As of April 1 in Illinois, they have taken step 1 in protecting the uninsured. A new law caps uninsured patient bills at cost +35%.

Hooray! A good first step!

Now don’t rest on your laurels, Illinois.

Cost plus is great if you can understand the “costs” portion, but most patients do not. Step 2 is to root out the inefficiencies and poor procedures.

For example, it’s reasonable to charge someone an amount for a service well done and efficiently. But for the patient who gets 5 nurses at bedside, 3 specialists and the whole battery of tests to determine that he has a splinter, cost plus is not effective. Cost plus just rewards the hospital with an amount they can pursue aggressively and justifiably in collections. The patient may still be exposed to inefficiencies like improper diagnosis, inappropriate treatment and inefficient practices.

Step 1 is easy. Now for the hard part. Step 2 – improve the standard of care.

Still, congrats to you Illinois!

Just saw the CNN report on 13 million uninsured 20-somethings in this country. New to the job force and turning down their health insurance.

What are they thinking?!?! Do they believe that they can just go out and buy what they need in terms of medical goods and services on the free market? Good grief! This is America for goodness sakes.

So what are they doing in lieu of buying insurance?

Radical things like minding their health– watching what they eat, working out, bundling up before they go out in the cold, washing their hands (oh, these kids – they’re like modern day hippies shunning the norms of society).

They go to the doctor only when absolutely necessary instead of for every little ache and pain. They go to retail clinics (like Minute Clinic and The Little Clinic) where they know the costs BEFORE they buy (oh my, what are these kids coming to wanting to know the price before they blindly incur the expense). They look things up on the internet (It may be MY chronic disease but shouldn’t the doctor know more about it than me? He treats it, and I only live with it…every single day of my life).

But why should these 13 million have insurance? In case something happens.

Hellooooo – they’re 20-somethings and invincible.

But seriously, why should they? Because it underwrites the rates of the older portion of the population. If they don’t get healthcare, they don’t offset the risk pool – they don’t underwrite the older segment of the population. And we know what that means – our rates will go up because they aren’t contributing monetarily (and taking less out than they put in) as we expect them to do.

But we can still get them. In New Jersey, children can stay on their parents insurance to age 30! Thirty!!!! In many other states it’s only 24 or so.

So now I’ll set aside the sarcasm.

What we are seeing is the revolution. The new generation is taking a stand. We have a product – health insurance – AND THEY ARE NOT BUYING! The business world should get the message here. These folks are going to opt for surgery overseas, retail clinics and internet consults. They are going to cost shop prescriptions and doctors. They are going to demand affordable access to care and they are going to want to know the price AHEAD of time. And they are going to return health insurance to truly being insurance – a safety net for catastrophic situations instead of the all you can eat buffet for $20 we have bad for soooo long – too long.

Do NOT think that it is the sage old regime of healthcare executives and politicos in D.C. who are going to change healthcare. It is the 20-somethings. They alone are able to break out of the old ways of thinking. It has been that way generation after generation. THEY have the new ideas. THEY are taking a more rational approach. They are getting organized and THEY are not content to go along with the system as it has been.

Yes, they are 13 million without health insurance…and growing. THEY will change healthcare.

Tomorrow marks the one year anniversary of the Mass State Health Plan deadline requiring most individuals to carry health insurance. Though the insurance law has been praised by some and criticized by others, Drew Altman president of the Kaiser Family Foundation believes the law falls somewhere in the middle.

So what’s the main problem, and everyone’s number one concern? COST… go figure.

The USA TODAY article Mass. Pioneering Health Plan turns 1 highlights some of the plans successes and failures. The success story highlights a woman who had lost coverage when she lost her job and was able to get coverage discounted through the state. Lucky – she was even able to get coverage after being diagnosed with cancer. She is now in remission!

Failures? Well the article doesn’t do a very good job of examining this side. They touch on a woman who is self-employed. Her monthly premium last year was $422. In August that will increase to $615. $615 x 12 = $7380. Now I am not exactly sure how that works with tax write-offs (being self-employed) but that number is ridiculous.

Now I applaud Mass for getting their uninsured down to 7%, however the program/law needs to take into account the cost of insurance to everyone… not just those with low income. In a scenario where someone is paying $615 a month for health care , or even half of that, is difficult for me to digest considering the amount of money I make (thank you change:healthcare for covering my health insurance). No wonder people don’t purchase health insurance. At that price… I would be tempted to keep my fingers crossed that I don’t get sick.

With the changes in our economy, especially on the verge of electing a new president, finding a health insurance solution for the whole country is going to be anything but easy. And the Mass approach will not work for every state, or the whole nation for that matter.

Keeping costs down needs to be one of our main concerns. The fact that health care is 20% of our GDP, compared with similar countries hovering around 10%, is proof that something has to change. (I would not harp on the 20% if we ranked near the top of the list for infant mortality and life expectancy… but we don’t, we are actually in the bottom third.)

Our second focus needs to be quality and subsequently preventative care. As one of our partners pointed out, we do not have a HEALTH CARE system, we have a SICKNESS TREATMENT system. The shift to health care must take place.

Renovating a system that is so set in its ways is not going to be easy. As you can see with Mass, its a work in progress, and very few people embrace change with open arms. However, focusing on changing the ways in which we approach insurance coverage and enrollment, as well as the ways in which we approach our health are good places to start. Add in the end goal of reducing cost, improving quality, and extending access… and we can begin to change:healthcare as a country. Since Mass has tried to change first, lets take this as an opportunity to learn from their successes and failures.