By Mr. Bredesen, the governor of Tennessee, USA.Dottie Landry is one of those uninsured Americans. She lives in Nashville and is self-employed. She makes and sells jewelry. Over the years, she has been generally healthy but uninsured. In 2000 she got very sick -- from a tick bite -- and had to spend about $9,000 for medical care. She put most of it on her credit cards, which took years to pay off.
We all want to help Ms. Landry, but here's the problem: a comprehensive health-insurance policy for her costs about $5,000 a year, and someone has to pay that. That's a real number that won't go away with group purchasing or by beating up insurance companies. Ms. Landry can't afford that, and in a world of trillion-dollar deficits it's hard to see how the federal government can either.
We need a national health-insurance solution, but isn't it sensible in the meantime to make sure everyone has a basic health plan before we give a few more people a perfect but expensive one? Shouldn't we make sure everyone at least has a Chevy rather than providing a Cadillac to a few and letting the rest walk? We're trying that in Tennessee with CoverTN.
CoverTN, which began in 2006, is a health-insurance plan for those who are self-employed, or who work for small businesses that can't afford a traditional policy.
It is not free health care. Rather it is a limited plan with shared costs. In devising this plan, we didn't start out the usual way -- by defining what benefits we wanted -- but instead set how much we wanted to pay. And then we began a competitive-bidding process to see how much health care we could buy. We initially set the amount we would pay at an average of $150 a month, and split the responsibility for that premium three ways. The company would be responsible for $50, the individual for $50, and the state for the final $50.
The bidding was vigorous. It was ultimately won by BlueCross BlueShield of Tennessee with a benefit package that meets a great many -- not all -- of the real needs of the uninsured at a cost far below conventional plans.
Coverage with limits is better than no coverage at all.
At these premium levels -- less than half of what a conventional plan might cost -- the benefits are limited. But the benefit structure is also different than in a conventional plan. Most limited plans achieve their savings with high front-end deductibles, requiring a person to spend often thousands of dollars out-of-pocket before benefits kick in. But when we asked our customers -- uninsured Tennesseans -- what they actually wanted, we found that they were most interested in some help with the more common things; a doctor's visit, prescriptions, a short hospital stay.
CoverTN emphasizes covering these front-end costs. It features free checkups, free mammograms and $15 doctor visits without deductibles, for example. And it achieves its savings on the back end, with relatively low limits on hospital stays and an overall $25,000 benefit limit in any one year. It does not cover truly catastrophic events.
This makes medical sense. Good access to a doctor and a drugstore when you first have a problem can avoid a lot of cost and heartache later.
Read the rest of the article on The Wall Street Journal site.
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