Have some new thought s on this. It really is pretty darn easy to fix with some very simple policy changes.
For starters, a single payor govt system sounds good on paper but will never work. For one thing, this is America and we thrive on private enterprise. There is no reason for the govt to handle things that the private sector does better and much more efficiently. The biggest reason, though, is simply because the govt can't handle the task. By BO's own admission the Medicare & Medicaid (M&M) have something like $300 B in waste/fraud/abuse. It is where he has told America he will find the biggest savings in our economic policy reform. For the life of me, I have no idea why no one, candidate or media, jumps all over this. That is like 30% of the entire cost of the program!! There is constant debate about what the govt can do but the proof is in the numbers.
The whole system can be refined by:
1) Mandatory Insurance Coverage- Not sure why the repubs are so against this, but it is the only way the system works. Everyone has insurance so every new born is automatically covered. The policy is owned by the individual or family just like auto/home/life insurance. Businesses can give employees money for insurance costs as a perk and it would still be a deductible expense to the business and a tax preferred benefit to the person.
The advantages to this are many:
a) No one is uncovered so Medicaid is eliminated completely.
b) No medical underwriting or pre-existing exclusions or gaps
c) Complete portability
d) Insurance companies have put it in writing they will lower premiums across the board by 10%
e) Eliminates state dollars allocated to dependent coverage like CHIPS
f) Controls costs eliminating fraud and abuse
g) Employ thousands of Americans
h) Many many more
How to pay for it:
1) Set a threshold based on income similar to how Medicaid works now. The govt will make the premium payments directly to the insurers for this group. Hugely important note here- for this to be cost effective a high deductible basic coverage plan has to be used. This will involve HMOs, and generic drug benefits, small doctors vist copays to curb frivilous trips to doc, no elective type surgery. just very good but basic care that all Americans should be entitled to. The reason a high deductible plan must be used is that the premiums for this are drastically lower. Like 75% less than low or no deductible plans. The govt will set aside reserves to cover these deductibles for this group for the small percentage that end up needing them due to expensive procedures. The cost to the govt for this type of set up will be a fraction of the cost currently being spent through Medicaid.
2) Everyone above the threshold buys their own. I would suggest a massive marketing campain on the different options for coverage that exist, especially high deductible plans.
3) Extend the medicare kick in date to age 70 for anyone currently 40 or younger. This cuts medicare costs in the long run by a ton.
4) The hardest part- setting reasonable coverage basics for Medicare. There are all kinds of supplemental policies that can enhance the basic care of Medicare and anyone that wants to use them should be able to. Again, we owe a basic level of care and quality of life to our citizens. However, that does not entitle anyone on medicare to an $18,000 electric wheel chair. It just can't. We should set age limits for treatments of cancer/liver/heart disease etc. It sucks, but has to be done. Maybe 85 or so. EOL discussions have to be had buy everyone at age 70 and updated every 3 years. Some 80% of medical costs are spent in the final months of life. We are spending massive amounts of money to make family members feel good but not really offering any true benefit to the patient. No one cares about the cost because the govt is paying. It is a horrible set up.
As to pricing, like I said, the insurers have already said that rates would be cut 10%. The companies are already highly regulated and percentages should be set for how much of every premium dollar must be spent on actual medical costs. I'd suggest 65% or so.
There must be published set rates for everyone. Everyone knows thier worst case scenario from a premium standpoint. you get cancer or have a horrible injury or whatever, you are going to pay the max but it is capped. Insurers can then offer discounts from the set rates based on behavior. I actually think this could have a huge positive affect on overall health and obesity. If I am a dad paying say $800/month for insurance and they tell me that if my wife and kids lose 20 pounds each and I quit smoking that I can save $300/month, I'm buying my kids celery and water!!!. Obviously that is extreme, but money is a very powerful motivator to humans. If this even has a positive effect on 30% of the population, it will be huge for us. Not only in real immediate savings to the family but also in the long term health costs of the country as a whole. Because Insurers have to spend x amount of every dollar on claims then if the overall health of the country improves, the base rates for coverage will have to come down accordingly.
Another nice benefit to this is that because rates are pretty much set, the biggest way that insurers can compete for our business is by offering discounts and offering better service. Might include better doctor coverage. They have to differentiate themselves based on good things for the insured (what a concept).
It is hugely important to keep the insurers as for profit operations. This is the only way that costs can be truly controlled and service an actual benefit.
Lastly, some type of tort refom must exist. This is another tough one. I am not sure what the best approach is here. If any of you spent a week in the work comp courts you would understand the issues better. There must be a way to give legitimate cases their day in court while using some type of system, outside of the courts, to determine if a case is meaningful. I"d suggest panels. The panels would have to made up of a non-partial mix. Maybe 7 person panels made up of 2 civilians, 2 medical professionals, a PI attorney, a Insurance rep and a judge. I'd have the panel members (like the docs and attorney) by specialty. All paid for by the Insurance companies. Both sides present their case and the panel only has a say in whether or not the case goes forward. Yes means the case proceeds. No means its over.
A plan like this would save us hundreds of billions a year in health care costs and provide all of the benefits that a country like America should provide.
