First of all, let me tell all of you that the current health care insurance program is in really sorry shape.
I laugh when I hear pundits say that 80% of people are satisfied with their current health care. Rodney Dangerfield used to say that well-adjusted people are just people that you don’t know very well. If you are satisfied with your health insurance, you probably haven’t gotten sick.
I am an insurance risk manager as well as an HR generalist. I am also the primary participant for a chronically ill immediate family member. The details of both are unimportant, but suffice to say that I have seen the private health care system from both ends, and it works really well, until you get sick!
To this end, I am going to solve the health care problem by putting forth a viable compromise based on my experience as both administrator and patient.
The problem with the current proposed federal plan is that no one really understands what the government wants to do. Mr. Congressman, if you pass this reform, what will it look like, and how will it affect me? The last time health care was overhauled was 1974, so if you’re going to saddle us with a plan that will last half my lifetime, then what’s the hurry? Let’s take our time, get all the information, and then go forward.
I would much prefer the devil I know rather than the devil I don’t. The current health care system gives me immediate access to health care that I generally cannot afford, while the future plan may limit my access to health care, AND I still may not be able to afford it.
The Current Reality
ERISA (The Employee Retirement Income Security Act) became law in 1974. One of the most important provisions was that it provided for employers to accept all workers into their health insurance plan, regardless of medical history. Workers have the right to opt out, but employers cannot employ adverse selection or qualify workers by medical history.
If the employer is covered under ERISA, you can get coverage, and you would pay the same as the guy or gal in the next office. If you offer a variety of plans, the chosen program(s) would be tax-free to the employee.
The trade-off in this plan is that patients whose plan is under ERISA cannot sue their health care plan in state courts, and in most instances, can only recover actual damages in federal court. Since the federal courts are harder to navigate, have a higher burden of proof, and if you win, you still have to pay the legal cost of getting there, most health care companies are bullet-proof from legal challenge.