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Fix Medicare, then allow all Americans to enroll

The wide-ranging proposal by Gov. Arnold Schwarzenegger to extend health insurance coverage to all citizens in California is a bold step to improve the dysfunctional health care system. Nonetheless, without a universal health care plan for all Americans, costs could skyrocket if impoverished, seriously ill and uninsured people flock to states that provide affordable health care.
That would be avoidable if Americans had the option to buy affordable health insurance, backed by the federal government, that provides basic coverage and is portable from job to job. The best way to achieve these goals is to reform Medicare, then offer it as an option for all Americans.

Although many Americans are frustrated with exorbitant premiums, prior approvals, 800 numbers, voice mail and detailed questionnaires every time they need care, they are fearful about the possibility of change for the worse.

Regrettably, Medicare has become a complicated program for its 40 million adult beneficiaries, as well as providers. For example, traditional Medicare includes three parts, A, B and D, each with an annual deductible, co-payment and monthly premium.
In addition, beneficiaries are routinely confronted with complex and expensive decisions, such as whether to enroll in a managed care plan, purchase a supplemental policy or which of the many prescription drug plans to choose.

Medicare was a great achievement when it was designed in the 1960s, but it is overdue for meaningful improvements. Before coverage can be extended to all Americans, it needs to be reformed and simplified into a manageable 21st century program.
For example, merge all three parts into one program and eliminate the annual deductibles since they increase administrative costs. A tradeoff for eliminating deductibles would be an increase in monthly premiums by about $10.
It is also important to include co-payments that increase significantly if patients visit specialists without a referral from a primary-care doctor. Many private insurers use this type of system effectively; why can't Medicare?

An investment in affordable health insurance would help businesses compete with other industrialized countries. American businesses are at a significant economic disadvantage, because only in the United States are employers responsible for providing health insurance. Just consider the downside for American automakers that spend more money on health care per car ($1,500) than they do for steel!

The Medicare plan described above would go a long way toward improving the quality of life for older Americans, the self-employed, the impoverished, the 247 million Americans with health insurance and the uninsured.

Thomas M. Cassidy, a clinical associate professor at the School of Social Welfare at Stony Brook University, is the author of "Elder Care/What to Look For/What To Look Out For!"

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