UBHC

Universal Basic Health Care (UBHC) yep, this is a tough subject for anyone to broach and for a lot of reasons...so of course I have opinions!!!

So let's start with why I am calling it UBHC? Simple answer is UHC is United Health Care and I don't want confusion.

So what is UBHC? Some will call it "Single Payer Health-care" others will call it "Socialized Medicine" in a sense both are correct, but they are loaded terms. Due to...let's call it "propaganda." Basically we have pundits and politicians that usually have no idea what they are talking about spouting

• "DEATH PANELS!!!"

• "RATIONING!!"

• "DO YOU WANT THE PEOPLE RESPONSIBLE FOR THE IRS CHOOSING YOUR HEALTH-CARE!!"

• "SOCIALISM!!"

Is any of that justified? Maybe, maybe not. Now let's look at this from the point of view of someone who admits I have no idea what I'm talking about, but I have the internet!

Let's begin with the Elizabeth Warren faction "Medicaid for all." No, just no. Medicaid has a veritable plethora of known issues:

• Not all doctors will take Medicaid patients

• The system is gain-able

• Apparently teeth are not a part of your body

• Hearing aids are apparently not a medical device for most

• It varies from state to state because each state administers their own semi-autonomous variant

How about expanding the VA (Veteran’s Administration Health-care) system? Again NO. The VA system is stretched and is completely dependent on the whims of Congress

So where do we start? As any good engineer would tell you, if the system is too bad to save, don't.

Each state regulates health-care independently, for single payer this won't work. We are a transient nation it isn't odd for someone to live in say Illinois yet work in Missouri. So if they have a local doctor the doctor is bound by Illinois law, but their insurance is bound by Missouri law because their job is located in Missouri. Again each state regulates health-care and health insurance locally. So how do we stop this? The Interstate Commerce Clause of the Constitution.

Uh oh! Maura just suggested Federalizing something. Yes I did. Why do we have 50+ (States and territories) different sets of health regulatory agencies? 50+ sets of insurance regulations. 50+ sets of medical regulations. 50+ medical licensing boards. Then there are the federal level regulations.

We could streamline this entire system by moving all the regulatory system under one agency. Now I bet someone out there is going "But Maura, another federal agency?!" No, we have one already but we need to do a little shuffling:

• First we change a name the Food and Drug Administration becomes the Federal Medical Agency or FMA

• Move Food regulation out of the former FDA to only the USDA (United States Department of Agriculture)

• Now we move licensing doctors to prescribe medicine from the Drug Enforcement Agency (DEA) to the FMA

• We move medical licensing from 50+ jurisdictions to the FMA

• Moving licensing to a central point also eliminates sub-par doctors from jumping state to state and puts their malpractice records in one data base—I admit this is not a major issue but it is a bonus

• We move medical insurance regulation from 50+ jurisdictions to the FMA

• We move hospital and surgical facilities regulation to the FMA

• Now all those state level workers that are out of work? We move them to the FMA to deal with local offices and inspections

Now that we have done our federal shuffle, what's the next step?

We start the process of building the new UBHC system. We need to set a few solid ground rules up front:

• UBHC should not be allowed to force or mandate treatment for ANYTHING, that decision should be strictly between the patient and provider

• UBHC should cover end of life costs (including long term care facilities), but be prohibited from mandating or paying for assisted life ending

So what should the new system cover?

• Everything from the top of your head to the soles of your feet

• So teeth are a part of health care—ever hear of Temporal Mandibular Joint Disorder? Apparently your jaw is a weird anomaly as health insurance says it is a dental issue and dental insurance says it’s a health issue

• Orthodontics regardless of age

• Glasses and eye-care

• Hearing aids, dentures, and other prosthetics--yes this would include implants be they dental or breast, I know why?  Because too many women suffer emotionally with underdevelopment issues, and reconstruction from cancer, if we try to micro-manage we will in the end cut out nesacerray treatments to stop a few people from being happy.

