Health Reform 101

With so much information out there, where do you begin? There’s nothing simple about health reform, but here’s a primer for North Dakotans.

What’s the problem?

What’s the solution?

How to make it affordable?

What’s the problem?Problem One:

Health insuranceHealth insurance and quality health care are difficult to afford today. More than 75,000 North Dakotans are uninsured. When they get injured or become ill their choices are few. They can pay cash for medical care, or go without.

As costs continue to rise, even more people will be squeezed out of the health care system, unless we take action.

What’s the problem?Problem Two:

Wasted moneyOf every health care dollar spent, 75 cents goes to treat chronic illness—things like high blood pressure, heart disease, type II diabetes and others. Many of these illnesses are avoidable.

Another expanse is medical waste. That’s the money spent on excessive tests, duplicated procedures, unnecessary emergency room visits and other types of care that don’t really make you any healthier.

In some countries, people use the health care system to stay healthy. In North Dakota, and across the country, we typically wait until we get sick and expect our health care system to cure us. The end result is a nation that spends more on health care than similar countries, but is among the least healthy.

What’s the solution?House bill. Senate bill. HELP bill. There are many different ideas being discussed. If and when we see a final health reform package signed, it could include some—or all—of the ideas below.

One idea:

Insurance for everyone—healthy or sickOne of the most talked-about reforms is that health insurers should be required to insure everyone whether they are healthy or sick. You’ve likely heard this called guaranteed issue.

This idea is really dependent upon the next idea, which requires peopleto get insurance.

What’s the solution?Another idea:

Requiring everyone to purchase insuranceMost proposals have built in some sort of requirement for everyone to be insured, similar to drivers being required to carry auto insurance.

Why?

So people don’t wait until they’re sick to get insurance. Think of what would happen if drivers could get insurance after a crash. Obviously no one would pay for insurance until they need it, causing prices to skyrocket. And it defeats the purpose of insurance. So it is with health insurance.

In North Dakota, health insurance works because all of us pay into the system, allowing costs to be spread out. The healthy share in the cost of care for the sick.

What’s the solution?Another idea:

A government run systemAlso being discussed is doing away with the current structure altogether and letting the government administer healthcare—just like it runs the post office and the education system.

Problem is, this option could end up looking a lot like Medicare, which underpays providers, especially in North Dakota. If medical providers aren’t getting paid enough to cover their costs—the current case with Medicare—how long could they keep their doors open?

A “light” version of this idea is to let people choose between private insurance plans and a government insurance plan.

What’s the solution?Another idea:

Employer mandatesShould employers be required to offer health insurance to workers? That’s another issue being debated. Some would rather see a way for people to get coverage on their own—apart from the workplace. They envision a clearinghouse that connects shoppers with health care insurers.

No matter how these ideas come together, there will be additional costs. The government, or rather taxpayers, will need to help some people pay for insurance. So it’s in everyone’s best interest to make it affordable. Question is how to do that.

How to make it affordable?One idea:

Efficiencies through technologyUsing technology can help make the health care system more efficient and reduce costs. Determining how to use it is a topic of conversation in many different groups.

How to make it affordable?Another idea:

Empower shoppersIn most any other product or service you buy, you have the opportunity to compare price, quality and convenience. Many reform discussions include debate on how to give you that same power in choosing health care. Some options, though, have a one-size-fits all answer.

Giving you the information to make your own decisions will help you use your health care funds most efficiently.

How to make it affordable?Another idea:

Paying for quality of care, not quantityToo often, patients get treatments that don’t ultimately improve their health. If we refocus on paying medical providers for the outcomes, rather than the amount of care they provide, it would help curb medical spending waste, not to mention people would get better faster.

How to make it affordable?Another idea:

Practice preventionFocusing on keeping ourselves healthy will be a big part of health care affordability. If we can learn how to avoid some of those chronic illnesses that dominate our current health care spending, it will go a long way in curbing costs. Any reform should include tools and incentives to help people eat right, exercise and manage conditions before they become full-scale problems.

Conclusion

The government is looking at all of these options, but so far there’s no clear winner–or winners. We could end up with any combination of ideas—or something brand new. We’ll keep you posted.

Ready to dig deeper?