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Specific Reforms Needed
Health reform is not so hard. First we must understand that there are two markets at work here. There is the market for actual health care. And then there is the market for health insurance. The market for health care needs to be more transparent. So encourage providers to get together and establish a standard list of a la carte services and procedures. Require that these prices be published and kept up to date. When a person/family member wants to arrange for healthcare, require providers to give an estimate for this care. Establish fairness in the law that would subject providers to excessive service, price gouging and under-estimating complaints. Let the trial lawyers do the rest. On drugs, open up distribution rights to all foreign sourced drugs. Allow exclusive rights only to patented drugs. Limit patent terms and allow one renewal only. Allow foreign prices to be used in drug price gouging actions.
The health insurance market was largely state regulated before the ACA. Let the states still regulate the insurer ratings/qualifications, claims and complaints in their states, however get them out of the policy term/coverage regulation business. Let the industry come up with a standard insurance form to be used nationwide. Let the insured select the coverage, deductibles and self insured limits from a standard, easy to understand menu for any policy. Policies would all be written as “major medical” policies with or without “routine and well-care.” Limit coverage to US risks. Let people buy special policies for out of country risks. Allow the insurers to provide discounts to those who belong to health maintenance or consierge care programs.
Other actions (which could be separate bills), limit torts for medical malpractice to actual damages with a top end limit. Exempt drug/device manufacturers, once products are FDA approved, from class actions. Limit damages to incidents of gross negligence.
Eliminate the “employer provided” insurance tax preference. Allow anyone to use pretax (income and withholding) dollars to buy immediate family medical insurance without limitation. Encourage other groups – union, fraternal, religious, academic, alumni, social – to get into the group insurance business. If they allow once a year open enrollment, allow them to participate in a high risk pool program.
Expand health savings accounts. Let contributions and interest be pretax and pre-withholding. Let insurers manage these accounts to tie into health insurance and provider payment.
Establish a national “high risk pool” reinsurance group. Use professional actuaries to establish what specific risks qualify as “high risk” and what assessment on each dollar of insurance sold needs to be paid into this fund on every policy written. Redistribute these funds to the insurers to cover a ratable portion of their underwriting losses from high risk policies.
The keys here are: we negotiate our own deals with health care providers. We buy our own insurance. We use pretax dollars for all health related expenses. We are treated fairly by providers. Those groups who provide insurance and allow open enrollment will have the benefit of reimbursement for underwriting losses on high risk policies.
Published in General
The Congress can initiate a bill anytime they want. I’m sure that there are plenty of think tanks who are now outlining the reforms needed. I’d rather see it in pieces, in any case. We should stop this arrogant idea that our government can “fix” healthcare. We’re not fixing it. We are giving it back to the marketplace to sort out and refereeing the process. It is simplistic arrogance to presume that government should run anything other than justice, defense and immigration. Their record on those delegated authorities is bad enough. They’ve made a hash out of just about everything. The last thing we should put them in charge of is our health!
Get rid of the employer/health insurance link and a lot of the market distortions go away. No one gets their homeowners insurance or auto insurance through their employer. No one loses their homeowners insurance or auto insurance when they leave a job. Neither homeowners insurance nor auto insurance is in crisis.
There is no rational reason to tweak (let alone perpetuate) an idea born of the WWII era that has far outlived its usefulness (assuming it had any to begin with).
But the people did, too, though – and still do. In taxes, you can easily avoid working a shift down at Meals on Wheels because hey, you pays yer taxes. Let somebody else do the actual work. I hear so much from friends saying “I don’t mind paying taxes, it helps people” (paraphrasing horribly here), which misses the point entirely, and sidesteps the harder, much harder question: If you didn’t have to pay taxes, would you then go out and help people?
Guaranteed the special tax-paying people who frequently utter these words aren’t going, for a second, to dive into the muck of the lousy end of the stick where the poor actually live. They won’t go there. They won’t be seen there. They will certainly expect someone else to do the work Americans won’t do anymore (an ironic twist on immigration, natch) – and the tithe is the conscience-avoider employed on a daily basis.
The public does not agree. If it did, we wouldn’t have Medicaid, or mandatory emergency room care. Keep in mind that group employer plans have a mandate embedded in them, and it’s really not fair to small employers or, especially, independent contractors if they don’t have access to a similar risk pool.
We have mandatory emergency room care because of federal court judge rulings. The one case I’m aware of where it was up for a vote, Prop 187 in California, the public overwhelmingly voted no.
And did any conservative pundits oppose it in 2009/2010? I remember hearing quite a bit of praise for that policy from the right, from e.g. Rush Limbaugh, Sean Hannity, Tom Sullivan, etc.
But you didn’t say ‘conservative pundits’, you said ‘the public’. Granted it has been a while since that vote, but don’t be sure the public is in favor of what pundits and politicians are promoting. The election of Trump would seem an indication of a distinct lack of favor.
By the way, reinsurance (which is not “high-risk pools”) does nothing to prevent death spirals. If you have an individual mandate, then reinsurance is just how insurers distribute the risk amongst themselves. This can be done with a public utility, but ultimately the goal should be a functional, privately-run reinsurance market.
I just have a hard time believing voters oppose it, if they did then Medicaid wouldn’t exist.
With the federal government involved in so many things that are of supreme importance to certain groups of people, you can’t get a constituency to eliminate any entitlement, even if a majority are against it. The people getting it are rabid about getting it and most other people don’t care as much as they do.
With the two party system, my realistic choices of candidates are the guy who I don’t agree with half the time, or the guy who is completely awful. And the half awful guy probably likes Medicaid. My opinion on the subject never gets heard.
This is a good point. I’ll take either one, given the current environment, but you are right that making health insurance and/or health care costs deductible keeps control by the government.
Doctors can be replaced by $50K assistant herd managers. Come to think of it, maybe an ObamaCare replacement should require that physicians who work for the government be given that official title, to be displayed on all paperwork, etc.