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Bipartisan UHC system.

spud_meister

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So, for a UHC system that meets liberal goals, using conservative methods, I propose a flat income tax of 2% to fund it (arbitrary number), that is able to be opted out of if one has private healthcare. The system limits the role of government to that of the billpayer, you go to a doctor, you get surgery, you have therapy, the government pays for this for you. The government has a list of things it covers (GP visits, essential surgery/therapy), maybe some others it merely subsidises(dental or optical), and some it doesn't touch (elective surgery, unproven treatments). If you want something not on the list, you get private health care that covers it, or pay out of pocket.

Any ideas or modifications?
 

CaptainCourtesy

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I originally posted this nearly 30 months ago and updated it last year. I've mentioned it to a few posters recently, who liked it... and I got a bit of support across the political spectrum when I originally posted it. So, here is my plan:

Heath care would be broken up into a three-tiered program:

1) Tier 1: Government subsidized health care. Plans paid for and monitored by the government. These plans would be universal and would be paid for via taxes of folks who "opted in" to this plan. It would be "one size fits all" with no variation on the plan itself. Any treatment deemed medically necessary by the treating physician would be covered. No elective, non-necessary or experimental procedures would be, however.

2) Tier 2: Private insurance, Similar to what we have now with some notable exceptions. No utilization review, Insurance companies no longer have the right to deny coverage for any reason, as long as the benefit is available. Only the treating medical professional can decide whether a treatment is appropriate or not. Strict government regulations aimed at streamlining the paperwork aspect, including mandatory centralization both of billing locations and of billing and other forms. Failure to comply with these regulations, suspend the company's ability to do business.

Folks who go this route, automatically "opt out" of the government plan and are not due to pay the taxes that subsidize that plan.

Borrowing from HarryGuerilla, plans are developed on an "ala carte" basis. You want coverage for catastrophic illness only? No problem. How about physicals and x-rays, only? Easy peasy. What about the works, except for obstetrics? Good to go. This kind of choice will allow for folks to get precisely the kind of coverage they want, rather than getting coverage for things they do not.

3) Tier 3: Private Pay. Complete out of pocket, pay for service plan. No insurance whatsoever. "Opt out" of government plan and related government taxes in total effect.

Additional parts to this.

1) Under no circumstances are illegal aliens covered under any health plan, government or private.

2) If you opt out of the government plan, and you do not have catastrophic coverage under your private plan, under no circumstances will the government subsidize your care. If a doctor chooses to see you, unsure of your ability to pay for the service, even with a catastrophic illness, even if it is a child, it is then on the doctor to collect fees. The government will NOT subsidize in any way, nor is any doctor or hospital required to provide any charity care. You make a choice, you need to live with it.

3) Bankruptcies will NOT eliminate medical costs. They must be paid in full, no matter what.

4) TORT reform with reasonable caps on any suing for malpractice.

5) The ability to sue an insurance company for not paying for services that are in a patient's benefit package. Yes, this happens more often than you think, currently.

6) I love the "apprentice" program that has been suggested in this thread, and am incorporating it in my plan. As one who has trained and supervised many professionals, I would like to see this expanded. Getting appropriate experience is one of the major challenges to entering this field.

7) Denial for pre-existing conditions is eliminated in both the government and the private insurance plans.

8) Preventative care is covered fully by both the government and private insurance plans. No co-pays whatsoever. Tax breaks could be given to insurance companies and doctors who encourage preventative care, and to citizens who engage in this.

9) Reduction of the time period that pharmaceutical companies hold patents on medications, preventing generics from being produced. My thought would be no more than 5 years.

One thing of note. #6... the apprentice plan was actually suggested by LaMidRighter... and now again in the Welfare thread by reefedjib. It was a good idea then, and still a good idea, now. As you can also see, my "plans" tend to be tiered, with different levels of control and freedom, attempting to cater to all sides of the political spectrum, socio-economic levels, but with allowing for the least amount of manipulation.

