Keeping Politics Out of Government Operations: Focus on Healthcare

1.????? Recognizing that Congressional approval is required; the President is well positioned to advocate for changes in the Healthcare System as it currently exists in the United States to permit access to all;

2.????? Medicare for all is a wonderful talking point but Medicare Parts A and B never covers more than 80% of healthcare costs leaving the balance for the beneficiary;

3.????? Medicare Part C is necessary to see some relief from the cost of medications for beneficiaries;

4.????? Access to either a Plan paying any balances of Medicare A & B Plan balances, or that include services in addition to those not covered by Medicare A& B is available on the open insurance market as it exists;

a.?????? Navigating this market is cumbersome and difficult for many participants and the process is in need of evaluation for improvement of its user interface;

5.????? The most dangerous room in an American home is the bathroom and Medicare provides no equipment to enhance safety in that room;

a.?????? It is in instances such as these where Medicare Advantage plans available in the private marketplace protect beneficiaries from unsustainable financial burdens;

6.????? Private insurance coverage is generally, at the least, equivalent to Medicare coverage;

7.????? Medicare supplemental as well as "Advantage" insurance policies play an important role in protecting the solvency of the American Health Care system as well as the citizenry;

8.????? A blend of public and private insurance coverage would, therefore, be the logical pathway forward;

9.????? Adding Medicare to the offerings of employers required to provide insurance may expand the selection sets available to employers to offer affordable coverage to employees through a combination of Medicare and supplemental insurance coverage;

10.? Further, a larger pool distributes risk more broadly thereby reducing costs to each individual;

a.?????? This may be seen in insurance across the spectrum with which the average consumer is familiar:

i.????? Automobile;

ii.????? Homeowner;

iii.????? Health;

iv.????? Renter;

v.????? Disability;

vi.????? Vision and\or Dental;

vii.????? Life; and even,

viii.????? Travel or Pet Insurance.

Based upon this brief overview of the toll taken by the failure to provide universal access to healthcare I offer the following explanation of its need and some insight into how to address this need of the American People while always working to limit the cost burden on our citizens.

The American healthcare system stands as a complex and often controversial topic in political discourse. While changes to the system require Congressional approval, the President of the United States holds a unique position to advocate for reforms aimed at expanding access to healthcare for all Americans. This advocacy must be rooted in pragmatic solutions that balance public and private interests, ensure financial sustainability, and prioritize patient safety and access. This article explores the multifaceted aspects of healthcare reform, focusing on the need to depoliticize the process and achieve a system that serves all citizens effectively.

Presidential Advocacy for Healthcare Reform

The President's role in advocating for healthcare reform is crucial. By leveraging the executive platform, the President can influence public opinion, set legislative agendas, and work towards bipartisan support for necessary changes. The current healthcare system in the United States, marked by disparities in access and quality, necessitates reforms that ensure every citizen has access to essential medical services.

The Affordable Care Act (ACA), passed in 2010, was a significant step towards expanding healthcare coverage, but gaps and challenges remain. Approximately 27.5 million Americans were uninsured as of 2018, highlighting the need for further action (Berchick, Barnett, & Upton, 2019). The President must address these gaps by advocating for policies that build on the ACA's successes and address its shortcomings.

One approach to achieving universal access is the proposal of a Medicare-for-All system. However, this concept, while popular in political rhetoric, has significant limitations that need addressing.

The Reality of Medicare Coverage

Medicare, the federal health insurance program primarily for individuals aged 65 and older, provides essential healthcare coverage but has notable gaps. A critical issue is that Medicare typically covers only 80% of healthcare costs, leaving beneficiaries responsible for the remaining 20% (Centers for Medicare & Medicaid Services, 2020). This cost-sharing structure can place a significant financial burden on seniors, especially those on fixed incomes.

Moreover, Medicare does not cover certain essential services that are vital for the elderly, such as dental, vision, and hearing care. One of the most glaring omissions is the lack of coverage for home safety equipment, particularly in the bathroom—the most dangerous room in an American home. Falls in the bathroom can lead to severe injuries, yet Medicare provides no support for safety equipment like grab bars and non-slip mats. According to the National Institute on Aging (2020), falls are the leading cause of fatal and non-fatal injuries among older Americans.

