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Community Health Services Associations CHSA

A New Form of Health Assurance

by Larry Hawes

Today’s loud and distracting arguments over health care reform have taken our attention off  the real health care problems real people are facing every day. Those problems have not changed, no matter how loud the shouting or how many run naked in the streets screaming Nazi.

The problems are basic. 1. People can’t afford health care. 2. People can’t get it, if they have a pre-existing condition. 3. If they do have it, their policies can be cancelled for reasons known only to health insurance companies.

Worst of all our current system creates an atmosphere of fear and doubt. An atmosphere where our society is literally destabilized by the possibility facing everyone in this country - that if they get sick they either cannot get the care they need or they could lose everything.

What if we, as a nation, could focus our attention on that instability created by the fear and doubt? What if, as a nation we could could turn our attention to systems and policies that created an inherent stability within our nation? And what if, as a nation, we can't? Can we find ways to stabilize our local communities instead?

Up to this point our national representatives have proven they do not have the skills or the will to create systems and policies that add stability to our society and benefit the entire nation. If they did we would not be having today’s screaming matches masquerading as policy discussion. We would sense it as a society. We would know in our gut that they were working in our best interests. But each and every one of us knows something very different.

So if we know we cannot depend upon our representatives to create the security and stability that is part of their job description (remember that general welfare and domestic tranquility stuff in the Constitution?) then whom can we depend on?

What if we found a way to depend on each other? What if we could create a health care system of the community, by the community, and for the community? And if we could, what could it look like?

First off we’d need a clear purpose, one that could be served in any number of ways. A purpose that clearly stated what we wanted to do.

Something like: We propose to create an affordable, stable, community based health care system, available to all, denied to no one, in order to provide the best health care, funded by and serving its own local community.

Simple enough. Now how could we intend to create such a system.

One of the first things is to create a large enough network consisting of a central hospital, or hospitals, which would in turn be supported by satellite outpatient/urgent care centers to administer health services throughout the community. This Community Health Services Association (CHSA) network could be composed of ‘members’ that would pay a monthly fee that would go directly to each outpatient center (OC) and hospital to defray operating costs and capital expenses at all locations.

The actual costs for services rendered would be strictly monitored by each community so each member could know at any time the actual costs for any procedure performed at any locations. Those actual costs would be the costs that the entire membership would be responsible for. And those actual costs would be the basis for the monthly fees charged each member. The costs usually incurred by the insurance and administrative overhead would be reduced or eliminated.

The first thing this model would do is add to the stability of the economic portion of the system. Today, one cannot find out how much a specific procedure will cost. No one knows the actual cost of a procedure until they receive a bill from either the hospital or the insurance company. Until that moment no one knows their financial exposure, thereby destabilizing the system.

With this proposed business model everyone could know. And not know just the round about estimate, but the actual cost of every procedure. The ultimate system would require quite a bit of detail to be worked out but the intention is to create a system that reflected the actual costs of service minus the unneeded overhead.

 Anyone can join their local Community Health Services Association (CHSA) even those with pre-existing conditions. This stabilizes the community system even further as the concern that there may be some fine print they missed that will cause them to lose their coverage is eliminated.

When a patient, who is a member of a local CHSA checks into a hospital or OC their needed services are provided for free or are charged a small co-pay depending on the service provided.

Once a member of a local CHASA that member will never be denied health care for any reason. Very secure in knowing you cannot be denied coverage.

 All equipment, drugs, and all hospital and OC materials would be negotiated by the (CHSA) membership. This may or may not save money but the CHSA membership will know that anything purchased for the communities care will be purchased at the best price and at the highest quality.

Each employee of each hospital and OC would be required to be a member of the local CHSA. This means that each CHSA member has a stake in the success of each location. Each employee/member would share in the responsibility of the smooth operation, cleanliness and overall superior patient care provided at that local CHSA. Each employee would also know they would be treated at their own facility.

Decisions and policies would be created and administered by an administrative governing body appointed by CHSA members that would alternate between members. One problem noted at more than one hospital can be the apparent disconnect between the administration and staff. This would solve that issue. It might even be wise to require staff to sit on the administrative board as part of the responsibility as CHSA members.

Monthly fees would be set according to the operating and capital expenses of the local CHSA. Any moneys not used in a given year would be used to expand and upgrade facilities or returned in the form of lower member monthly fees.

We’ve covered two of the three major concerns of today’s system. Getting coverage no matter what and never being denied service because of a procedural error or decision from an outside source.

The one issue that has not been addressed is what to do with people who cannot afford any care at all. The poor who cannot afford a ‘membership’, how would they get the needed care? Leaving them out of health care services would go counter to the purpose of providing top quality health care to the community and could create a dangerous public health situation.

Perhaps if their were truly a community based system there could be some financial provisions set aside for those in need. Perhaps a small percentage of fess could be set aside to treat those who cannot afford any coverage at all. Or there could be a free day of volunteers to give care to the needy?

There are, of course, many questions to be answered before a system like this could be implemented but the most important question is, ”Could it work?”

This writer thinks it can. There are certain economic realities that need to be addressed. Like how many members must there be and at what cost before the system becomes viable? How we define the community and where and what boundaries constitute a community? If there were more than one CHSA can it piggy back its services with another in another area?

Those answers will come but first we must have the will to create a genuine community that serves its members in many ways that Washington either will or can not do. Ways that include solutions that create a firm, stable foundation for each community. Health care might be just a start but if we could rest assured that we will not go bankrupt if we get sick or that we will not die if we cannot afford the care it would make a very good start.

If we wait for Washington to solve our local problems we can, from experieince only hope for a solution that addresses problems we most likely do not have.

Comments welcome in the forum