So, go to it. Thoughts? Feedback? Suggestions? Additions?
 

phoenyx

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Before having a truly Universal Health Care plan, I think a little more time should be spent analyzing what type of health care people should have. I'm not sure if anyone here is familiar with Naturopathic Medicine or Alternative Medicine in general, but I've believed in its abilities to prevent many problems before they need to be treated by conventional forms of medicine. To modify an old phrase, 'a penny to prevent, but a buck to cure". Preventing diseases is frequently a lot cheaper then curing them, if indeed they're curable at all.

For those who have only the foggiest notions as to the history of alternative medicine, I found the following passage from one of Naturopathic Doctor Jonn Matsen's book to be quite interesting:

***
An introduction to Naturopathic Medicine

Naturopathic medicine is time-proven. Its therapies are rooted in antiquity. Hippocrates stated "let food be your medicine, and medicine be your food". All cultures have used herbs, hot and cold, fasting and diet to maintain health over thousands of generations. Few of the drugs and surgical methods used in western medicine are over a hundred years old, yet during that period of time naturopathic medicine was almost eliminated.

During the last 50 years, "miracle drugs" and surgical techniques were to rescue helpless humanity forever from the perils of disease. As Big Medicine took over the responsibility for health, the voices that spoke of obvious connections between lifestyle and disease were drowned out by the thundering stampede to junk food and irresponsible lifestyle. During the ero of big fin cars, suburbia, ice cream with every meal and a pill for every ill, a purge of "unscientific" medicine began in the political halls and courts of North America. The almost hysterical self-righteousness of the medical profession and its political clout overwhelmed lifestyle-oriented physicians. Rights to practice were withdrawn in state after state, until naturopathy was confined mainly to a few Pacific Northwest states and a few Canadian provinces.

(cartoon picture of a medical doctor setting a light to a bonfire thing with people labelled "midwives", "naturopaths", "homeopaths" and "herbalists")

That the demise of alternative practictioners in the U.S. has been high-handed is well-documented. The following is the initial decision by the Administrative Law Judge, Ernest G. Barnes, Docket No. 9064, dated November 13, 1978:

"The Federal Court determined that the AMA has produced formidable impediment to competition in the delivery of health care services by physicians in this country. That barrier has served to deprive consumers of the free flow of information about the availability of health care services, to deter the offering of innovative forms of health care delivery that could potentially pose a threat to the income of fee-for-services physicians in private practice. The costs to the public in terms of less expensive or even, perhaps, more improved forms of medical services are great."


In Canada, similar events took place. In his book "Canadian Medicine: A study in Limited Entry", Ronald Homowy summarizes:

"The following study's conclusions dispute the widely held belief that the various statutes and regulations raising the requirements for medical licensure were, in the first instance, enacted to protect the public from so-called incompetents. The historical data provide substantial evidence that the profession's motives in raising the standards of entry in medical practice and in instituting policies that prohibited advertising or any sort of price competition were almost purely ones of economic interest.... It is foolish to suppose that their occupation exalts them above using the means at their disposal to act in their own private interests."

The depletion of health in many children can be readily reversed, as shown in the letters from patients (he has many letters in his book from patients, I can quote some if anyone is interested). The expense of naturopathic medicine is not high. Few of my patients pay over a few hundred dollars for their care at my clinic (his sessions are like $20 for 15 minutes).. Not only did they recieve relief of chronic disease that was considered incurable, but they also received a lifelong understanding, as they now know what caused their health problems and what to do to prevent these from returning. Education, not expensive technology, is the key to health.

This is not to say there is no place for high-tech medicine. There is not a diagnostic device, drug or surgical technique that doesn't have a time and a place to be used to someone's advantage. Remember though that it is the results of disease being dealth with, not the causes.

Since no doctor, type of practice or philosophy of healing can help every patient or every type of problem, it's important that there be a variety of approaches to the treatment of disease. A person who slips through the "safety net" of one mode of healing might still have hope that another practitioner with different experiences and insights might catch them and help them back to health.

(picture of a guy on a tightrope, with a naturopatic below him, a family doctor below him, and 2 guys with a stretcher below him).

