Alternative Model for Paying for Medical Care?

An interesting article on NPR about a health clinic in Maine that is trying out a different method of paying for health services:

Deb Barth is raking leaves for Lesley Jones. But Barth isn't earning money for her yardwork, at least not in physical currency. She's earning "time dollars" — for every two hours she spends doing odd jobs, she'll earn a free visit with her doctor.

The Bay Area is filled with a number of close-knit, dedicated communities.
Could this innovate method of paying for health services work here as well?

Opportunities in Healthcare

Bett Martinez • There are great opportunities in health care if we can put “care” back in. I keep talking this up to any Silicon Valley VC I meet...unfortunately, (to my mind) they seem to be seeing opportunities only in tech sectors, like IT, social media.

My sense is that healthcare is needing much more "face-to-face". In today's terms, it would be "coaching", navigating.

But I remember the time when basic needs were met by Grandmothers! They had all kinds of remedies, both tangible and emotional, at their beck and call, and not until those were exhausted would they send family members forth to doctors and /or emergency rooms. There was rarely an error in their form of triage.

An American doctor proposed some time ago that this art be developed as a training.
Can say more, but only if interest is sparked.

Bett Martinez, M.Ed.
Broker / Consultant
Bay Area

Developments in Florida Health care

So if freedom from government intervention means swallowing a 20% rate hike in business health insurance, is that acceptable?

Florida rejects money for rate-hike review

Another Approach to the Mandate?

Noted healthcare blogger Alan  Katz, a long time insurance broker and consultant, has made a proposal that seems pragmatic and will allow insurers to be protected from higher claims while making it incentivizing the public to buy in to private health insurance before they need it.


Writing on February 7, Katz proposes:

The PPACA imposes a fee (or a tax, depending on whom you ask and when) if an individual fails to obtain health insurance. This is the constitutional weak-link in the law. Those asking the courts to overturn the law describe this approach as Congress forcing Americans to engage in an economic activity or pay the equivalent of a fine to the government.

Instead of this government-centric approach, I proposed replacing the fine with alternatives enabling carriers to protect themselves from consumers who have waited until they are on their way to a hospital before seeking coverage. As has happened in New York and New Jersey, without such protections premiums skyrocket even faster and higher than medical inflation would normally require. Creating an open enrollment period (perhaps the applicant’s birth month) would counteract this dynamic. Allowing carriers to set premiums higher for those who have gone without coverage and to exclude pre-existing condition for some period of time, would help keep the cost of insurance lower, too. (These are financial disincentives imposed on individuals who fail to maintain medical insurance. Fairness would dictate that these disincentives should be commensurate with how long the individual went without coverage, thus the limited time during which a premium surcharge or benefit exclusion would be permitted).

Carriers would not be obliged to impose these penalties. If they were commanded to do so by law some would argue they are simply agents of the government and the Administration would be back defending the constitutionality of a government-imposed individual mandate. By allowing, but not forcing, carriers to use an open enrollment period, increase premiums, or exclude coverage for existing conditions, the government is out of the equation. And so are constitutional challenges – at least to this provision.

The impact of this approach on other provisions of the Patient Protection and Affordable Care Act is minimal. In fact, by shifting the enforcement of personal responsibility from the IRS to private carriers this alternative might even save money overall.