Future Health Care

The current U.S. health care system isn’t working. The health care reform bill under consideration now might help, or it might be too little too late.

Many countries use a single-payer system, which sounds good. The government collects taxes. The government pays for health care. The people pay nothing (aside from the taxes) or minimal co-pays for health care.  Everyone is taken care of.

However, there’s strong resistance to single-payer health care in the U.S., and I would now question whether it’s financially feasible on a national level.

I think that at some point in the future, health care decisions won’t be made on a national level.  I think what will work is a community-based system.

There are some existing hints of what this might look like.

The Transition Towns movement includes health care as one of the topics communities need to address in the post-peak oil era. A look at plans developed by Totnes and Kinsale in the UK shows that they’ve thought a great deal about what health care will look like and what kind of health care will be needed, but less about how this will be paid for or otherwise made available to the community.

Christian Healthcare Ministries, which I’ve heard about from Jesus-following radical Shane Claiborne, is a medical cost-sharing nonprofit organization.  Members pay a monthly amount into the program, and after a 45-day waiting period, are eligible to submit medical bills to the organization for assistance with payments. Pre-existing conditions are excluded, however (which is one of the problems with our current health insurance system). Members have a “personal responsiblility” amount they must meet each year, similar to a deductible in a traditional health insurance plan. There’s also a $125,000 lifetime limit for cost-sharing.  Could this work on a local level? You might need a certain number of people involved to make it work.

The Mondragon Cooperative Corporation in Spain, in addition to operating its cooperative businesses and schools, provides health care for its members, independently of the state.  So, people pay to be members of the cooperative, and as part of their membership benefit, they get health care.  Sounds pretty good! Again, you might need a critical mass of people involved in order to make it work.

The Co-Op Village Foundation has created a model (they hope to build an actual village soon) for cooperative villages which would include medical care for all members.  You can download their free book, which details the entire plan, but here are the basics:

-A group catastrophic health policy would be purchased to cover those who do not have entitlement health coverage.
– The Village might contract with a local medical group for primary health care for self-insurance, with X percent of the fees paid for by the Village and the balance paid by the resident. Over a period of time, the full amount might be paid by the Village.
– A pre-existing medical condition clause may be required to protect the Village from being overburdened by current catastrophic conditions. This clause probably would be required by the insurance provider but might apply to the Village self- insurance as well.

The village would also maintain access to preventative care for members, preferably on-site.  But it sounds like their plan is mainly to pay health care costs for members, rather than maintain their own health-care facilities.

That might work for a while.  I think that at some point communities will probably need to be more self-sufficient and less reliant on outside sources for medical care.  I think we’ll probably need something closer to the cooperative system, in which everyone in the community would chip in (at a level appropriate to their income) to hire medical practitioners for that community.  But that might mean that some communities couldn’t offer much more than food and housing to medical practitioners, which could result in great inequities if the doctors prefer to go where they’ll be paid more.

None of these solutions is perfect, and our future is very much in motion. It will be interesting to see what unfolds.