For starters, a single payor govt system sounds good on paper but will never work. For one thing, this is America and we thrive on private enterprise. There is no reason for the govt to handle things that the private sector does better and much more efficiently. The biggest reason, though, is simply because the govt can't handle the task. By BO's own admission the Medicare & Medicaid (M&M) have something like $300 B in waste/fraud/abuse. It is where he has told America he will find the biggest savings in our economic policy reform. For the life of me, I have no idea why no one, candidate or media, jumps all over this. That is like 30% of the entire cost of the program!! There is constant debate about what the govt can do but the proof is in the numbers.
The whole system can be refined by:
1) Mandatory Insurance Coverage- Not sure why the repubs are so against this, but it is the only way the system works. Everyone has insurance so every new born is automatically covered. The policy is owned by the individual or family just like auto/home/life insurance. Businesses can give employees money for insurance costs as a perk and it would still be a deductible expense to the business and a tax preferred benefit to the person.
The advantages to this are many:
a) No one is uncovered so Medicaid is eliminated completely.
b) No medical underwriting or pre-existing exclusions or gaps
c) Complete portability
d) Insurance companies have put it in writing they will lower premiums across the board by 10%
e) Eliminates state dollars allocated to dependent coverage like CHIPS
f) Controls costs eliminating fraud and abuse
g) Employ thousands of Americans
h) Many many more
How to pay for it:
1) Set a threshold based on income similar to how Medicaid works now. The govt will make the premium payments directly to the insurers for this group. Hugely important note here- for this to be cost effective a high deductible basic coverage plan has to be used. This will involve HMOs, and generic drug benefits, small doctors vist copays to curb frivilous trips to doc, no elective type surgery. just very good but basic care that all Americans should be entitled to. The reason a high deductible plan must be used is that the premiums for this are drastically lower. Like 75% less than low or no deductible plans. The govt will set aside reserves to cover these deductibles for this group for the small percentage that end up needing them due to expensive procedures. The cost to the govt for this type of set up will be a fraction of the cost currently being spent through Medicaid.
2) Everyone above the threshold buys their own. I would suggest a massive marketing campain on the different options for coverage that exist, especially high deductible plans.
3) Extend the medicare kick in date to age 70 for anyone currently 40 or younger. This cuts medicare costs in the long run by a ton.
4) The hardest part- setting reasonable coverage basics for Medicare. There are all kinds of supplemental policies that can enhance the basic care of Medicare and anyone that wants to use them should be able to. Again, we owe a basic level of care and quality of life to our citizens. However, that does not entitle anyone on medicare to an $18,000 electric wheel chair. It just can't. We should set age limits for treatments of cancer/liver/heart disease etc. It sucks, but has to be done. Maybe 85 or so. EOL discussions have to be had buy everyone at age 70 and updated every 3 years. Some 80% of medical costs are spent in the final months of life. We are spending massive amounts of money to make family members feel good but not really offering any true benefit to the patient. No one cares about the cost because the govt is paying. It is a horrible set up.
As to pricing, like I said, the insurers have already said that rates would be cut 10%. The companies are already highly regulated and percentages should be set for how much of every premium dollar must be spent on actual medical costs. I'd suggest 65% or so.
There must be published set rates for everyone. Everyone knows thier worst case scenario from a premium standpoint. you get cancer or have a horrible injury or whatever, you are going to pay the max but it is capped. Insurers can then offer discounts from the set rates based on behavior. I actually think this could have a huge positive affect on overall health and obesity. If I am a dad paying say $800/month for insurance and they tell me that if my wife and kids lose 20 pounds each and I quit smoking that I can save $300/month, I'm buying my kids celery and water!!!. Obviously that is extreme, but money is a very powerful motivator to humans. If this even has a positive effect on 30% of the population, it will be huge for us. Not only in real immediate savings to the family but also in the long term health costs of the country as a whole. Because Insurers have to spend x amount of every dollar on claims then if the overall health of the country improves, the base rates for coverage will have to come down accordingly.
Another nice benefit to this is that because rates are pretty much set, the biggest way that insurers can compete for our business is by offering discounts and offering better service. Might include better doctor coverage. They have to differentiate themselves based on good things for the insured (what a concept).
It is hugely important to keep the insurers as for profit operations. This is the only way that costs can be truly controlled and service an actual benefit.
Lastly, some type of tort refom must exist. This is another tough one. I am not sure what the best approach is here. If any of you spent a week in the work comp courts you would understand the issues better. There must be a way to give legitimate cases their day in court while using some type of system, outside of the courts, to determine if a case is meaningful. I"d suggest panels. The panels would have to made up of a non-partial mix. Maybe 7 person panels made up of 2 civilians, 2 medical professionals, a PI attorney, a Insurance rep and a judge. I'd have the panel members (like the docs and attorney) by specialty. All paid for by the Insurance companies. Both sides present their case and the panel only has a say in whether or not the case goes forward. Yes means the case proceeds. No means its over.
A plan like this would save us hundreds of billions a year in health care costs and provide all of the benefits that a country like America should provide.