The Role of Private Insurance

Private insurance often provides coverage that is at least equivalent to Medicare, if not superior in certain aspects. Many Americans rely on private insurance to fill the gaps left by Medicare. Private plans often offer broader coverage options, including preventative care and wellness programs that Medicare does not. This dual structure of public and private insurance plays a crucial role in the healthcare system, providing comprehensive coverage that can adapt to individual needs.

The Importance of Supplemental and Advantage Plans

To mitigate the financial burden on beneficiaries, many turn to Medicare Supplemental (Medigap) and Medicare Advantage plans. These policies are designed to cover the costs not paid by Medicare, including copayments, coinsurance, and deductibles. Medigap plans, sold by private insurers, help protect the solvency of the healthcare system by distributing the financial risk more broadly (Medicare.gov, 2020).

Medicare Advantage plans, also offered by private companies, provide an alternative way to receive Medicare benefits. These plans often include additional benefits, such as prescription drug coverage and dental care, which are not available through traditional Medicare. By offering these supplemental options, the healthcare system can provide more comprehensive coverage to beneficiaries, enhancing their financial security and overall health.

A Blended Approach to Healthcare Coverage

Given the strengths and weaknesses of both public and private insurance, a blended approach to healthcare coverage appears to be the most logical pathway forward. This approach would involve integrating Medicare with private insurance options to create a more flexible and comprehensive system. For instance, adding Medicare to the insurance offerings required by employers could expand the selection sets available to employees. Employers could offer a combination of Medicare and supplemental insurance coverage, making healthcare more affordable and accessible.

Such a blend would also involve expanding Medicaid eligibility and encouraging the use of health savings accounts (HSAs) and other financial instruments to help individuals manage their healthcare expenses. By combining public and private resources, the system could provide more robust coverage while maintaining financial sustainability.

Expanding Employer Insurance Offerings

Requiring employers to include Medicare as part of their insurance offerings could significantly expand access to affordable healthcare. Employers already play a significant role in providing health insurance to their employees, and integrating Medicare into these offerings could provide additional options for coverage. Employees could benefit from the stability and predictability of Medicare while supplementing it with private plans that offer additional benefits.

This expanded pool of insured individuals would distribute risk more broadly, thereby reducing costs for each person. Larger insurance pools tend to lower premiums and out-of-pocket costs because the financial risk is spread across a more extensive base. This approach could make healthcare more affordable and reduce the economic burden on individuals and families.

Reducing Costs through Broader Risk Distribution

One of the primary benefits of a larger insurance pool is the broader distribution of risk, which can lead to lower costs for everyone involved. When more people are insured, the financial risk associated with high-cost medical care is spread across a larger group, making it less burdensome for any single individual. This principle is fundamental to the concept of insurance and is particularly relevant in healthcare.

A blended system that includes both Medicare and private insurance options can take advantage of this principle. By incorporating a larger and more diverse group of insured individuals, the system can reduce overall costs and improve financial sustainability. This approach can help control the rising costs of healthcare and ensure that more Americans have access to affordable coverage.

Addressing the Challenges of Healthcare Reform

While a blended approach to healthcare coverage offers many benefits, it also presents several challenges that must be addressed. One of the primary challenges is ensuring that the integration of Medicare and private insurance does not lead to increased complexity and confusion for beneficiaries. Clear communication and education will be essential to help individuals understand their options and make informed decisions about their healthcare coverage.

Another challenge is ensuring that the system remains financially sustainable. While broader risk distribution can help reduce costs, it is also important to address the underlying factors driving healthcare costs, such as high prices for medical services and prescription drugs. Policymakers must work to implement cost-control measures and encourage greater efficiency in the healthcare system.

The Role of Technology in Healthcare Reform

Advancements in technology can play a significant role in improving the efficiency and effectiveness of the healthcare system. Telemedicine, for example, has emerged as a valuable tool for expanding access to care, particularly in rural and underserved areas. By leveraging telemedicine, healthcare providers can offer remote consultations, follow-ups, and even certain treatments, reducing the need for in-person visits and lowering overall healthcare costs (American Telemedicine Association, 2020).

Electronic health records (EHRs) are another technological advancement that can enhance the healthcare system. EHRs improve the accuracy and accessibility of patient information, facilitating better coordination of care among providers. They also support data-driven decision-making and can help identify trends and patterns in healthcare utilization, enabling more effective management of resources (Office of the National Coordinator for Health Information Technology, 2020).