• Mental health coverage can be equal and we can begin weeding out the bad providers

• Quality of life medical issues, joint replacements, hormone replacement therapy, adaptive medical devices ie: hand operated controls for a car or a power lift for a wheel chair

• Prescriptions

• Chronic illnesses should be cured if possible not just treated--UBHC would be a needed push on this as it would suddenly be way cheaper to say cure cancer or diabetes than to keep treating the symptoms

Now how do we bring it in? Well not all at once because that would be asinine. So to prevent asinine actions here is my idea to phase it in and believe me this is going to sound odd but follow along as I lay this out from our randomly chosen start year of 2025

• Wave one 2025, every person born between the years 2015 and 2025, why? Because statistically this group is of the lowest cost to insurance companies so by default allows the first group to not strain the new system.

• Wave two 2026, every person born between 1985 and 2014. Again low cost to cover, not a huge slam on the new system.

• Wave three 2027, every person born between 1970 and 1984. Now we start tightening up as this age group is beginning to use more health-care. Diabetes begins to show up. Heart disease, cholesterol issues, back strains, hernias, etc, this will be the first real stress test of the system

• Wave four 2028, all persons born between 1960 and 1969. We now are hitting the era of persons in there 60s to pushing 70s. At this point we are no longer adding people to Medicare as they are on UBHC

• Wave five 2029, we transfer people on Medicare and VA to UBHC and the Medicare/Medicaid and VA systems are finally taken off-line as they are no longer needed.

Now why did I phase it in over five years? Like all major roll-outs you never do all at once or mistakes that could have been minor become major as they cascade fail. By beginning with the least likely to need care and gradually working our way up we find flaws at a lower rate. If we flipped it we suddenly have a lot of people who need typically the most care stressing a system to it’s limits immediately. This is as much a tech issue as it is people issue. For the most part people already above 65 at roll-out are already on Medicare so no real reason to swap them out in the Beta phase either.

“Maura, this will cost a fortune and why do we need UBHC?” Yes it will not be cheap, but neither is Medicare/Medicaid/VA or no insurance and bankruptcy.

Why do we need this? (Questions below are rhetorical so no I am not seeking answers)

• Because everyday people die from treatable ailments

• Everyday people lose jobs and by default health-care

• Everyday people have to choose between do I buy food or see the doctor

• Because we live in a transient society and people constantly move from place to place and with every job change comes the 30 to 90 day no coverage gap

• How many of you worked a job you couldn’t stand because it offered health insurance?

• How many young people age off their parents plans only to be without for years and end up in the Medicaid system?

• How many people with marginal employment are told to use the Exchanges only to find the payments are higher than what they bring home?

• Most of our country is one major illness away from insolvency and losing everything at any given time.

So how do we fund this? For starters:

• This should be an 80/20 plan so UBHC covers 80% of a hospital bill

• Emergency room visits should have a steep fee if not admitted much like traditional insurance say $1,000 or 20% (whichever is lower) of an Emergency Room visit, but $50 for Urgent Care

• It needs to have an out of pocket cap to prevent bankruptcy so let’s set it at say $5000

• The system will have to negotiate prescription pricing to reduce costs

• Prescriptions could be on a tiered co-pay system let’s use $5 generics, $15 brand

• Medical providers will have to understand that much like the U.S. Dollar is accepted for payment so is the UBHC

• Doctor’s should not have a co-pay, honestly it just adds to the cost associated with patient care. Instead the doctor’s office files that John Doe was in my office on____, for medical code ____, and submits for payment—this encourages people to use a doctor’s office instead of urgent care facilities

Tune in for my next unscheduled episode when we see what hair brained scheme Maura is pushing with this to help fund it.

“The true measure of any society can be found in how it treats its most vulnerable members.”

— Mahatma Gandhi

Dreams are often most profound when they seem the most crazy.

—Sigmund Freud

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