Catastrophic coverage needed

Sloganeering politicians, since before the birth of the Affordable Care Act, have talked about health coverage while patients continue to struggle to access care.

Patient experiences with highdeductible, high-premium and heavily subsidized Obamacare have pulled back the curtain on the government’s false promises to heal the woes of the health care system. Care costs have soared to 17% of gross domestic product, and Medicare and Medicaid pay doctors less to do more in an era of advancing technology for treatments and in cumbersome computer documentation.

The solution on how to cover more than 30 million people without health insurance is certainly not more government involvement in medicine or even more overloaded private insurance. It is not to replace the employer-based health care system with a multitrillion dollar single-payer system that rations care. It’s also not to add an expensive public option or buy-in to Medicare to supposedly compete with Blue Cross, Aetna and others.

What makes sense instead is to continue the march toward price transparency, low cost insurance alternatives, direct-care models, as well as more generic and bio-similar drugs. Another positive development has been the public/private partnership known as Medicare Advantage, which has doubled in size in the past decade.

At the same time, the federal government should provide universal catastrophic insurance for all those without public insurance. As outlined in an article in National Affairs in 2012, this insurance would be high deductible except for sudden severe illness. It could help reduce private insurance premiums, not to replace those policies.

Since preventive care also saves lives and health care dollars in the long run, I would add to these policies a limited number of basic tests – such as an EKG, mammogram, colonoscopy and cholesterol check – where the deductible doesn’t apply. Essential vaccines should be included because they protect the community as much as the individual.

You would be surprised how quickly doctors would accept cash from tax-deductible health savings accounts (for use when insurance deductibles haven’t been met), even if the amount paid were far less than what an insurance company or the government offers. Anything to get out from under the bureaucratic morass of red tape.

Hospitals would benefit by receiving payments for catastrophic care (heart attacks, strokes, car accidents) that previously had been uncollectable, and patients would benefit by avoiding bankruptcy-inducing bills. Lives and bank accounts would be saved. And yes, I see no reason not to extend this kind of insurance to noncitizens to further protect our country’s hospitals and doctors.

The proper role of government is to protect its citizens, which translates to public health, not to comprehensive health coverage. The hollow slogan “a right to health care” has been used by too many hollow politicians to justify expanding coverage for every bunion removal, tummy tuck, or even the misuse of antibiotics for viral infections.

Providing complete coverage to the most vulnerable – the elderly and the poor – makes sense, but the emphasis should be on ridding Medicare and Medicaid of billions of dollars in fraud and waste, not expanding them to larger and larger groups.

Instead, our lawmakers should focus on the more practical idea of providing catastrophic/preventive health coverage to the millions who lack insurance as well as to those who might someday lose it. This insurance – which would cost billions, not trillions – would bolster the health care safety net provided by federally qualified health centers and emergency rooms, which already can’t turn anyone away by law. It is time they are guaranteed payment for providing this care.

Marc Siegel, a member of USA TODAY’s Board of Contributors and a Fox News medical correspondent, is a clinical professor of medicine and medical director of Doctor Radio at New York University Langone Medical Center. Follow him on Twitter: @DrMarcSiegel