Tom, that was the original idea behind health insurance... Catastrophic care coverage, not day-to-day care.
The problem with health coverage started when insurance companies stated getting involved with day-to-day coverage. Once the day-to-day coverage became the norm, and insurance companies, rather than individuals, became the primary payment method of the medical industry, the result was that insurance companies were able to force price fixing into the system. In order to compensate (and get compensated), doctors had to find ways to "game" the system... Extra tests, multiple diagnoses, over-treatment, etc. The result was rising medical costs. The same thing happened for pharmaceutical companies.
In my opinion, this can be fixed by doing exactly what you just said... Get insurane companies out of the day-to-day care business and leave them in place for catastrophic coverage only. That way they have less of a say in the industry, the price-fixing ends, and doctors and pharmaceutical companies can stop gaming the system and just charge a fair market rate for care.
The other thing that needs to be addressed is tort reform. The ability of individuals to frivolously sue health care providers for unreasonable sums of money forces practitioners to pay huge sums for malpractice insurance coverage. A typical Ob-Gyn these days pays most of his income to insurance companies... Even if he has never been sued. Without that coverage, they can't practice. And it isn't the malpractice insurance companies faults either... They have a risk of having to pay out millions for every suit or claim, a risk which is too often met, and they need to make money too. So they charge huge amounts for their coverage. So the doctors have to charge more for care in order to cover their insurance expenses. And we get screwed.
The only way to stop this is through tort reform. But what type of tort reform? For years we have heard about capping the amounts of the suits, caping punitive awards, setting time limits, etc. I have a different idea.
My idea is to set up grand-juries for civil cases.
In a criminal case, a grand jury determined whether the prosecutors have enough of a case to charge the defendant and go forward with the case. Cases where the grand jury feels that the prosecutor does not have enough to go forward are rejected.
I would like to see a similar system put in place for civil suits, especially medical malpractice cases. That would accomplish several things:
- Frivolous suits will be kicked out of court early in the process, but cases with merit will continue forward. We would not have to limit awards, because only cases with real merit will go forward. The cases without merit will stop wasting the court's time and money.
- Plaintiffs will ALWAYS get their cases heard by a jury, if only a grand jury, so they will always have the chance to have their case heard. And if they can't convince a grand jury that there is a case, they probably would not have been able to convince a petite jury either.
- Wait times for civil cases will be shorter.
- Outrageous awards for frivolous cases will be limitted without limiting the awards for cases with merit.
- Because there will be fewer cases going to trial, malpractice insurance costs will decrease, and insurance premiums will follow. This in turn will lower doctors' expenses and thus medical care costs to individuals.
In my opinion, it's a win-win situation for everyone, including the plaintiffs, the defendants, the courts, the insurance companies, the doctors and the patients.
So that's my idea. Now... How do I go about presenting it to law-makers?