The first step in health care reform is to make a Medicare sponsored “Medicare Supplement” available directly
from Medicare for those current Medicare patients who want a supplement as part of their plan. There would be a reasonable premium
charged for the extra coverage. A Medicare Part D drug benefit would be part of the standard offering. Then to dismantle all of the
Medicare Advantage plans and roll their existing patients back into Medicare, as expanded above. Fees currently being paid into those
plans would be scrutinized for fairness, adjusted as needed, and paid directly into Medicare. Standard fees would have to be reasonable
for everyone, though there will need to be a declining “co-pay” schedule for those in lower economic classes. With this in mind, however,
everyone needs to have to pay something to help them feel vested in the system and to help prevent over utilization. In the process
we need to ensure we have the infrastructure in place to handle the increasing administrative load. This might be a way to utilize
some of the existing claims processing capacity of the current private plans, allowing many of their employees to transition into
Medicare based employment, as opposed to losing their jobs as the private market contracts.
The next
step is to organize the second most expensive segment of society, one that is in large part supported by a huge and inefficient patchwork
of governmental agencies and programs, as well as private insurance. All persons under age 18 would be enrolled into the Medicare
plan as expanded above. Each enrollee would have benefits specific for them, as opposed to being a member of a “family plan”. Monies
currently utilized for the current coverage could be consolidated and used to defer the cost of the new system. Costs would be further
reduced by establishment of a reasonable resource based premium assessed to all. These monies would be collected from the parents
or guardians, much as their current insurance premiums are at present. Again, time would be allowed for the consolidation of
the infrastructure required to run the system.
Once the two most expensive age groups above are fully
incorporated, we could then incorporate the remaining, and more “profitable” age groups into this expanded Medicare plan. Perhaps
starting at age 64 and working backward till all are incorporated. The speed of this enrollment would only be limited by the expansion
of the required infrastructure. As each age group is enrolled, they would begin paying their health care premiums directly into Medicare,
as mentioned above.