Health Care Reform - If I was King

Part of the package that passed tonight was desperately needed modification of how health insurance companies operate. As a small business owner, I absolutely HATE the news that comes each August as my annual renewal notice for my company's medical insurance premium arrives. Has it EVER gone down year over year? Nope. I usually hear my insurance agent say "Well, they wanted to increase it by 25%, but I got it down to an 18% increase." A Pyrrhic victory at best. I have been screwed, glued and tattooed by insurance companies over the years and they have lied on several occasions. I have also seen how "groups" are the biggest way that these companies really penalize small employers by creating artificial entities which are rated in a vacuum. With these statements, I hope I have established my bona fides that I am not a shill for the insurance companies.

So, what would I do if I was the king? On the insurance front I would make a few fundamental changes. First, I would remove the ability of each state to set separate requirements and rules for insurance underwriting. Of course, this would all be un-constitutional in the United States (oh, that's right... so is the new Health Care Reform bill that just passed a few minutes ago. Ooops. Sorry.) I would allow individuals to purchase insurance from any company that offers a legitimate policy from any of the several states.

I would also mandate that individuals would purchase their own insurance policies and that employers would be removed as the purchaser of most of the health insurance in this country, making health insurance like home, auto, life, disability, supplemental, flood, umbrella and any other insurance that an individual wants and purchases.

I would retain the ability of an employer to pay, with pre-tax funds, a certain amount of money toward an employee's health insurance premiums.

I would level the playing field for pre-existing conditions by issuing the following rule: If an individual has a current health policy, either from parents, organizations or by one's own money, any insurance company has to accept them if they want to move over and choose one of their plans. If an individual chooses NOT to have a health insurance policy for whatever reason and they contract a condition that would preclude them from getting insurance, or from having that condition covered, TOUGH. They should have thought about that while they were pocketing the $200/mo when they were young and healthy. If an individual decides later in life to purchase insurance and he or she does not have a pre-existing condition, their costs for the rest of their life would be a certain percentage higher than those that have always had insurance (and this percentage would increase the later one waited to get on-board.)

As much as it pains me to do it, I would have a plan to subsidize health insurance premiums for those who are not working or choose to not work, so that no one who truly wants health care insurance cannot get it.

I would require individuals to have to pay some percentage of the premium if the government is footing the bill. It CANNOT be free because most people just do not appreciate nor take care of something that is given to them for nothing. I would also require individuals to have to pay a co-pay for the same reason.

I would have a minimum coverage floor set for the cheapest plans, which would cover comprehensive needs above $2000 and catastrophic needs before the cap. I do not believe that health insurance should be mixed up with health maintenance. Just like you don't place a claim with your homeowner's policy to paint your home, or to fix a broken window, because you know that you have a substantial deductible and that your rates will likely go up, you shouldn't expect to have your health insurance pay for every little sniffle and sneeze during cold and flu season. There are those who say that if you do this, that it would put a chilling effect on the ability for people to get care that they really need. Well, I think that if you wear out your shoes and you need shoes, you will find a way to get shoes. If you are hungry, you will find a way to feed yourself. If you are truly sick, you will find the money or the way to pay to get well.

Because the last paragraph would make me seem like a cold-hearted SOB, I would also ensure that there are very affordable places to go for primary care besides an emergency room. These urgent care facilities are already in place in much of our country and they can provide basic medical needs like front-line diagnosis, X-Ray, prescriptions, physicals, lab work, etc. There is absolutely no reason that your local Wal-Mart or other store couldn't provide this service.

Medical fees should be available from doctors, hospitals or other health care providers. Just like you know how much gasoline costs before you pull in to the station, so should you know what your medical care will cost. Because I am just a regular king, not a King Solomon, I cannot yet figure out how to pay the providers once the insurance starts paying for it. I guess they will just have to continue to negotiate with insurance companies and perhaps accept less payment than they want from insurance and bill patients the difference. If the patients do not want to pay more than their covered amount, they can go down the street and find someone who will do the work for scale. Doctors need to be paid fairly to compensate them for the rigorous training they go through, but if they want the $4 Million mansion, fancy cars, yachts, etc. they are going to have to make if from their patients because they are just damn good and the people are willing to pay (see cosmetic surgeons if you have doubts that this system could work.)

Also, since I am not a King Solomon king, I haven't wrestled the what-constitutes-the-end-of-life monster to the ground yet. Important element, but not make or break.

(Note: I keep hearing these anecdotal arguments about people that had terrible cancer, or heart attacks that died because they didn't have health care insurance (in other words, they couldn't pay for the care they needed). How does that square with the fact that no hospital can refuse care to people who need it? When gangs shoot each other, who picks up the tab for the ride in the ambulance and the care at the trauma center? Do the Crips and the Bloods have a Major Medical plan? I don't think so, but these scumbags get patched up, often with heroic efforts by the medical staff, and put back out on the street. So why can't someone's mom get care? You tell me.)

