Trimming Medical Care Costs – Part 2

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Below is an excerpt from my book (in draft) The Next Golden Age of America – We Can Give Our Grandchildren a Better World

How do we pay for extreme medical care (care that exceeds typical insurance lifetime caps of $1 to 2 million)…and should we?  In Medical Care – Part 1, I discussed John, a hemophiliac, who requires $50,000 – $60,000 per month in treatment and drugs.  John has burned through several $ million in medical care.   Pre-Affordable Care Act (ACA) John would be out of insurance and likely to suffer a minor (for most of us) injury which would be fatal for him.  The ACA removes his lifetime cap by requiring his insurance to cover him without limit.  In other words, all other subscribers to John’s insurance company will pay higher rates to cover John’s costs.  I emphasize, there is no free lunch for medical care.  Who pays? The people with jobs, the people growing the food, creating the products, and delivering the services that ultimately go (via insurance payments and taxes) to medical care givers and drug companies providing treatment to John.  And there are many Johns and Janes receiving various extreme medical treatments.

A few ideas for affording/funding John’s and Jane’s extreme care, without breaking the bank:

  • How much profit are the drug companies making on John’s prescriptions?  Would they be willing to cut profits in half for the balance of his treatments?  Same question for the medical providers.
  • Establish a general “Extreme Care” non-profit organization which would accept donations and disburse funds.  This would enable people who believe in “no limits” to directly support that belief.
  • Entitlement programs do not presently have budgets voted on by Congress.  They are funded “As needed”.   I believe these programs should have budgets voted by Congress.   This would force Congress to actively look at the entire budget, not just the “discretionary” portion.   If Congress creates good budgets, there should be a little Medicare/Medicaid money left over at the end of the year.  This could be put in an “Extreme Need Fund.”
  • Finally, the Medicare/Medicaid budget could include a budget for extreme care.  The “Extreme Care Fund” could be allowed to exceed its budget by a given amount for one year, with the shortfall taken from predesignated sources (e.g. 5% from the Highway Construction Fund, and/or 5% from the Defense Department) the following year.

The above plans for extreme care are not unlimited, but they do provide explicit plans for contingency funding.  Note: I believe the ACA’s elimination of lifetime caps is not fiscally sustainable and will be reversed sooner or later.  If the above funds are not enough to cover all of the extreme care needs, we will ultimately be faced with a moral issue: Is it moral to draw a line in the sand and say, “Taxpayers and insurance clients have spent all of the money they can afford.  John and Jane, you are on your own.”   Is it moral for John and Jane to accept the gift of unlimited care?  The money (food, products, and services) expended for extreme medical care could be used for educating more doctors, researching better treatments, or many other things benefiting society as a whole.  I propose at this point, the recipients must be brave and say, “Thank you everyone for the many years of medical care you’ve given me,” not, “Where’s more!”

We cannot give our Grandchildren a better world by burdening them with an unlimited Medicare/Medicaid debt.  What’s your solution?

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