, and dislocated souls. They were also unemployed. They became welfare eligible and they joined millions of others, including many children of the poor and impoverished across America in the State administered Medicaid programs. Even as a GOP Congress fought to kill Medicaid, it morphed right under their noses into a growing insurance system for covering the emergency medical needs of disaster victims especially poor and needy children. Medicaid is a federal funded program and administered by the various fifty state governments. More and more people are going onto Medicaid. It is the fastest growing healthcare program in America. The U.S. and State governments are the program administrators while the existing healthcare facilities are the providers of medical services. Medicaid has a schedule of what it will cover and what the fee amounts are that it will pay. Fees differ by State and reflect the uneven distribution of medical costs across America. The medical establishment has to accept the state fee as full payment for services and for the most part they do.

Other people that can pay for health care insurance out of their own pockets, by virtue of being financially well off, are now doing so. If they are business owners they have generous tax subsidies to recover their expenses. All of us have pretty good tax deductions to recover excessive health care costs and those will be tuned-up to reflect systemic needs as our national treasury permits.

Some who have precious skills are recruited by companies who require very specialized talent and these talented employees are covered by employer provided health care plans. This pool is rapidly shrinking yet it’s a recruiting tool for corporate needed talent and it covers many who work in American companies. These lucky workers continue to get employer provided health insurance for themselves and for their families. That health insurance is administered by private sector insurance companies who are pruning the health insurance membership to eliminate as many at-risk customers as possible, thus assuring their own profitability. They have caps and co-pays and can use itemzed taxes to recover some of the excesive expenses.

The elderly are already on Medicare and that program is being expanded with prescription drug coverage. Nevertheless, retiring Baby Boomers are moving onto Federal provided healthcare plans at a pretty good rate. They have to pay a portion of expenses out of pocket for their treatment, drugs, and facility use. As Baby-Boomers age this program will become the critical path insurance plan for the majority of older Americans.

War veterans are dying off and no new health entitlements are being given out in that area. Soon however, some sort of Iraqi Veterans program will come forth that will turn VA facilities over to the military for Administration and then the Iraqi veterans who fall through the cracks will get their medical care at nearby military base health care facilities. If they were wounded or disabled in the service of our country then they will get free care. As the troops come home from Iraq you will hear more on this.

Finally, some sort of Federal program will come through permitting the purchase of lower cost healthcare insurance to those who must pay the freight themselves or for their corporate employees. This will help business obtain added subsidy for their costs. Likely it will be a fine-tuning of the corporate and personal income tax deductions or credits allowing even more generosity as deduction of medical expenses including the cost of insurance from taxes.

Then it will be done and over with and we will have a four tier healthcare system. Tier one will be for the poor - Medicaid. Tier two will be for the middle class who must pay their own way and will be subsidized via tax deductions and if they have needed skills then their companies will pay while the corporate insurance will be subsidized by the tax system. Tier three will be for those veterans who fall through the cracks plus the active duty soldiers and their families – Military Health Care. Tier four will be for the retired and elderly (Medicare). Tier five will likely be explored in due time for terminally-ill patients and those on long-term life support systems. Most of these tiers are now in place and are working pretty well. The 2008 presidential election will likely assure the finalization of the medical insurance tax subsidies and begin the tier five dialog.

Is this the product of some political party strategist? Maybe it’s the result of Intelligent Design? Or is it a de-facto creation of order out of chaos from a society that deplores chaos? We don’t know for certain but we can see the handwriting on the wall and it is labeled: “American Healthcare System.” This change-over is happening gradually and surely. Hurricane Karina has expedited it.

We hope this handwriting on the wall is not graffiti. We also hope the Democratic Party perpetuates the trends. We pray that the GOP demands that the medical industry restrain cost increases so as not to bust the system. We do not want an Aviary Flu pandemic to test the structure and integrity of the newly evolving system either.

We suspect that we can make technical advances that will use the Internet to deliver increased health services such as patient monitoring, patient interviewing, patient symptom gathering, patient diagnosis, plus computer sampling and digital input and conversion of vital sign health data including radiology and permit online drug prescriptions. There is a lot of opportunity there for the future and it’s called Telemedicine. Just down the street from me there is a huge facility dedicated to developing and extending this technology. It is in heavy test use now and it will soon manifest itself on a computer near you.