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The reform solution: Cash for Clunkers

July 2009

If you follow the daily headlines, you know that it is politics as usual when it comes to health care reform. From the left, there’s a call for universal coverage while some argue that we should be more concerned about how to pay for it.

From the right, there’s a call for limiting the government’s intervention into health care while some argue that Medicare and the VA system are reasons for a public option for insurance. Special interest groups of all stripes are arguing for, well, their special interests. It looks like we won’t be able to achieve effective reform anytime soon and that what we get may be worse than what we already have.

There is nothing like frustration to bring out my best sarcasm (and please read it as such; we all realize that solving our great country’s health care problems is no laughing matter). With that in mind, I offer the Obama administration this solution to our health care mess.

My solution borrows heavily from the one Obama policy that has been universally successful: Cash for Clunkers! The once dead auto industry is actually moving cars, an event that seemed unimaginable only a few short months ago. We are getting more gas-efficient vehicles on the road while boosting a sorely ailing economy.

What does this have to do with health care? Bear with me a moment as I explain. Right now, end-of-life care consumes a vastly disproportionate amount of health care costs (just as fuel-inefficient cars consume a disproportionate amount of gas). At the same time, the ranks of the uninsured have swelled.

Let’s put the Medicare population into play and give them the option to “trade in” their health care coverage to those in need. If your grandmother was anything like mine, she would jump at the opportunity to help an uninsured family member or friend. Furthermore, she never would have tolerated unnecessary tests or procedures and was very clear about her (hands-off) end-of-life wishes.

Cash for Clunkers health care version 1.0 would permit her to transfer her Medicare benefits to the uninsured. In exchange for this, the “clunkers” (yes, the government will have to come up with a better name for elderly patients) would have to agree to forgo any futile therapy, to sign a DNR if they are faced with an irreversible illness, and to live with some other limitations that I am sure will not be the least bit contentious. Maybe as an added bonus for our field–and for cost control in general–they will agree to see only hospitalists if they require hospitalization.

While I am not an actuary, I am sure the math will add up. Extending Medicare to a generally healthy population (now covered for preventive care) would cost only a fraction of what the current Clunker Medicare system costs, once that population agrees to Medicare Light coverage. The trade-off will not only help save the country health care dollars but also help an uninsured person in need. Perhaps the only debate looming over this type of reform solution will be whether it tastes great or is less filling.

President Obama, your health care headache is over. Not convinced that most of this country’s citizens would be altruistic when offered the chance to directly affect those in need without compromising their own basic care? Well, you come up with a better idea. After seeing your recent health care stump speech in which an audience member stated, “I don’t want government-run health care, I don’t want socialized medicine, and don’t touch my Medicare,” I believe my Cash for Clunkers may be as good as it can get.