Paying for Healthcare
Health is one of the most important aspects of human life. Having and maintaining good health contributes significantly to our well-being. Currently, different countries adopt different payment models to pay for healthcare. In some countries, citizens pay for their own healthcare using the Full Price payment model. This means that citizens are limited by their own wealth when obtaining healthcare. In some other countries, citizens pay using the Full Price but paid by Insurance payment model. Then, there are some countries that provide many aspects of healthcare to all their citizens for free, that is, in these countries, citizens pay using the Free payment model for many of their healthcare needs and for the rest of their healthcare needs they either have to use the Full Price or Full Price but paid by Insurance payment models. Each one of these payment models has some undesirable aspects. This chapter discusses the reasons Healthcare should be considered as an essential need, and we should use the Utopian Payment Model to pay for healthcare. We will also discuss the ramifications of this choice.
Healthcare is Essential
Our health depends on a combination of at least the following influences: genes, nurturing, education about health (which includes nutrition, hygiene, physical fitness, intellectual fitness and useful emotional attitude), unfortunate accidents, general efforts by society to increase health of its citizens, intentional or unintentional harm caused by others, adverse weather, adverse environment, adverse natural situations. That is, a bunch of educational, environmental and social factors influence the goodness of our health. Education and the environment are themselves under significant influence of society.
Considering the fact that our health is not solely in our control and is significantly influenced by society, the health of an individual citizen is a shared responsibility of the citizen and the society. Any society or country aspiring to be a Utopia will try its best to ensure that all its citizens can have the best health.
In Utopia, citizens are expected to be independent and self-sufficient. Usually and for most citizens, the expenses on health services are moderate and can be anticipated by the citizens themselves. Hence, every citizen is expected to pay for the health expenses that are normal for society.
The healthcare system ensures that citizens do not suffer health setbacks or if they do, then they recover from these setbacks with minimal damage. For most citizens, the need to use the healthcare system is sporadic or episodic. These events that need healthcare occur throughout their lifetime. Without a healthcare system, the usefulness of a citizen to others can be reduced. In the worst case scenario, without healthcare, a citizen may become totally dependent on others. The healthcare system maintains and fixes our health. Healthcare enables us to be independent and self-sufficient. When we are deprived of healthcare, we suffer an impairment in our ability to be independent and self-sufficient. For this reason, not having healthcare is harmful. This is the first reason why healthcare should be considered essential.
Sometimes, a citizen may encounter a situation of health emergency or significant health impairment and the expenses on health services to remedy the situation could be well beyond the financial resources of the citizen. If lack of money prevents a citizen from accessing healthcare, then that will cause harm to that citizen. This is the second reason why healthcare should be considered essential.
When we are thinking about healthcare, the first thing that comes to mind is doctors, hospitals, prescription drugs, etc. But there is much more to healthcare than just that. People can do plenty of things to minimize their need to rely on doctors, hospitals and drugs. These are things that don't need professional supervision. These are things like taking walks, riding bikes, exercising, playing active sports, weight training, swimming, running, etc. Considering the principle of "prevention is better than cure", citizens should engage in activities that keep them healthy. In order to do any of these activities people need to buy shoes, bicycles, weights, sports equipment, gym memberships, etc. Money is needed to have access to these kinds of products and services that are required to maintain and improve health. These things may well be beyond the financial resources of a poor person. If we want everyone to have opportunities to maintain and improve their health, we need to make sure that such opportunities are made available. In these kinds of cases, availability of money can provide the opportunity. Hence, these kinds of products and services should also be regarded as essential.
When we are thinking about making our society and our country a Utopia, then in our society and our country we need to ensure that everyone is able to afford healthcare. We need to ensure this affordability for those individuals with healthcare needs that are higher than normal. We need to ensure this affordability for those individuals for whom the costs of healthcare go well beyond normal expenses and hence are beyond the normal means of those citizens. After all, our society would not be called a Utopia if there are citizens in our society who cannot have good health because it is unaffordable to them. Our society would not be called a Utopia if society cannot help those who need such help the most. After all, the benefit of all humans is the sole purpose of Utopia.
To ensure that all citizens can meet their healthcare needs, we should adopt the Utopian Payment Model to pay for such items.
Professionally Supervised Healthcare
We should create a category called "Professionally Supervised Healthcare" and let healthcare professionals place those items that they deem as important and necessary for their professional task of supervising healthcare of citizens. For example, if doctors are of the opinion that specific products and services are required to assist in providing healthcare to citizens, then the professional body of doctors will have the authority to classify these products and services under the category of healthcare. When the same professional body decides that some products and services are useless for healthcare, they will remove them from the category of healthcare. Healthcare professionals then must use only those products and services that they have classified as belonging to such a category.
Then we mark the entire category of "Professionally Supervised Healthcare" as essential. This enables citizens to pay for healthcare using the Utopian Payment Model.
Having classified healthcare as essential, it implies that society should set up all the necessary regulatory infrastructure for overseeing this essential industry.