Naturopathic training includes as much basic medical science as any health-care profession. Research is an important part of the naturopathic colleges. The quality of naturopathic education and a more open political environment have resulted in the passing of new laws in recent years in Washington, Oregon, Arizona and Alaska that have expanded the rights of naturopathic physicians to practice. Many other states are also considering expanding or relicensing this traditional appraoch to health care.
***

Source: Eating Alive by Dr. Jonn Matsen N.D., pages 143-145

Here's a film concerning the work of a German doctor named Dr. Gerson, who found the power of foods for curing diseases in the late 1920s. Being Jewish, in the 1930s he emigrated to the U.S. and continued his work there. There has been atleast 2 documentaries done on his life and work, but I've only seen this one at present:



The other one I've only just found and so can't comment on its contents. It can be seen here:
The Gerson Miracle a cure cancer - YouTube
 
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RabidAlpaca

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I originally posted this nearly 30 months ago and updated it last year. I've mentioned it to a few posters recently, who liked it... and I got a bit of support across the political spectrum when I originally posted it. So, here is my plan:

Heath care would be broken up into a three-tiered program:

1) Tier 1: Government subsidized health care. Plans paid for and monitored by the government. These plans would be universal and would be paid for via taxes of folks who "opted in" to this plan. It would be "one size fits all" with no variation on the plan itself. Any treatment deemed medically necessary by the treating physician would be covered. No elective, non-necessary or experimental procedures would be, however.

2) Tier 2: Private insurance, Similar to what we have now with some notable exceptions. No utilization review, Insurance companies no longer have the right to deny coverage for any reason, as long as the benefit is available. Only the treating medical professional can decide whether a treatment is appropriate or not. Strict government regulations aimed at streamlining the paperwork aspect, including mandatory centralization both of billing locations and of billing and other forms. Failure to comply with these regulations, suspend the company's ability to do business.

Folks who go this route, automatically "opt out" of the government plan and are not due to pay the taxes that subsidize that plan.

Borrowing from HarryGuerilla, plans are developed on an "ala carte" basis. You want coverage for catastrophic illness only? No problem. How about physicals and x-rays, only? Easy peasy. What about the works, except for obstetrics? Good to go. This kind of choice will allow for folks to get precisely the kind of coverage they want, rather than getting coverage for things they do not.

3) Tier 3: Private Pay. Complete out of pocket, pay for service plan. No insurance whatsoever. "Opt out" of government plan and related government taxes in total effect.

Additional parts to this.

1) Under no circumstances are illegal aliens covered under any health plan, government or private.

2) If you opt out of the government plan, and you do not have catastrophic coverage under your private plan, under no circumstances will the government subsidize your care. If a doctor chooses to see you, unsure of your ability to pay for the service, even with a catastrophic illness, even if it is a child, it is then on the doctor to collect fees. The government will NOT subsidize in any way, nor is any doctor or hospital required to provide any charity care. You make a choice, you need to live with it.

3) Bankruptcies will NOT eliminate medical costs. They must be paid in full, no matter what.

4) TORT reform with reasonable caps on any suing for malpractice.

5) The ability to sue an insurance company for not paying for services that are in a patient's benefit package. Yes, this happens more often than you think, currently.

6) I love the "apprentice" program that has been suggested in this thread, and am incorporating it in my plan. As one who has trained and supervised many professionals, I would like to see this expanded. Getting appropriate experience is one of the major challenges to entering this field.

7) Denial for pre-existing conditions is eliminated in both the government and the private insurance plans.

8) Preventative care is covered fully by both the government and private insurance plans. No co-pays whatsoever. Tax breaks could be given to insurance companies and doctors who encourage preventative care, and to citizens who engage in this.

9) Reduction of the time period that pharmaceutical companies hold patents on medications, preventing generics from being produced. My thought would be no more than 5 years.

One thing of note. #6... the apprentice plan was actually suggested by LaMidRighter... and now again in the Welfare thread by reefedjib. It was a good idea then, and still a good idea, now. As you can also see, my "plans" tend to be tiered, with different levels of control and freedom, attempting to cater to all sides of the political spectrum, socio-economic levels, but with allowing for the least amount of manipulation.

So, go to it. Thoughts? Feedback? Suggestions? Additions?
Minus Tier 3, this is almost exactly the system that Germany has. Having lived here for over 4 years and seen myself and my family members go through the medical system many times over, I can say it works absolutely phenomenally. You can also get insurance boosters. Like if you want a little more coush, you can buy a cheap add on insurance to supplement the UHC.