So, in a nutshell, here is my King Asterisk health care plan:

The kingdom decrees a baseline coverage for an acceptable minimum health care policy. The premiums are based on your age and where you live (there are already plenty of regional multipliers available and acceptable for pay and benefits because, lets face it, it costs more for things in New York City than it does in Grinder's Switch, Arkansas.) Each individual would be responsible for the first $2,000 of payments per year and then the insurance would kick in and pay for 100%. The caregivers would NOT know if the individual had met or exceeded their 'deductible' amount, nor could they ask, so that they would assume that the patient was paying and would have to act in a prudent manner and not waste money on things just because insurance was going to pay for it.

Employers would know what the matrix for health coverage looks like for their area because everyone's fees come from the same schedule. Employers could pay a percent of this amount (even exceeding 100%) pre-tax for health insurance, but they could not pay more than what someone pays out for premiums (to avoid profiteering by the employee.) Insurance companies would be allowed to tack on riders for individuals that engage in risky behaviour, including smoking, excessive alcohol or drug consumption, dangerous sports, carrying excessive body weight, etc. The cost for these riders would also be known and standardized for the minimum, kingdom-controlled policies. Employers would NOT be allowed to pay for these riders.

Employers would have to include the amount that is paid to employees for health insurance as a line item on their compensation report, even though it is not taxed. This would be similar to how the military pays non-taxable allowances to service members for housing and food. This would ensure that each employee would know what their true salary is. This would also make it much easier for employees to compare wages and benefits between potential employers.

Supplemental insurance policies could exist to pay for the gap before the Major Medical plan kicks in. If an individual is destitute and cannot pay for the first $2000, then charities, family and as a last resort, state and local government could assist. The point is to make it such that everyone has some skin in the game. This might make people take better care of themselves, but at a minimum, it would cost them out of pocket to use the health care system for trivial items.

I wouldn't force anyone to purchase insurance, but I would make it very attractive for them to do so. If they chose not to have a policy, then when they need care, they must suffer the consequence of their own bad decision.

Insurance companies could not reject anyone coming from an existing approved insurance policy for reasons of a pre-existing condition. There would not be lifetime caps allowed, but once an individual reached a threshold of, say, $2 Million, a mandatory review would be required to determine where the money has gone and if more should be spent. The denial of coverage could be issued only if there is evidence of fraud or malpractice. If it is the latter, malpractice insurance payments would be in order.

I would attempt to bend the cost curve of medicine down by providing standardized payments for procedures and any amount in excess of the baseline could be charged by the provider if the patient is willing to pay. If not willing to pay, the provider must accept the standard payment, or the patient can go elsewhere. Providers must have a schedule of costs readily available for patients. Can you think of ANYTHING that you buy that you don't know how much it costs before you sign up? Let the free market rule.

Experimental drugs could be paid for by insurance companies, charities or individuals, but would not be paid for by the basic policy. Sorry. (If you had gotten sick two years ago, the experimental drug probably would not have even been an option. Wait a few years and it will probably be on the formulary. Is this rationing? I don't think so, but you have to draw the line somewhere.)

Approved medical expenses could be tax deductible which would encourage people to get the care that they need.

There you have it. My not-all-inclusive idea on how to reform our health care system. Is it perfect? No. Can it be gamed? Of course it can, but anyone caught cheating or gaming the system should be dealt with harshly and with prejudice, including jail time. Once people found that the penalties for cheating were severe, most would not do it. Take those 16,000 new IRS agents approved in the new HCR bill and make them Medical Coverage Auditors. Cut them loose and let them check out claims of bad conduct by patients and providers alike.

The Democrat Congress and the President claim that this monstrosity of a bill will bring down costs, squeeze out fraud and waste, extend Medicare 10 years and make your breath smell minty fresh. If you can point at any government program that has come in under budget, then I may consider listening to your argument. Ergo, my skepticism.

PLUS, show me a government program that does not grow and metastasize over time to exceed what even the most optimistic supporter could have imagined. That adds dramatically to costs.

They all told us how great this bill will be and how little it will cost us. Who do we complain to in 2016 when we find out it was all a total fabrication?

Comments

The Asterisk said…
Of course, you can complain to President Donald Trump!

Interesting how so very few of the income producing aspects of the ACA (Cadillac tax, fees (excuse me, taxes) on non-conforming citizens, medical device tax, surcharges, etc.) have never come to fruition. So, when it comes to scoring by the CBO, fuggedaboutit. It is all smoke and mirrors.

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