The healthcare system of yesteryear cannot meet the needs of today, but do our political representatives understand these modern needs? In the days of yore, healthcare plans came as a benefit of employment. Most folks were married. Most jobs other than secretary, teacher, and nurse were filled by men. As such, the cost of healthcare plans was generally covered by the employed male and his employer. If married, a family plan was chosen to cover a wife and any children that came along. If unmarried, an individual plan was chosen. The employer didn’t mind if the family plan cost more than an individual plan because most married employees were more likely to stay with the company, accruing and retaining skills that increased productivity.
Government regulation required that male and female premiums for individual coverage were the same even though average female healthcare needs exceeded average male needs. As a result, in the long term, males ended up paying an estimated 90% of the premium costs while receiving an estimated 10% of the healthcare benefits. The exact cost difference between females and males is difficult to obtain, but it is easy enough to compare the relative numbers of females vs. males in nursing homes and doctor’s offices, the amount of shelf space for female products in drug stores, or the number of over-the-counter medications and prescriptions purchased by women, not to mention the whole pregnancy thing.
In regard to employment, today people change jobs an average of ten to fifteen times during a career, with extended periods of unemployment or relocation a consequence of each change. Healthcare coverage does not transfer with the employee and healthcare providers vary by State. Also, many workers are undocumented with no healthcare coverage yet their jobs tend to carry the most risk of injury. Accrued skills through tenure, do not necessarily match new job requirements.
In regard to marriage, today the overall rate is about to go below 50%, and Time.com estimates that 25% of Millennials will never get married, not to mention the whole same-sex marriage thing. Coverage for a spouse under a family plan is an outdated concept.
In regard to family, today more women are choosing either paid employment over motherhood or delayed motherhood with or without a partner. This also complicates the old family plan concept for healthcare coverage as known in the past.
So how do our political representatives think these modern needs should be met? The Democrats think the solution is easy. Just make healthcare an entitlement of any person who is physically located in the United States, paid for by the government with tax money from those folks who still pay taxes. Single payer! That might solve all the problems relating to employment status, marital status, and family configuration, in addition to pre-existing conditions or which State you’re in. But, it gets a little controversial when a line has to be drawn by the government, limiting treatments that are extraordinary, experimental, or far too expensive to be available to everyone.
For example, in the past, when a male thought that he was a female, it was treated as a mental disorder. Today, it’s treated as a physical disability and gender reassignment surgery is performed. Tax dollars were used to turn Bradley Manning into Chelsea Manning because the US Army was his employer. There have been cases where a male actually thought he was a chicken. Instead of treating this as a mental disorder, future tax dollars might go towards chicken reassignment surgery. As Woody Allen once said, “Because we could use the eggs”.
On the other hand, Republicans tend to think that individuals should be responsible for their own healthcare needs, with a safety net for those folks without any means of support. In this way, coverage options can be chosen by the individual based on personal needs and the resources available to pay for them. The problem today is that too many individuals would rather have the latest smartphone capability than a prescription for a statin to avoid a heart attack. Given a free choice between paying for healthcare coverage when a person is perfectly healthy or paying for the latest wireless services and social networking, the latter will win out. Obviously, Republicans think the government should not interfere with that decision.
How should a modern healthcare system be designed for today’s societal environment, where employment, marriage, and family have been redefined? How can we assure that the maximum number of people have healthcare coverage without a government mandate and associated penalties?
Well, let’s discard conventional thinking. Instead of providing healthcare plans as a benefit of employment, they should become a benefit of wireless cell phone contracts. Far less than half the population has jobs, but there are more cell phones in the U.S. than people. This would provide true universal coverage. Maintaining cell phone service would result in maintaining healthcare coverage, just like it used to be important to retain employment. The premiums could be split between the provider and the customer, much as they were with an employer.
Second, marriage would not enter the picture at all. No longer would a spouse get a free ride on someone else’s premiums. Premiums would be based entirely on gender, chosen or natural, and they would be calculated using actuarial tables for average female healthcare needs separate from average male healthcare needs.
Third, the family configuration would also be irrelevant. Single mom, single dad, sister moms, or absent dad would not matter. For children, whoever pays for their cell phone service pays for their healthcare coverage.
The idea of linking healthcare coverage to cell phone contracts might seem foolish, or even a joke. But what we have done to fix the system has not worked, and out-of-the-box thinking is required. The world today is unlike any era in the past. Society’s norms are so different today, they couldn’t be imagined just two or three generations ago. Let’s hope our political representatives don’t try to implement a system based on the outdated concepts of the good old days.