A better mousetrap: a national health plan America can afford

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Rather than enter into the polemics of the left versus right debate, I would like to report on an actual, affordable working model: "the WHO plan." The World Health Organization (WHO) has tens of thousands of current staff and retirees all around the world, fully covered by affordable health insurance in every country on this planet — not only their own, but every country they visit, whether on duty or traveling for other purpose. That means more than 200 countries. Let’s look at what the WHO plan provides.

The WHO plan covers at least 80 percent (or more) of all ordinary medical bills and prescribed medicines. It covers ALL medical issues — including doctors’ bills, hospitalization, surgery, stem cell and other therapies, pre- and peri-natal care, immunizations, accidental injuries, prosthetics, rehabilitation, elder care, dental work, eyeglasses, family planning, psychiatric care and mental health. In other words, it covers a wider spectrum of health needs than almost any high-price private insurance scheme in America.

The WHO plan covers your entire family, beginning with children at birth. It travels with you, wherever you go, wherever you live. A significant exclusion is purely cosmetic service. It doesn’t do "extreme makeovers" and similar cosmetic interventions except in so far as the health of the patient is concerned. Then the plan covers it.

When medical expenses for a given condition, cancer or heart for example, exceed a certain amount, instead of cutting off or denying coverage, the WHO plan coverage shifts to as much as 100 percent of cost. It doesn’t abandon people just when they need help most. (Compare this policy with the findings of Michael Moore’s "Sicko" in current for-profit practice.)

Here’s an example for comparison: A young woman in our area of northwest Connecticut is diagnosed with breast cancer. The tumor grows so rapidly and so large, she has to undergo special surgery. The surgery and treatment are successful, but expensive. So, the private insurance company says, "The tumor is so large, the surgery had to be ‘experimental.’ Read the fine print: It doesn’t cover experimental surgery."

Now, the for-profit insurance company is gambling on the statistic that more than 80 percent of patients in this situation will not press their legitimate claim. They better think again in this case because we are going to full- court press — whatever it takes to get a settlement. Now for the comparison: In the WHO plan, you don’t have to read the fine print. There isn’t any.

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Ah, yes, but how about the costs to the insured? The premiums must be astronomical, right? Wrong. To cover my family, as an American, and a former WHO employee, I pay a flat $268 a month. That’s all, and the amount I pay as an American is actually slightly higher than other nationalities pay in other countries, for reasons explained below.

My contribution is matched by a contribution from a fully funded WHO insurance fund. The principal in that fund is wisely invested, and its growth offsets much of the cost of the plan to employer and employee alike.

Not to make too sour a point on the matter, several years ago the U.S. administration tried to force WHO to abandon this full-funding principle in its terminal (end of service) account and its insurance fund. The U.S. administration failed in the attempt. But the wider point is this: Full funding is also the key to a really successful,balanced and sustainable national health system. America can learn from this.

Surely, you will say, the WHO plan must be running in the red, piling up deficits, right? No. Just the opposite. The WHO plan is operating in the black in nearly 200 countries around the world. In fact, the original WHO plan, standardized for everybody, has never been in the red in any country in the world — save one. Guess which one? You guessed it, the United States of America. So, Warren Furth, the American ADG, and I, with our Staff Association, amended the premium rate slightly upward for American citizens (like ourselves), so that American participants in this country would not be subsidized by Nigerians or Frenchmen, in order to keep the plan balanced.

Because some medical services and pharmaceuticals are so outrageously expensive in the United States, we employ Bluecross Blueshield, not to fund our plan, but rather to screen providers’ claims for reasonableness of pricing. Most providers are amazingly cooperative — once they realize they are being watched. This is a really critical feature of any successful national health plan. You have to be willing to scrutinize and regulate prices. Reasonable profit margins, yes. Unconscionable ones, no.

This is something Germany, for example, has been willing to do, and it’s the only reason their national plan has survived since circa 1870, when Mrs. von Bismarck leaned across the breakfast table toward her conservative husband and warned, "Otto, if you don’t provide national health insurance, you’re going to have a social revolution on your hands."

Part II of this column will appear in the Nov. 1 issue of The Lakeville Journal.