Depoliticizing Healthcare Reform

To achieve meaningful and lasting healthcare reform, it is essential to depoliticize the process. Healthcare should be viewed as a fundamental right and a public good, rather than a political battleground. This requires a commitment to bipartisan cooperation and a focus on pragmatic solutions that prioritize the needs of the American people.

The President can play a crucial role in this effort by advocating for policies that are based on evidence and expert consensus rather than political ideology. Engaging with stakeholders from across the healthcare spectrum, including providers, insurers, patients, and policymakers, can help build a broad coalition in support of reform. By fostering a collaborative and inclusive approach, it is possible to create a healthcare system that is more equitable, efficient, and sustainable.

The Importance of Preventative Care

Preventative care is a critical component of a successful healthcare system. By focusing on prevention, the system can reduce the incidence of chronic diseases, lower healthcare costs, and improve the overall health of the population. Preventative services include vaccinations, screenings, and lifestyle interventions that help individuals maintain their health and detect potential issues early (Centers for Disease Control and Prevention, 2020).

Integrating preventative care into both public and private insurance plans is essential for promoting long-term health and reducing the burden on the healthcare system. Policies that encourage regular check-ups, screenings, and healthy behaviors can lead to better health outcomes and lower healthcare costs over time.

Addressing Social Determinants of Health

Healthcare reform must also address the social determinants of health, which are the conditions in which people are born, grow, live, work, and age. These factors, including socioeconomic status, education, and access to healthy food and safe housing, significantly influence health outcomes (World Health Organization, 2020).

Policies aimed at improving social determinants of health can have a profound impact on the overall health of the population. This includes investing in education, affordable housing, and community development, as well as ensuring access to healthy food and safe environments. By addressing these root causes of poor health, the healthcare system can reduce disparities and improve health outcomes for all Americans.

The Role of Education in Healthcare

Education is another critical factor in healthcare reform. Educating the public about health and wellness, as well as the importance of preventative care, can lead to healthier behaviors and better health outcomes. Health education should be integrated into school curriculums and community programs to ensure that individuals have the knowledge and resources they need to make informed decisions about their health (U.S. Department of Health and Human Services, 2020).

Healthcare providers also play a key role in education. By taking the time to educate patients about their conditions and treatment options, providers can empower individuals to take an active role in their healthcare. This patient-centered approach can lead to better adherence to treatment plans and improved health outcomes.

The Economic Impact of Healthcare Reform

Healthcare reform has significant economic implications. The high cost of healthcare in the United States is a burden on both individuals and the economy as a whole. By implementing policies that reduce healthcare costs and improve efficiency, the system can support economic growth and stability.

Expanding access to affordable healthcare can also have positive economic effects. When individuals have access to necessary medical care, they are more likely to maintain their health and productivity, reducing absenteeism and increasing workforce participation. Additionally, reducing the financial burden of healthcare can free up resources for other essential needs, such as housing, education, and savings (Kaiser Family Foundation, 2020).

The Importance of Mental Health Care

Mental health care is an essential component of a comprehensive healthcare system. Mental health conditions, including depression, anxiety, and substance use disorders, affect millions of Americans and have significant impacts on overall health and well-being. Ensuring access to mental health services is crucial for addressing these issues and improving the overall health of the population (National Institute of Mental Health, 2020).

Integrating mental health care into primary care settings and expanding access to mental health professionals are important steps in improving mental health care. Policies that support mental health parity, ensuring that mental health services are covered at the same level as physical health services, can also help address this critical need.

Conclusion

Reforming the American healthcare system is a complex and challenging task that requires a multifaceted approach. While the President can advocate for change, it is essential to recognize the role of Congress in enacting legislation and the importance of bipartisan cooperation. A blended approach that integrates public and private insurance options offers a promising pathway forward, providing comprehensive coverage while maintaining financial sustainability.

By expanding employer insurance offerings to include Medicare and supplemental plans, it is possible to broaden access to affordable healthcare and reduce costs through broader risk distribution. However, achieving these goals requires a commitment to depoliticizing the process and focusing on pragmatic, evidence-based solutions. With the right leadership and a collaborative approach, it is possible to create a healthcare system that serves all Americans effectively and equitably.