We really need to adopt this system in the US. Everyone who wants UHC gets it, everyone who doesn't, doesn't have to pay for it. Costs drop substantially for both parties.
 

cpwill

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So, go to it. Thoughts? Feedback? Suggestions? Additions?

The chief problem with our current healthcare system is an abundance of awkward and disruptive government interference. This has led to the dominance of a third-party-payment model which discourages cost-awareness and encourages over-consumption among health care consumers. Government pays for roughly half of our healthcare consumption, and of all third-party payment options, government is the one least likely to be capable or willing to nimbly find ways to impose cost awareness on those capable of sending it bills. The result is a healthcare system in which costs rapidly spiral out of control (we have a similar problem in our higher education industry). Any system which does not alter that disruption and incentivize cost-awareness among consumers for the vast majority of medical purchases will not address the chief underlying flaw of our current system, and we will continue to see costs spiral outside of the control of the citizenry and government.



Reforms which have pushed cost-awareness back onto consumers have demonstrated impressive results at lowering expenditures:

Indiana offered HSA's, - which have patients save money in tax-free accounts (where it grows and remains theirs forever and ever unless theys pend it) - matched with high deductible plans to it's employees. Employees began to respond to price signals, and medical costs per patient were reduced by 33% and expenditures to the state were reduced by 11%.

Safeway has instituted a program that gave financial incentives to people who engaged in healthy behavior by allowing price signals in the insurance side of the market to work (Indiana worked on the medical side), and saw it's per-captia health care costs remain flat from 2005-2009; when most companies saw theirs jump by 38%.

Whole Foods instituted HSA's, and let's the employees choose what they want the company to fund. This institutes price pressure on the medical side (WF covers the high-deductible plan 100%), and their CEO points out that as a result Whole Foods' per-capita costs are much lower than typical insurance programs, while maintaining employee satisfaction.

Medicare Part D utilized market pressure on the insurance side, and saw expenditures come in at 40% UNDER expenditures - the only such government program in history to do so.

Wendy's instituted HSA's, and saw the number of their employees who got preventative and annual checkup care climb even as they saw claims decrease by 14% (in one year).

Wal-Mart's low cost clinics and prescriptions save us oodles of cash. Wal-Mart reports that "half of their clinic patients report that they are uninsured" and that "if it were not for [Wal-Marts'] clinics they would haven't gotten care - or they would have gone to an emergency room".

Dr Robert Berry runs a practice called PATMOS (payment at time of service). he doesn't take insurance at all - but simply posts the prices of his services. By removing the cost of dealing with mutliple insurance agencies, medicare, and medicaid, the prices he is able to list are one half to ONE THIRD of industry standard.



... and so Conservatives in general make the reintroduction of price-pressure for consumers the centerpiece of their desired healthcare system reforms. Any system which fails to capture and build upon these successes (for example, the laudable attempt in post # 2) is thus unlikely to capture significant enough conservative support, and will fail in its' application to actually stem the loss to our standard of living while providing a desired level of care. (The major Conservative critique of Progressive reforms (that they would encourage rent-seeking and overwhelm the budget) is adequately handled in Option #1 where it is explicitly laid down (and, presumably, written in blood) that the program shall be entirely funded from the payments of the beneficiaries.)


The response will likely be that Option #3 does introduce price pressure - and the answer is that it does so in such a manner that it is exceedingly unlikely to be utilized by a significant portion of the populace, and will therefore fail to produce the positive systemic effects on pricing. There is good reason to have catastrophic health insurance. By increasing federal power over and tightly regulating the private health insurance, Option #2 denies people the ability to have catastrophic health insurance and have an incentive to make cost-conscious decisions, for example as regards "preventative care", the universal application of which is not cost-effective. The author does not say, but if guaranteed issue is combined with community rating, then the incentive structure is for people to remain uninsured until a catastrophe occurs, and then immediately apply for the insurance they cannot be denied. This causes the price of private insurance to spiral, creating a problem of the commons in which the incentives are increasingly for everyone to have private insurance only if they are currently or about to incur major medical expenses, crashing the private insurance market. If the author does not intend to include community rating with guaranteed issue, then this critique is severely reduced. A new critique becomes prevalent in that instance - which is that this means that those with preexisting conditions are likely to be priced out of the private market, and forced on to the government option.

