I work for one of the Big 5 health insurance companies and I am currently assigned to figuring out how we can bludgeon our way into/pillage/plunder a particular state's Medicaid and other low-income residents' coverage contracts, so I have spent a lot of time recently researching and thinking about how to
realistically expand the coverage pool. If I were made Czar of Health Care in America tomorrow, this is how I would respond to your questions:
#1Lack of insurance coverage: So attack this issue at 2 levels. For low income people, increase state funding and health education. For middle class and upper class, increase the requirement for employers to provide insurance, while government makes it more affordable for employers to do so.
Increasing state funding is not a lasting fix in a fiscal context in which cost drivers (based on demographics) are going in the wrong direction--no state, not even the wealthiest ones like Maryland, Connecticut, New Jersey, can afford to commit to expand coverage/spend significantly more on low-income health coverage given what the low-income coverage pool is likely to look like in 10 years' time. As for the Mississippis and Wyomings of the U.S.--you do not want to be poor and live in a Red State in this country--these states cannot even meet their own Medicaid and HCSN statutory obligations as they stand today. The HMOs and provider groups who currently contract to fulfill Medicaid and similar programs are increasingly unwilling, even at higher compensation rates, to participate, because the economies of scale do not justify what they see as an endless black hole of un- and under-compensated associated care.
A novel potential approach that could lessen the burden, IMO, is, instead to focus on the pools of uncompensated care funds which every state, every large provider group, and every hospital network already maintain (as required by law, not out of the goodness of their hearts). When an uninsured person goes to the ER for care (and consumes, say, $1000 worth of services where $100 worth of preventive care could have avoided the necessity of the trip to the ER)--and cannot pay the bill, this bill still gets paid, out of these uncompensated care funds (which every taxpayer and every insured person pays into via higher premiums, dedicated taxes and "fees", etc.)
Why not allow low-income people to have access to these funds ahead of time, as collateral to find private sector coverage? These funds are going to be paid out anyway, and for this same group of uninsured people--why not give them access to basic coverage now, enabling them to access primary care, reducing the need for more expensive secondary and tertiary care, and improving low-income health outcomes to boot? Institutional inertia is the only answer I can come up with.
#2 Even with insurance, doctors dont get compenstated enough for vaccines and treatments. Government should regulate pharm. industry and make them lower prices.
This is irrelevant, because increased oversight of the pharmaceutical industry will not happen anytime soon--they have the best lawyers, and spread their money around the political spectrum brilliantly--as a political and policy junkie, I get slightly turned on just thinking about how good they are.
The federal government already has excellent compensation in place for physicians to vaccinate children, via the Early and Preventative Screening, Diagnostic, and Treatment Program (EPSDT)--children in Medicaid and similar programs have better coverage for vaccination and similar standard, early-life care than their private sector counterparts.
The problem is poor utilization--how do you get a low-income individual to get their child into the clinic at the appropriate time for the approriate shot when they don't have a phone/moved three times last year/can't be found/can't read. I haven't seen a good model for better communication with and health education for low-income Americans yet--but I hope someone is working on something better than what we've got.