Armchair policy makers: Post your plans to fix our health care system.

[meldroc]

OK, we've all heard George W. Bush's plan, which he'll pimp tonight in his SOTU speech. Flat out - it stinks. It's yet another band-aid on a sucking chest wound. There's no way that a little tax deduction is going to make health insurance premiums even slightly affordable for people that buy individual health insurance, and that's assuming you can get health insurance (if you have had any sort of medical conditions during your life, most insurance companies won't touch you at all, or charge you insanely high premiums, or write exceptions into the policy that ensure that when you do need medical care, they won't pay for it.)

On top of that, *'s proposal would pay for this band-aid by making employer-based health insurance taxable. You'd have to pay taxes on that health insurance your employer provides for you, if you're one of the lucky bastards, and your employer would have to pay payroll taxes on their health insurance costs, ensuring that many employers will drop their health insurance benefits, leaving even more millions of Americans uninsured.

In short, this proposal will float like a lead balloon, and for good reason. We need a better idea.

Here's an idea (stolen blatently from a half-remembered think-tank proposal (AmericaCare or something like that - I forgot the correct name and URL...))

- A new government health care system, similar to Medicare, let's call it AmericaCare (I think that's the original proposal's name), will be created, except that unlike Medicare, it's pay-as-you-go, like health insurance, and anyone in the U.S. can join if they want. You pay a monthly premium, this plan pays for all your health care needs. AmericaCare doesn't have to give out extra luxuries or pay for Cadillac health care, but it should cover basic medical necessities reasonably well.
- All employers, no exceptions, will be required either to either pay into AmericaCare, or pay for private health insurance that's at least as good.
- All people in the United States shall be required to have health coverage. There will be a means test - if a person's income is greater than MinIncome (I'll leave it to the number-crunchers to define what MinIncome is) - they have to either use their employer's health insurance (assuming they're working for someone else) or if they're self-employed, they have to pay into AmericaCare or private health insurance. If a person's unemployed or otherwise has income < MinIncome (and they don't have an employer that's paying into AmericaCare or providing them with private insurance) they're automatically eligible for Medicaid or Medicare, and if they don't get health care by other means, they have to take Medicaid. In short, if you can afford it, you have to pay for health coverage. If you can't afford it, you'll get help. You WILL NOT do without. And no, Wal-Mart, you can't stiff your employees on health care and then sign them up for Medicaid so the taxpayers get stuck with the bill.
- Private health insurers can still operate, and are encouraged to, so there's competition in the system. Caveats: Coverage must be at least as good as AmericaCare, not worse. If you can do better and cheaper, thumbs up, but if AmericaCare covers a procedure, you have to cover it too. You can do things like provide private hospital rooms when AmericaCare only pays for shared rooms. Nobody who offers health insurance in the U.S. is allowed to deny coverage based on medical conditions, or raise premiums based on medical conditions. The healthy 25-year old pays exactly the same as the heart-transplant patient, and the heart-transplant patient cannot be turned down. No pre-existing conditions clauses or crap like that. The insurer can set the rates as necessary to make money, and can market their plans so they can find more healthy payers to cover the cost of the heart transplant patients, but they have to compete against each other, and against AmericaCare, who likewise can't turn anyone away or jack up prices.
- Oh, almost forgot. All health care providers - hospitals, doctors, etc. in the U.S. will be required to accept patients covered by AmericaCare. Some checks will have to be built into the pricing and payment systems so care providers don't get stiffed like Medicare sometimes does, but there will also have to be negotiation room (none of the ridiculous prohibitions Medicare has against negotiating prices for drugs with the pharmcos...) so we can avoid things I've seen like $50 for a Tylenol and $10 for a bag of ice (yes, I've seen this on a hospital bill...)

In short, the government provides a baseline system that anyone can pay into and use. Health insurers can offer better care if they can do it at a price people are willing to pay. Insurers get a tradeoff here. On one hand, since everyone in the U.S. will be required to have health care, there will be more healthy people paying in. On the other hand, they're no longer allowed to turn away people for medical reasons or jack up their premiums.

[meldroc]

1. Shameless kick...

Nobody here can do better than Bush or the plan I mentioned in bringing decent health care to all Americans? C'mon...

[sinkingfeeling]

2. Pretty much the same here. Uni-coverage of all Americans. Big Pharma will

be required to negotiate drug prices based on volume discounts.

[w8liftinglady]

3. I would only include a dental component-

not cosmetic,but covering pediatric dental care and cavity,root canal,and one cleaning a year.

[meldroc]

7. Definitely. Also include mental health...

Too often, health insurers treat people with mental health issues as second class citizens and stiff them on coverage. You get limitations on counseling, abbreviated treatment for conditions like eating disorders, leading to increased recurrence, people unable to get treatment leading to suicides, inability to work, etc.

[LSK]

4. ummm maybe study what works in Canada and Europe

Its not like this is uncharted territory!

