A health-care money manager's plan to reform the U.S. system of delivery
Recent polls indicate that a majority of Americans (including myself) disapprove of President Obama's health care reform proposals.
If I have my way, the reform will be enacted on an incremental basis. The process will be deliberate and logical but with very little disruption to the current delivery systems. The results should achieve the goal of providing affordable coverage for all uninsured; reducing or stabilizing health care costs; and improving efficiency and quality of care.
Here's what we need to do:
On coverage for the uninsured: Hold up approval of a health care bill until these things are appropriately defined or estimated.
* We need to establish eligibility criteria;
* We must spell out the benefits, premium rates and co-payments;
* We've got to know who and how the administration and delivery of health care services will be provided and processed;
* Provide a basis for rates of reimbursements for health care providers;
* Provide a detailed summary of the projected total costs;
* Explain the assumptions, justifications and total revenue for each source;
* Make public cost containments and controls and financial reporting procedures;
* Create a marketing strategy and incentives to ensure that all eligible beneficiaries are enrolled in the program.
The Congressional Budget Office needs to provide a complete report on anticipated revenues to legislators from both parties for evaluation and debate before enactment of the bill.
We need these details now to alleviate financial failures similar to the ones experienced by other government-run health-related entitlement programs. One hundred percent enrollment of eligible beneficiaries is essential in establishing level playing fields to minimize adverse selections and enhance the attraction of a broad cross-section of insurance risks.
The government should continue to fund the cost of providing emergency services to this population until the program is proven to be budget neutral. Explore the possibility of increasing federal funding to enhance capacity and quality services provided by safety net clinics and hospitals, especially in the underserved areas where they will be a major provider of services for this program.
Reduce health care costs: Health insurance reform should be immediately enacted and enforced to provide uniform federal regulatory standards that require or promote:
* Mandatory coverage for pre-exciting conditions;
* Effective control of wastes, frauds and abuses;
* Malpractice insurance reform to discourage frivolous lawsuits and settlements and establish reasonable cap for punitive damages;
* Standardize underwriting and rating procedures that minimize adverse selections, prohibit premium variation by health status and include a premium rate stabilization fund;
* Limit the number of standard benefits to high, low and average with reasonable affordable co-pays and deductibles for the low benefits and elimination of any lifetime limits.
* Protect the rights of all participants in the health care systems;
* Prohibit any full risk shifting to providers.
Improve the quality of care: Federal and state regulations for health insurance plans should be revised to insure that health plans have resources and systems capabilities to monitor and report providers' performances on compliance with Healthcare Effectiveness Data and Information Set (HEDIS) measures, and to identify and resolve quality problems with overuse, underuse and misuse of services and variation with established medical treatment practice.
Tony Borromeo of Bakersfield is the retired chief financial officer of Kern Health Systems, the largest health plan in Kern County, with a network of more than 500 contracted providers.
