Before I retired, my day job for 21 years was founding president and CEO of one of the country’s largest and most successful commercial purchasing cooperatives. I know a lot about getting large groups of people together to solve common problems. Buying and selling things in huge quantities for the benefit of all is a business I well understand.
Our national health care “system” is a shambles. The problem isn’t just money — our annual per capita expenses already exceed every other Western country. According to 2014 data, we spent about $9,024 per person, while the next nine countries spent between $3,207 (Italy) and $6,787 (Switzerland). The money is there — it just isn’t in the right places at the right time. And still we have our uninsured millions going to hospital emergency rooms with a cold or the flu.
We need to put the law of large numbers to work by not asking insurance companies to underwrite a smaller group with a disproportionate number of older and sick people in the pool. If the underwriting companies can’t make any money, they’ll exit the business — which is exactly what’s happening to the Affordable Care Act right now.
Based on my experience, this is what we should do:
Gather stakeholders from across the country — parents, doctors, patients, teachers, politicians, medical insurance companies and vendors — at regional meetings to determine the broad outline of what would constitute “minimum basic coverage.” This level would begin with preventative care (vaccinations, weight-control and other programs) and go on to cover the basic and extended-care programs we all want and need.
Divide all 319 million of us into 10 groups, determined by the last digit in our Social Security numbers. (Mine ends in a zero, so I’d be in the 10th group to start.) Each would cover a nationwide group of nearly 32 million, with an equal distribution of old and young, healthy and sick, fit and unfit.
Each of the 10 groups would be required to provide the same basic level of coverage. Health care providers — hospitals, clinics and medical groups — would also have to agree to provide the minimum basic coverage at a specific annual per capita price point.
Once that minimum level of care is established, traditional medical insurance companies could bid on part or all of a group’s business. Enrollees would have to stay in their assigned group for at least three years. Then they could migrate from their current group to one that they felt better met their needs or did so at lower cost.
From the beginning — or over time — groups might choose to enhance their offerings above the basic level. One group might concentrate a bit more on pediatrics, another on geriatrics. Another might add better coverage for sports injuries.
The key point is that both underwriters and health care providers would compete with their peers to provide the best level of service at the lowest possible unit price.
You’d have programs that encouraged — through lower prices and other incentives — participants to quit smoking, exercise, get needed vaccinations, deal with their substance abuse and take better care of themselves. Over time, the best groups could grow and prosper.
I am not suggesting the dreaded “single-payer” system. This plan depends on the participation of insurance companies, unlike the ones we have now in Social Security, Tricare (covers the U.S. military) and Medicare.
I don’t have room in 600 words to provide every detail in this plan. We already know what doesn’t work — it’s what we’ve been trying for decades — so why not try something new?
Michael L. Pandzik is the retired founding president of the National Cable Television Cooperative, based in Lenexa. He is also a retired captain in the Navy Reserve. He can be reached at firstname.lastname@example.org.