Adding 47 million (the number that all seem to quote – who took that poll?) to the insurance rolls will NOT reduce overall costs. Increasing access to healthcare NEVER reduces costs. It always increases them. Simple formula, give me access, I use services, services cost money etc, etc. The so called offset from lack of use of emergency rooms and productivity etc is soft and longer term and never fully realized due to the current construct of the system. For example, presidential elections are never for the long term.
What is the flaw? Health insurance period.
How to fix it. Well, here are few thoughts.
(1) Private health insurance must be re-structured to function as a regulated utility. Their rate structure should be only that needed to operate (process payments, review claims etc) plus a set profit of 8-10%.
(2) As a regulated utility, the prices set should be wholly market based and not risk stratified for individuals or select groups
(3) By extension, adoption of item 2 means pre-coverage physicals, pre-existing condition exemptions and the like will no longer be necessary – the premium is set and if I can afford it I buy it. Companies will have to compete on efficiency of their systems and overall quality of their services.
(4) As a regulated utility the base package of services required to be offered is pre set and supplements can be offered. However, the base must be very broad to make sure the pricing factors in overall gross population risks, as opposed to sub group risks.
(5) The truly financially disadvantaged should be folded into the current Medicaid system with revisions, in that they should pay needs based premiums as with any private plan.
With this format alone, the lack of access to health insurance should essentially disappear.
This solution however does not address the concerns about rising overall health care costs (overall, not specific) nor issues related to coverage provision (ie employer based etc) However, with adoption of the above, availability will only be a factor of cost not employment.
A format of the type above, would be a great place of either of the presidential hopefuls to start.