Which leads us to the most serious critique of the original proposal in Post #2, which is simply that it does not provide de facto coverage for those who are low income and/or suffer from preexisting conditions. As discussed above, the first tier (the government option) can only provide the services covered by the revenues paid by the beneficiaries. As the low income and unemployed are likely to dominate the government option, but they are unlikely to produce significant revenues, the healthcare they will be able to access will fall somewhere between insufficient and nonexistent. The implicit assumption that the revenues will be sufficient to cover "any treatment deemed medically necessary" is likely to prove unfounded.


A method is therefore needed of subsidizing these among us which does not enable poverty or create the tragedy of the commons that we currently face from our third-party-payer model. That is the central liberal truth that conservatives have to address for any proposal to gain bipartisan support, just as liberals must address the superior efficiency and results of the conservative structures vice third party payer (see above): some people cannot pay for their own healthcare and the rest of us have a moral (if not a legal) responsibility to lend them aid.


It Is Therefore Proposed that the United States thank the Laboratory of Democracy and build upon Indiana's success (Indiana has since expanded the HSA model from its public employees to Medicaid recipients). Catastrophic coverage plans tied to HSA's should be subsidized on a sliding scale for our low income populace through the mechanism of a refundable tax credit in order to clear the Conservative objection of Constitutionality while ensuring the Liberal objective of universal coverage.

Any loss of benefit should be flat in order to ensure that for each additional dollar of income gained, less than a dollar in subsidy is lost. In order not to punish those who are pushed by unemployment or any other of lifes' curveballs into government support, the tax treatment of employer and individually provided health care plans should be equalized by removing the employer deduction. The increased revenue that this brings is statically scored at $171 Bn; which is roughly enough to provide roughly $4,275 to each of the "40 million uninsured".

However, since approximately a quarter to a third of those are illegal aliens - and we are in agreement that illegal aliens should not be subsidized at the expense of low-income workers who follow the law - the actual subsidy will rise to somewhere between $5,500 and $6,500 per individual. So, for example, a catastrophic coverage subsidy of $3,500 per person per year could be matched with an HSA donation of $1,500 per person per year, and still have room to either produce savings to the government or catch any losses from dynamic effects. HSA's will grow tax free and remain the individuals' property; though subject to tight control as regards withdrawals (as for example, are our 401(k)s, IRA's, ESA's, etc. today). Upon the death of the individual, these accounts will be taxed at a flat rate and then the remaining funds poured into the HSA accounts of the next of kin (excepting in cases of a spouse, in which no tax need be paid), providing an additional source of revenue to the government to cover our long-term old-age medical costs and allowing even the low-income among us to engage in intergenerational wealth building. In this way not only are we ensuring universal coverage (liberal goal), but we are helping our poor to build capital to escape poverty, and giving people incentives to make cost-effective decisions (conservative goal).

Individuals in Medicaid will be shifted to the same program. Currently 58 million people are on Medicaid, at a cost of about $10,000 per person. Assuming that the cost of administrating a much simpler program that covers more people is roughly the same, we can produce savings to the government of a couple hundred billion dollars. Or, in the negotiations, if this becomes a sticking point, those savings can stand in place of the loss of the employer provided healthcare reduction.

We can create universal coverage while ridding ourselves of a third-party-payment model and without exploding the government's budget. Conservative and Liberal goals are not mutually exclusive, except to the extent that liberals refuse any option which does not lead to single payer and conservatives refuse any option which does not lead to the dismantlement of the social safety net.
 
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WI Crippler

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2) Tier 2: Private insurance, Similar to what we have now with some notable exceptions. No utilization review, Insurance companies no longer have the right to deny coverage for any reason, as long as the benefit is available. Only the treating medical professional can decide whether a treatment is appropriate or not. Strict government regulations aimed at streamlining the paperwork aspect, including mandatory centralization both of billing locations and of billing and other forms. Failure to comply with these regulations, suspend the company's ability to do business.