Initially, the top level category of healthcare will not have limits on spending. The first reason is that spending on healthcare for an individual is done under the supervision and approval of a healthcare professional. If a healthcare professional says that spending is required for some individuals, then we are currently not well-equipped with information to disagree with healthcare professionals and lay limits on such spending. The second reason is that spending on healthcare for an individual may occur when the individual is not conscious and may not want certain kinds of help. However, once some undesired help is given and if that help means that much more help is needed, then we cannot put a limit on such spending. After sufficient time has elapsed and when we have sufficient statistics about abnormally high spending, how they arose and their justifications, we can start discussing whether limits on healthcare makes sense. Until such time, we have no good basis to place a limit.
If, after due consideration, we decide to place limits on spending for the healthcare category, then and even then, those limits should be several times larger than the average spending in this category primarily because the health of the individual is a shared responsibility of the individual and society - as outlined previously. Thus, society has to bear a large part of costs to repair health and maintain life when such costs go beyond the normal expenses and hence beyond the normal means of the citizen.
Sometimes, society may mandate that citizens must avail some health related service. For example, society may mandate that all children of a certain age must get vaccinated. Society usually does not force all its citizens to do something unless there is a definite benefit in doing so by all, and in that case it is for the common good and hence it should be paid for using taxes. That is, when society mandates something related to healthcare, society bears the full cost associated with that mandate. Anyway, such mandatory vaccinations hardly cost anything when compared to the cost of healthcare for the entire lifetime. Most countries even today are fully capable of bearing the cost of such vaccinations for all their children. What needs to be realized and accepted is that social health mandates are social costs - not individual costs.
For every individualistic aspect of healthcare, individuals seek assistance from healthcare professionals and under their guidance buy some products or services that are categorized as healthcare. They pay for these products and services as per the Utopian Payment Model.
Self Directed Healthcare
We should create a category called "Self Directed Healthcare" and let citizens classify products and services in this category. The purpose of this category is to collect under one category all products and services that people buy at their own discretion, and all these products and services are in some way important contributors to the general health of citizens.
Some of the examples of things that would get classified as Self Directed Healthcare are gymnasium memberships, sports equipment, home gym equipment, bicycles, soccer balls, basket balls, jumping rope, etc. The idea is that if something when used by individuals helps them stay fit, it improves their health and by the principle of "prevention is better than cure", it should be considered essential and lack of money should not be a reason that people should not have access to these things as well.
When we, the citizens, are in charge of placing products and services in the category of Self Directed Healthcare, initially we may make mistakes in either placing things that are really not in this category or we may miss placing things in this category when we should have. It is a learning experience, and we have to start somewhere.
Having created the category of Self Directed Healthcare and having placed some health related products and services in it, we mark this category as essential.
This makes everything under this category eligible for payment using the Utopian Payment Model. Thus, we make products and services in this category affordable for all people. People can be in charge of using whatever products and services they deem necessary to maintain and improve their general health. People can have the products and services that are necessary to aid in maintaining and improving health without a need for a professional to supervise the healthcare activities.
Of course, every product and service that is placed under the category of Self Directed Healthcare must satisfy standards, and we will set up regulations and compliance checks for all products and services in this category.
We can start this category with limits that are automatically set and may review the need to alter these automatically set limits after a few years.
Characteristics and Implications
All the characteristics and implications of the Utopian Payment Model apply to healthcare. Here are some of the more important ones reworded in the context of healthcare:
Healthcare has two components: Self Directed and Professionally Supervised.
Every citizen is responsible for his or her normal expenses for health services.
The normal expense for a specific citizen depends on his or her wealth and is in the same proportion as the ratio of the "average spending of all citizens on products and services in the category of healthcare" to "average wealth of all citizens". This makes it possible for every citizen to avail the same level of healthcare services regardless of their wealth.
Every citizen is also responsible for a part of his or her expenses for health services when such expenses go above the normal expenses. However, any citizen, in any given year, will not incur a cost that is more than twice the citizen’s normal expenses on health services. This makes it possible for every citizen to take care of their larger than normal expenses if the citizen should encounter such expenses.
No citizen is dependent on another person for their health expenses. Even a newborn child is independent right from birth when it comes to bearing his or her own health expenses, and is financially no different from a poor adult or poor old person. In this system, every citizen pays for his or her own health expenses from the wealth that he or she possesses as an individual.
No citizen is dependent on an employer for his or her health expenses. Whether a citizen is employed is not a criterion for making healthcare available to citizens. Healthcare is available to all citizens.
All health related issues, for which health services exist and are recognized as health services, are covered. There is no need for an individual citizen to choose what kinds of health problems are covered and to what extent. All preexisting conditions related to health will be treated.
For every citizen, the risks associated with abnormally large costs for health related services are fully and fairly mitigated. Healthcare of every citizen is treated as a common good when the costs to the citizen go beyond the normal affordable levels for that citizen.
There is no such thing as public health insurance. The concept of commercial health insurance does not exist, and hence such a business is not permitted. In a ideal society, there is no such thing as buying health insurance.