Health Insurance Simplification

Hey, here is a goofy idea.

How about when Romney dumps and replaces the ACA, we replace it with something that’s actually a hell of a lot easier? Not just cheaper—there are plenty of good ideas on how to lower costs, and we can all agree that putting a few in play would bring healthcare costs down across the board while offering more coverage.

No, the Czar means just easier.

For example, the Царевич was complaining of chills and fatigue, and started to cough. The Царица, who can diagnose a child’s medical complaint in two syllables from 30 meters away, took him to a walk-in clinic for a ENT check and sure enough, he had an incipient ear infection that we knocked out of the way in 24 hours. He never even felt bad.

Hooray for medicine. But the clinic wouldn’t take the $20 co-pay because they were on a different network. Then, the insurance company paid only $25 out of the $89 tab, leaving us with an invoice for $64. Hey, that isn’t a whole lot to keep a kid happy.

But look at a different scenario. How about we walk into any clinic, present the insurance information, and offer no co-pay whatsoever. The clinic bills the insurance company, who agrees to pay 30% of any cost under $100, flat. No co-pay, no confusing calls, nothing. Just a bill from the carrier 30 days later that says Fees: $89 | Insurance (30%): ($26.70) | Balance Due: $62.30. Easy!

And you adjust the scale up: for fees $100.01 - $500, they pay 50%. From $500.01 to $1,000, they pay 75%. And from $1,000.01 and $2,000, 90%. Above that, they pay all of the tab so you never get smashed by a major unexpected health crisis bill.

Of course, you pay for this through your premiums, so the insurance company makes a profit each time. But everything: visits, wellness checks, medical supplies, medications, extreme care, ambulance fees, surgical stuff...you get one consolidated bill and no confusing paperwork.

The Czar cannot count how often he gets checks back from the insurance company because he overpaid on services simply because the provider and insurance company could not get their act together. This is no fun for either of them, although it is fun for us to get a check in the mail.

Further, the insurance provider could change the percentages as needed when you obtain your policy. For example, a 26-year-old in good health might get 50% of his bill paid instead of 30%, for example, because he pays in far more than he takes out, whereas a 48-year-old smoker might get only 20% paid. And so on.

And why not offer tiers, like you have deductibles in car insurance? Maybe the Czar qualifies for 30%, but by paying a little more each month, he gets 35% coverage for bills under $100. And the carriers can even lock you in, like they do with life insurance: join our program at age 26, and you could be paying lower bills right up to age 65.

We have some smart readers. The Czar welcomes your thoughts on simplifying—not lowering costs, mind you—just simplifying the health insurance process so that a normal person can understand it.