Why We Need the Balanced Choice Proposal
Health
care reform has been stymied because proposals for financing health
care have too many shortcomings. Single payer proposals offer the advantages
of universal coverage and cost savings, but involve unacceptable price
controls. Other proposals call for the aggressive use of managed care
and an expensive, inefficient, and inequitable expansion of insurance
coverage. The Balanced Choice Proposal is a hybrid proposal that overcomes
these shortcomings by combining the best of health care insurance and
single payer proposals in a system efficient enough to cover the uninsured
and all health care expenses for less than the U.S. currently spends
on health care.
Brief
description of Balanced Choice
The
Balanced Choice Proposal would establish a single, national health care
financing system operated by a nonprofit trust.
Preferred provider organization policies are the standard for high quality
health care insurance. In these plans, consumers have a choice of using
in-network providers at a lower fee than out-of-network providers. Likewise,
providers can choose to be in-network or out of network. Balanced Choice
also offers two payment options.
Copay
Option (similar to in-network)
Comprehensive
health care benefits are provided and patients make a small copayment.
Independent Option (similar to out-of-network)
Providers may charge more than the Copay Option fee, Balanced Choice
makes a base payment, and consumers pay the gap between the base payment
and the provider’s
fee.
Balanced
Choice has more consumer advantages than a preferred provider insurance
plan.
-
There are no deductibles.
-
The
first visit per year requires no copayment.
-
Balanced Choice waives copayments and gap payments for patients with
low income or catastrophic health care expenses.
-
Balanced Choice has universal coverage; consumers do not lose health
care if their employment or marital status changes.
-
Benefits are comprehensive including full mental health services and
long-term nursing home care.
-
Everyone has more flexibility in Balanced Choice than in a preferred
provider organization. Providers can have a mix of patients in each
Option and decide what portion of their practice will operate under
each Option. Patients can select either Option based on their needs
and circumstances at the time.
Gap
payments
When it is affordable, for medications, lab tests, and imaging tests,
Balanced Choice makes a base payment and patients pay the difference—called
the “gap”—between the base and the cost of service.
Information about the cost of gap payments is readily available and
on hand in doctors’ offices’ so that doctors can advise
patients about how to take cost into consideration. Balanced Choice
assists with gap payments for patients with low-income or catastrophic
health care expenses.
Example
of gap payment: Balanced Choice might pay $100 for one category of medication.
If one brand of medication cost $130, the patient would pay a gap of
$30. If another brand cost $150, the patient would pay a gap of $50.
Cost-consciousness
Balanced Choice makes it easy for patients to get information about
prices and gap payments. These gap payments are an important feature
in Balanced Choice because they keep consumers cost-conscious. If consumers
are cost conscious, there is no longer a need for managed care to control
costs. Without the enormous bureaucracies of managed care and the health
insurance industry, so much money is saved that Balanced Choice can
provide universal coverage and lower the amount
employers contribute to health care.
Availability of providers in the Copay Option
The Balanced Choice Trust has a Balanced
Funding Mechanism, which requires that 60% of the funds are spent
in the Copay Option. Because patients and providers always have choice
of which funding Option they use, Balanced Choice must adjust reimbursement
and base pay rates so that the Copay Option is chosen 60% of the time.
Consequently, patients are assured that 60% of the providers in any
specialty will accept the Copay Option.
Click here to download a PDF of
"A Brief Description of Balanced Choice"
A
full explanation of Balanced Choice is available in, Balanced Choice:
A Common Sense Cure
for the U.S. Health Care Systems.
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