The Congress is well under way with the consideration of health care reform bills that will make significant changes to our country's health insurance system. There is near universal agreement—on both sides of the aisle—that something must be done.
Unfortunately, the current approach to reform the insurance system is flawed, and I believe it will be detrimental to the practice of medicine and Americans' health for decades to come. I think that by making a few tweaks to the current health insurance system, we can get millions more Americans the health insurance coverage they need, reduce costs and provide higher-quality care. I outline below five ways I believe we can achieve our healthcare reform goals:
Portability: Millions of Americans face high insurance rates driven up by excess benefits required by state mandates. There are some pretty startling examples, like states requiring hair-growth procedures and fertility treatments for all insurance policies sold in-state. If existing law were modified to allow individuals to buy policies across state lines, Americans would be able to save thousands of dollars in insurance premiums each year.
The average health insurance premium for a family of four in New Jersey is about $10,000. The average health insurance premium for a family of four just across the border in Pennsylvania is about $6,000, and in Texas it is about $5,000.
There are little or no interstate commerce restrictions on purchasing car insurance, food, clothing, housing or other common necessities, so why should health care insurance be any different? Americans want more choices when it comes to deciding which health care plan is best for them, their families, and their businesses.
By allowing individuals and businesses to purchase health care coverage across state lines, we can create a more competitive market for health insurance, lowering cost, improving access, and increasing choice.
We should empower Americans and help them make their own health care decisions, and allowing portability would do just that.
Tax equality: Millions of Americans are pleased with the insurance they have. However, the average American worker changes jobs about 10 times in his or her working lifetime, so for many workers this means a new insurance company and a new plan each time they change jobs.
In order for individuals to actually keep whatever insurance they like, they must own the product themselves. Tax and regulatory reforms would make it easier for individuals to purchase their own coverage. Then, finally, an individual wouldn't have to worry about losing their coverage if they lose their job, go into business for themselves, or move to a different company.
Furthermore, this change has the added benefit of incentivizing an insurance company to invest in the long-term well-being of the consumer.
Medical liability insurance reform: An estimated 10 percent of our health care spending is on defensive medicine—unnecessary tests, procedures, and operations dedicated to insulating against potential lawsuits. Responsible medical justice reforms like caps on non-economic damages and standards of care will make defensive medicine unnecessary.
In so doing, health coverage will become more affordable and available to more individuals.
In my home state of Texas, we've seen stellar improvements in the medical profession and subsequent improvements for our patients following our 2003 medical liability reforms.
The results have been better than expected. For example, according to the Texas Medical Association: Texas has licensed 14,496 new physicians in the five-plus years since reform; 33 rural counties have seen a net gain in emergency room doctors, including 26 counties that previously had none; in my field of obstetrics, Texas has experienced a net gain of 192 obstetricians; and 26 rural counties have added an obstetrician, including 10 counties that previously had none.
So as you can see, one of the best things these reforms have done is attract more doctors to Texas, and especially the neediest areas of the state. We will need more doctors to care for the new Americans being insured, and this is a proven way to do that.
Insurance innovations: In the 1990s, medical savings accounts—and later in the early 2000s health savings accounts—represented two of the greatest innovations in health insurance. This creative approach to coverage allows individuals to develop and own their own insurance.
The individual has the ultimate choice over how their health care dollars are spent. There's no need to get pre-approval for an appointment, and there's no such thing as an out-of-network doctor.
We should also give employers and individuals more room to experiment with wellness programs and incentivize healthy behaviors. Corporations like Safeway and Wal-Mart Stores have proven track records of lowering costs for their employees, and we should give other companies the same opportunities.
Eliminate pre-existing condition barrier: Many Americans are struggling to find a health care plan that best fits their needs because of barriers for patients with a preexisting medical condition.
This is one of the primary reasons millions of Americans who want healthcare insurance cannot get it.
Reforming the current laws on the books that allow insurance companies to arbitrarily deny someone who wants a health care plan is the common-sense way to allow more Americans who want coverage to get it.
There is no doubt that the U.S. has the best health care in the world. A responsible approach to reform will ensure that we keep what works and fix what does not.
The views presented in this commentary are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.