Friday, October 2, 2009

Roger's Road To Common Sense Healtcare

(This piece is based upon twenty years in the individual and group health insurance sales business and an increasing need to get some common sense in this wildly out-of-control health insurance debacle.)

PRIMARY QUESTION: Why is health insurance centered around group health insurance policies provided by the employer or as proposed, the government?

It makes no sense! Health insurance is a personal matter. Once the insurance is provided by a business or large entity, it becomes necessary to include treatment for every possible malady known to man and to allow treatment by any and all “practitioners” who can demonstrate any benefit, however slight.

Many people are not interested in pregnancy coverage, drug rehab coverage, acupuncture coverage, aroma therapy coverage, overweight counseling or tribal medicine man coverage.

As it is now, payments for such coverage is being, or will be, forcibly extracted from our bank account, whether we want it or not … It is simply part and parcel of “group coverage.” Employer provided Group Insurance must provide a benefit for every goofy treatment available or else someone will complain that their favorite (and always “effective”) health practitioner is being discriminated against. I have seen through the years, coverage’s added to group policies for every and any sort of health practitioner that can present a good story. As each useless benefit is added, the cost is added to everyone’s policy.

I have long held that the most cost effective health insurance policy is an individually owned policy. The purchaser of an individual policy can select from a list of benefits that most closely applies to their situation. For example, would a 55-year old couple, well established in life select pregnancy or drug rehab coverage? Probably not. These two coverage’s are among the most expensive. The cost for a policy without pregnancy or drug rehab benefits would therefore be much more affordable.

Until now, obtaining a reasonably priced individual policy is elusive. The reason is two-fold: First, at this time, each policy is individually underwritten because, as a whole, individual policies are few, in relation to the vast group, employer provided policies. If you have any condition that might result in a potential claim, the applicant is either denied coverage or has a rated up premium. Second: State insurance laws favor the selective underwriting PLUS it restricts sales to those policies approved by the State Insurance Commissioner. (See any possible conflict of interest here?)

This whole problem can be eliminated by “National Underwriting,” in other words, any and all companies and policies that are financially sound, can be offered with NO underwriting and NO denial for preexisting conditions. In addition, for example, pregnancy and drug rehab can be offered as options, much like air-conditioning and power steering in the auto industry. Thus the policy would be priced accordingly. As time and circumstances change, options can be added or deleted, as appropriate.

The thought has been advanced that individuals are not “smart enough” to sort through all the “insurance language” and select a policy suitable for their situation. Baloney! If they can do their income tax, they can select an insurance policy. Not only that, a whole new industry of insurance consultants will spring forth to clearly promote the benefits of their offering. An individual can select from an inexpensive, high-deductable, catastrophic coverage only policy, to a near-zero deductible, total coverage policy with premiums proportionate to the selected coverage. The choice is up to the purchaser.

Another benefit of the individually owned policy is it is fully transportable, that is, it goes with the individual no matter where the person works … or even doesn’t work.

Since employers would be freed from the extremely high cost of their employee’s health insurance, they would be required to pass those savings down to their employees through increased wages. The tax benefits attributed to the employers would be similarly invested in the individual. The net effect would be “no-loss-no-gain” for the employer and a “win-win” situation for the employee.

BOTTOM LINE: “Roger’s Road To Common Sense Healthcare” is simply a no-nonsense way to provide healthcare for EVERYONE in a simple, cost-effective, transportable manner. Needless to say there is “fine print” that needs to be ironed out, but no “show-stoppers” are apparent.

(Roger say’s: If this sounds reasonable to you, pass it around … especially to your Congressman.)

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