Folks who go this route, automatically "opt out" of the government plan and are not due to pay the taxes that subsidize that plan.

3) Tier 3: Private Pay. Complete out of pocket, pay for service plan. No insurance whatsoever. "Opt out" of government plan and related government taxes in total effect.

5) The ability to sue an insurance company for not paying for services that are in a patient's benefit package. Yes, this happens more often than you think, currently.

7) Denial for pre-existing conditions is eliminated in both the government and the private insurance plans.

So, go to it. Thoughts? Feedback? Suggestions? Additions?

Just a few points to argue. Regarding private insurance, I believe that there should be a utilization review tool available to them, perhaps with regulations. If there is no review available, it opens the door for fraud and abuse of insurers by providers. It's a nice little clean idea to believe that providers won't over treat a patients beyond what they need, but trust me. If a post-acute care company knew they could make as many charges to a insurer (private or government) without fear of review, they would adjust the expectations of their clinicians and healthcare providers to maximize profits off those companies, increasing costs to consumers. Yes, I agree the way private insurers review creates a current situation of under-treatment as it stands now. I've seen this personally with Humana. But I've also seen my company push their therapists to provide too many services that were functionally unnecessary in order to make more money off the Medicare system, which can and does review cases, but not with nearly the eye that private insurers do.

To go with the no denial of pre-existing conditions, I agree on both government and private insurers not being able to deny coverage. However, in the case of private insurers, they need to be able to offset the risk they are taking by accepting those conditions with increasing premiums. Perhaps a coding system for the condition could be determined by the government ( we could utilize something like ICD-9 codes) and create a premium adjustment scale based on that. It seems a little unfair to ask private insurers to provide coverage, then give them no ability to make adjustments for essentially forcing them to cover increased risk, nor allow them any ability to check providers charges to their company.

I do agree an individual should be allowed to sue for denial of coverage.

Now to add my own food for thought here. I currently work for what is becoming a massive rehab company. Although they provide services across the spectrum of physical, occupational, and speech rehab in various post-acute settings, a majority of our payer source is Medicare. This is a for profit company, taking money from Medicare. Essentially the government is contracting out the healthcare of it's seniors to for profit agencies, and these agencies seek to maximize profit off the Medicare system, and then everyone wonders why Medicare is out of control and such a glut of our spending. So they make cuts to Medicare. Well the companies don't take the cuts off their profit margin. They increase productivity requirements of their staff while cutting their benefits, take away staff education programs, etc.....So the profits keep rolling in off the system even when Medicare cut reimbursement to the rehab component by 11% across the board and changed the rules and requirement for group led therapy making it essentially not worth a therapists time to lead a group session.

Now, take a system like that, a sub contracted healthcare platform payed for by tax payers to utilize for profit healthcare resources and spread it out to everyone. We would face the same problem, only on a much bigger scale. I'd be interested to see how we would solve that problem/stuff that genie back in the bottle?
 

Harry Guerrilla

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I want to see a law, mandating that prices or approximated prices, by the attending physicians and facilities be posted for all patients and for as many procedures, medicines, etc, as possible.
 

WI Crippler

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I want to see a law, mandating that prices or approximated prices, by the attending physicians and facilities be posted for all patients and for as many procedures, medicines, etc, as possible.

That would be good, but physicians aren't "charging what they want". There is usually a contract agreed upon between physicians and companies, or in the case of government, a set rate for services. It should be posted, I agree. Usually charges are discussed with patients who are out of pocket payers.
 

Harry Guerrilla

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That would be good, but physicians aren't "charging what they want". There is usually a contract agreed upon between physicians and companies, or in the case of government, a set rate for services. It should be posted, I agree. Usually charges are discussed with patients who are out of pocket payers.

They should at least display a patient price, instead of that bull crap they send in the billing statements.
Those are complete fiction.
 

ttwtt78640

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Math is not your friend here. You used an "arbitrary number" and a flat tax rate of about the same as Medicare (which is WAY underfunded) yet is only available to those at age 65 (or disabled). Considering that the average Medicaid patient now costs we the sheeple about $7,000 per year (that program now covers about 20% of the US population). The "break even point" of a 2% tax would then be $140,000/year which is far above the US median income of $50,054/year. Medical care expenses are now about 1/6 of the US GDP (or 18%). Take a realistic look at the care afforded to Medicaid patients; and the number of establishments that refuse to treat them, since the gov't reimbusement rates for care provided are far below that of "private" medical care insurance.

