The Five-Phase Plan for Reforming the
U.S. Health Care Systems with Balanced Choice

People need to learn about Balanced Choice. When you call, please encourage people to find out more about Balanced Choice through www.BalancedChoiceHealthCare.org or by reading Balanced Choice: A Common Sense Cure for the U.S. Health Care Systems by Ivan J. Miller.

A crisis is brewing in the U.S. We will need major health care financing reform—it’s only a matter of time. Our goal is to have the Balanced Choice proposal well known, a health care financing proposal prepared, and a constituency group that can advocate for this proposal ready when the time is right.

Phase One—Describing a solution
The book, Balanced Choice: A Common Sense Cure for the U.S. Health Care Systems, is the central part of the first phase in the plan. Before a new idea can be considered, it must be described with enough clarity so people understand how the new idea works—even when the new idea makes common sense.

Usually people need to think about a new idea before they warm up to it. There are questions and doubts that need to be addressed. People routinely approach an idea by looking for its weaknesses and probing for reasons it might not work. Skepticism is normal and healthy. The book does not need to conclusively argue that Balanced Choice, as currently envisioned, should be adopted immediately. Rather, it is intended to inspire readers to believe that Balanced Choice is headed in the right direction. If the book is successful, a reader will understand Balanced Choice well enough to discuss it as a viable proposal for health care reform.

Phase Two—Building an organization and conducting research
The second phase involves long-range planning and building the foundation for Balanced Choice development. To demonstrate feasibility and accurately estimate its fiscal requirements, additional analysis is needed to detail the costs and savings involved in converting to Balanced Choice. It is also important in this phase to enlist advocates and collaborators who can help introduce Balanced Choice into the national discourse on health care reform.

Examples of questions, which need to be addressed:

  1. How much can be saved by the elimination of multiple health insurance and managed care plans and converting to Balanced Choice? This evaluation needs to include the direct savings realized by eliminating health insurance plans as well as the indirect savings from eliminating the expenses that providers incur in working with these plans, the expenses that employers incur in managing health care plans, and the cost in time and money that consumers incur in dealing with these plans.
  2. What is the projected cost of Balanced Choice for the next ten years and twenty-five years?
  3. What level of funding will be required to maintain Balanced Choice for the next ten years and twenty-five years?
  4. How much does consumer cost consciousness affect prices in health care? This question can be answered by examining areas of health care that are self-paid such as over the counter medications, eyeglasses, and orthodontics.
  5. How well do gap payments lower costs? This question can be answered by looking at gap payments in the Australian health care system and at some European countries that use gap payments for medications.
  6. How would out-of-pocket costs in Balanced Choice compare to current out-of-pocket expenses for consumers?
  7. How would Balanced Choice affect different medical specialties? It is important to meet with representatives of provider groups to identify potential difficulties and possible solutions in Balanced Choice.
  8. Would the Independent Plan be feasible for major surgery or extended hospitalization? If not, how would these be handled in Balanced Choice?
  9. What are the costs of transitioning to Balanced Choice? This evaluation should take into consideration the possible retraining of employees in the obsolete health insurance industry as well as the many employees of providers whose positions are devoted to working with managed care and insurance entities.
  10. How would transition to Balanced Choice affect employers? This evaluation includes the savings realized from eliminating employer responsibility for health care and the health-related costs of workers compensation. The evaluation would also include the impact on employers who currently do not contribute to health care.

Phase Three—Alliance building and modifications
Although Balanced Choice is built on the advice and wisdom of many people, it is primarily the work of the author. One person can sometimes develop a more creative vision than a group can develop. However, a proposal to change the health care system cannot be the product of one person’s vision. To be successful, it will become the product of many people working together to provide the wisdom and knowledge needed to make it work. A working board and organization will be necessary to move Balanced Choice forward. Alliances can improve it. As more people become involved, it will be modified. As an evolving proposal, the authorship will move to a cooperative group until ownership transfers to the American people.

In this phase, it is important for Balanced Choice to build alliances with provider organizations and consumer advocate organizations. As these organizations join, they will undoubtedly have specific concerns and issues that require refinements or modifications of Balanced Choice. If Balanced Choice is to satisfy the interests of the stakeholder groups, it is essential to bring them into the planning process. These alliances will later serve as the foundation for educating the public and for successful legislative action.

Phase Four—Mobilizing to make Balanced Choice a political reality
Before turning Balanced Choice over to the legislative process, it is important that it is developed to the point that does not need to be changed in order to obtain widespread support. The legislature is not the best place for developing innovative ideas, designing new programs, or creating a new health care system. Legislators change every two years and consequently tend toward short-term planning. When legislation is developed, it often looks like a Christmas tree with ornaments attached for every powerful lobbing group. This kind of piecemeal process is not a good way to create a new health care financing system. If, however, Balanced Choice can design a comprehensive proposal that has broad-based support, the legislative process will only need to make adjustments and refine the proposal.

The strength of Balanced Choice is that it has a design that is indeed in the best financial interests of consumers, providers, and employers, and that it combines the security of universal coverage with the use of market forces. In other words, it achieves the goals of liberals and conservatives. It is also the right thing to do because it provides good care for all people.

It is necessary to combine the power of these three groups to overcome the lucrative and powerful lobbies that will oppose Balanced Choice. The health insurance industry is the primary opposition, and there may be opposition from other groups. To succeed, Balanced Choice needs the financial and political support of the business community.

Reforming the health care systems in the United States will require a different kind of political mobilization than typical legislative proposals. Reform cannot be just a Republican or Democrat issue. To be successful, it will require strong general support from voters and strong bipartisan support. An enormous amount of money may be needed to counter the resistance of the health insurance industry. It will need to be led by the stakeholders who are experiencing the health care crisis—consumers, providers, and employers.

The road to legislative success will be difficult. If, however, Balanced Choice does unite consumers, providers and employers, it can move forward. With adequate financial resources and the support of employers, provider groups, and consumer-advocacy groups, it would be possible to pass legislation that converted the multiple United States health care systems to Balanced Choice.

Phase Five—Implementing Balanced Choice
As Balanced Choice becomes a reality, transition will entail a few adjustments. Payment systems would need to be established, the previously uninsured would seek out treatment, and many of the employees of insurance companies would become unemployed.

Establishing payment systems should pose few difficulties. It would be possible to set up a payment system that had practice (dry runs) before the transition.

Providing treatment for the millions of previously uninsured could pose a substantial problem. Many of the uninsured forego treatment or postpone seeing a provider. If all of the uninsured became eligible for treatment on the same day, it could overwhelm the health care system. It may be necessary to prepare for several months of extraordinary high demand and system overload. The existence of this problem is a sad commentary on the plight of the uninsured.

When health care dollars are transitioned from the insurance industry to the delivery of health care, there will also be a transition of employment opportunity. Many employees of the obsolete health insurance industry will become unemployed, and there will be new opportunities in health care. Adequate unemployment insurance and job retraining funds could be made available. In addition, there would need to be a plan for training people for the new opportunities in health care once there is universal coverage.