commentary
STRUCTURAL FIXES TO HEALTH CARE IN AMERICA
BY ANAND MEHENDALE, MD The way we look at health care in this country is fundamentally flawed. This fact hit me hard, more than ever, one day fol- lowing the disastrous rollout of the Af- fordable Care Act (ACA). That day, I spent over half my time in my neurol- ogy office calming down my patients who were feeling sheer terror over uncertainty regarding their health care. I am doing the same thing, calm- ing down my patients, after President Trump’s inauguration. Health insurance is indeed a misnomer; it’s a health benefit. Insurance is a shared risk. When we insure 1,000 houses against fire, everybody pays a little bit. Not all owners use that insurance because not all houses catch fire; only one or two do. This way, when one house does burn, money is available for repairs as everyone has paid into the system. Health insurance today, in reality, is a health benefit since most everyone who has it uses it. We are the richest and most vibrant country in the world. Because of this, we must agree as a nation that no
American family should go bankrupt because one of their children is diagnosed with leukemia. This, I believe, should be a moral mandate for our country. Republicans and Democrats should
agree on this point. To be used in times of health crisis, I propose a “national catastrophic insurance” (NCI). This insurance would kick in when a person’s calendar year expenses exceed 10 percent of their previous year’s gross earnings. For example, for a person making $50,000 a year, catastrophic insurance will kick in for expenses over $5,000 every calendar year. This catastrophic health insurance funding will come from taxing activities and items that push people into catastrophic health circumstances, such as eating unhealthy foods, smoking, drinking alcohol, skiing, driving motorcycles, and so on. After this, existing insurance companies could offer “health benefit plans” (HBPs). To avoid excessive use of health services, Americans should spend 1 percent of their previous year’s gross
annual income as a deductible for these plans. The same person earning $50,000 will have to come up with $500 first before any benefits kick in. The cost of purchasing an HBP for that individual would be fairly inexpensive because the insurance companies are on the hook for only $4,500 a year. Many Americans will be able to get HBPs for $40 to $50 a month on the open market across state lines. However, the more money you
make, the more expensive your HBP will be. This is only fair. I propose that the NCI be managed and invested by titans of capitalism such as the Gates, the Buffets, and the Icahns, and should be out of reach of our legislators, lest they spend it frivolously on some ill- conceived programs. I believe America to be one of the
most humane societies in the world. Americans donate a lot to help the poor and unfortunate. For those less fortunate who do not have any means to buy an HBP, I propose the formation of a national health corps (NHC). The NHC would be organically grown and structured in local communities where physicians and hospitals could offer free care to the population in a separately designated facility, in empty emergency departments, or even in private physician offices. NHC volunteers would be fully protected
I need these structural changes to ACA so I can continue to take care of my patients.
March 2017 TEXAS MEDICINE 13
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