[RB TexLa]

5. All people in the United States shall be required to have health coverage.

You want to force people to buy health insurance? Will it have to be at a certain level? Every twenty-something will have to buy health insurance? What if they want to buy insurance that only covers accidents and risk health issues for a couple of years? What about my HSA? I have raised my deductible due to the amount of money I have in it for medical costs, of course my goal is to never use it for that. Would I be forced to buy a more expensive plan so as to be a healthy person paying more into it?

[meldroc]

6. To be blunt, yes.

One of the goals is to spread the risk, and spread the expense among as wide of a pool of payers as possible. Socialist? Yes, but I don't care. Three years of being unemployed or underemployed and uninsured has beat that out of me.

Part of the reason why health care is so expensive is because healthy people opt out, and the insurers have a smaller pool of people with more medical conditions. The insurers, in their usual cold-bloodedness, deal with this by cherry-picking their customers, accepting only healthy customers, and refusing to cover people with the worst medical conditions, leaving the taxpayers with the bill. In short, you end up paying one way or another.

As far as what level of care to require everyone to pay into, I'd say make the minimum level no-frills, but not inhuman - shared hospital rooms instead of private rooms, generic drugs instead of brand-name, etc. though all genuine medical needs are covered. I would be against a coverage maximum - no saying "Sorry, we only cover $100,000, but since your expenses are $350,000, you're SOL." I wouldn't mind having a higher deductible for people who have the means to cover it, though I'd object to policies with $20,000 deductibles. Maybe a maximum deductible of $1,000 - enough that some people could save on premiums if they're willing to risk this expense, but not so high that most people can't handle it if they do get hit with this bill.

It's not much different in my view than making everyone who drives a car on public roads have auto insurance.

Not sure about HSAs. Accommodate them, of course, though I personally find them to be too much hassle.

And like I said, I would make sure that people who can't afford it get help, so people don't fall through the cracks.

[RB TexLa]

9. The thing that's troubling is

the plan is "socialist," as you put it, but in terms of people's health. Healthy people already overpay based on the basic concept of insurance, which is fine, that is what insurance is. This plan would force people to drastically overpay based on their degree of health. This is far different than a debate over people who make or have more money paying higher percentages to cover health care or to subsidize health care for others. To accommodate HSA's you would have to allow people to have higher deductible plans, yes even the $20,000 annual deductible plan you mentioned your objection toward. If you are putting the maximum into an HSA which was $5,250 for an individual last year over time, it is easy to handle a $10,000 or $20,000 deductible plan. I haven't seen any $20,000 deductible plans yet but they are coming as people's HSA's grow.

The comparison to auto insurance requirements doesn't really fit. That is a personal protection for everyone else driving on the roads, to compensate for our personal loses from another drivers fault. If someone doesn't carry health insurance, there can be a public cost but there is not a personal cost other than the shared cost.

[Lydia Leftcoast]

8. If abolishing private insurance is unrealistic, here's what I'd do:

1. Reform Medicare administration so that it doesn't drive doctors crazy. (This is according to my brother who says that Medicare's rules are so complex and nitpicky that you can violate them without intending to.)

2. Allow anyone to buy into Medicare at the same rate offered to seniors. The addition of younger, healthier people will help ensure the solvency of the program. If Tom Twentysomething and Thelma Thirtysomething pay the same as Sam Seventysomething but Tom needs medical treatment that year only when he breaks his leg skiing, and Thelma needs it only for a healthy pregnancy and birth, while Sam needs treatment for a stroke, you can see the financial advantage in having these younger people enrolled.

3. The government should be able to negotiate drug prices.

4. The competition from Medicare will force private insurance companies to lower their premiums and deductibles and put their obscenely overpaid executives and shareholders on short rations.

5. As with Medicare, people will be allowed to buy supplementary coverage or pay for extras out of pocket.

6. Instead of having deductibles, insurance companies will be required to cover one annual physical with all the age-appropriate diagnostic tests.

[Vinca]

10. Universal health care for all Americans.

Look to Canada or the European nations for guidance. Paid for by a tax increase (incremental, depending on income) and/or sales tax on stuff that's bad for you: booze, cigarettes, junk food, fast food. I don't know about you, but my taxes would have to go to a whopping 75% to reach the stratospheric levels of the policy available to me (and which I can't afford) today. Medicare is in place and could be expanded to include more services and be open to everyone. There would be no need for separate services for the elderly or the poor (today's Medicare and Medicaid) because everyone would be covered under one umbrella, the new Medicare. I would not cover plastic surgery except for reconstruction or other medical necessity (tax payers shouldn't have to fund boob jobs, Botox and turn-me-into-a-space-alien face lifts). Cosmetic dentistry would be out (except for reconstruction/medical necessity), as would nonessential eye procedures such as Lasik surgery. Who would lose? Those poor, poor, insurance companies. Boo hoo. I didn't know until yesterday that insurance companies are exempt from antitrust laws which explains why they're as immoral and corrupt as they are.