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Another Voice: Principles of fairness should govern health insurance

By Donald P. Copley

The clash between conservatives and liberals over health care reform creates opposing imperatives. Conservatives say defense and the economy outrank health care. They want the private sector in charge. We can’t insure everyone for every illness at every age. Health care isn’t a right if society can’t shoulder the cost. It’s madness to throw money at inevitable death. States should manage health care for constituents. Market competition will control costs.

With equal vehemence, liberals insist government’s highest priority is citizen health, too complex a task to entrust to private industry. Health care is a right every citizen deserves, down to the poorest. Pricing human life is immoral. Society bears the guilt for its untimely deaths. Government makes better health care decisions than individuals. The free market interferes with health care.

The “Slider System for Healthcare” (SSH) is my fanciful scheme to satisfy conservatives and liberals alike. The idea is to use slide controls to adjust health care variables. Consider the sliders on a stereo amplifier that adjust bass and treble sounds. Imagine similar sliders for preventive care, emergency visits, drugs and other variables. These would be operated by enrollees on insurance websites. The slider range would extend from full coverage and no copay, to limited coverage and high copays.

Enrollees would adjust sliders to their needs and get immediate feedback on premium costs. Each slider would have its own dollar readout, plus a summation of all sliders together. Government would determine funding for the system, like the volume control on a stereo. Service providers would bid to be included. Real time data would allow all parties to assess their risk exposure. Yearly law revisions would be unnecessary except for setting the budget. We’d no longer fret about pre-existing conditions, employer coverage or job discontinuity.

Health care in the United States costs about $8,000 per capita per year. With SSH, a universal tax of $2,000 would go toward basic coverage like yearly checkups, preventive care and emergency visits. Money left over would go to all citizens. For higher slider settings, premium costs would be capped at $20,000 per year. Sicker citizens could increase coverage by raising sliders pertinent to their disease while saving costs by lowering sliders for unnecessary services.

The sickest enrollees (1 percent of the population) could use maximum coverage for routine expenses, but would need outside funding for special treatments like experimental drugs or novel surgeries. Resources would inevitably run out, leaving only the natural terminal outcome. With SSH, all parties could say they contributed their fair share to each citizen’s treatment, with no need to blame anyone for resource limitations.

My home-grown mechanism for applying principles of fairness to health care delivery is only an approximation, a fantasy, like a concept car at the auto show. However, for a real health care plan to succeed, these same fairness objectives should be included.

Donald P. Copley, M.D., is a retired cardiologist from Amherst. 

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