Medicare Tax and the Unearned Income Medicare Contribution Tax

https://www.cms.gov/Research-Statis...arialStudies/downloads/MedicaidReport2011.pdf
 

X Factor

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I originally posted this nearly 30 months ago and updated it last year. I've mentioned it to a few posters recently, who liked it... and I got a bit of support across the political spectrum when I originally posted it. So, here is my plan:

Heath care would be broken up into a three-tiered program:

1) Tier 1: Government subsidized health care. Plans paid for and monitored by the government. These plans would be universal and would be paid for via taxes of folks who "opted in" to this plan. It would be "one size fits all" with no variation on the plan itself. Any treatment deemed medically necessary by the treating physician would be covered. No elective, non-necessary or experimental procedures would be, however.

2) Tier 2: Private insurance, Similar to what we have now with some notable exceptions. No utilization review, Insurance companies no longer have the right to deny coverage for any reason, as long as the benefit is available. Only the treating medical professional can decide whether a treatment is appropriate or not. Strict government regulations aimed at streamlining the paperwork aspect, including mandatory centralization both of billing locations and of billing and other forms. Failure to comply with these regulations, suspend the company's ability to do business.

Folks who go this route, automatically "opt out" of the government plan and are not due to pay the taxes that subsidize that plan.

Borrowing from HarryGuerilla, plans are developed on an "ala carte" basis. You want coverage for catastrophic illness only? No problem. How about physicals and x-rays, only? Easy peasy. What about the works, except for obstetrics? Good to go. This kind of choice will allow for folks to get precisely the kind of coverage they want, rather than getting coverage for things they do not.

3) Tier 3: Private Pay. Complete out of pocket, pay for service plan. No insurance whatsoever. "Opt out" of government plan and related government taxes in total effect.

Additional parts to this.

1) Under no circumstances are illegal aliens covered under any health plan, government or private.

2) If you opt out of the government plan, and you do not have catastrophic coverage under your private plan, under no circumstances will the government subsidize your care. If a doctor chooses to see you, unsure of your ability to pay for the service, even with a catastrophic illness, even if it is a child, it is then on the doctor to collect fees. The government will NOT subsidize in any way, nor is any doctor or hospital required to provide any charity care. You make a choice, you need to live with it.

3) Bankruptcies will NOT eliminate medical costs. They must be paid in full, no matter what.

4) TORT reform with reasonable caps on any suing for malpractice.

5) The ability to sue an insurance company for not paying for services that are in a patient's benefit package. Yes, this happens more often than you think, currently.

6) I love the "apprentice" program that has been suggested in this thread, and am incorporating it in my plan. As one who has trained and supervised many professionals, I would like to see this expanded. Getting appropriate experience is one of the major challenges to entering this field.

7) Denial for pre-existing conditions is eliminated in both the government and the private insurance plans.

8) Preventative care is covered fully by both the government and private insurance plans. No co-pays whatsoever. Tax breaks could be given to insurance companies and doctors who encourage preventative care, and to citizens who engage in this.

9) Reduction of the time period that pharmaceutical companies hold patents on medications, preventing generics from being produced. My thought would be no more than 5 years.

One thing of note. #6... the apprentice plan was actually suggested by LaMidRighter... and now again in the Welfare thread by reefedjib. It was a good idea then, and still a good idea, now. As you can also see, my "plans" tend to be tiered, with different levels of control and freedom, attempting to cater to all sides of the political spectrum, socio-economic levels, but with allowing for the least amount of manipulation.


So, go to it. Thoughts? Feedback? Suggestions? Additions?

Do you envision private insurers making any kind of (using a dirty word here) profit? If it's truly private, then lift your arbitrary regs and let them compete. Theoretically, could I call an insurance company from the ambulance after I've had a major accident and they would be required to pay for me? Afterall, it would be a pre existing condition, right? Or could they then get on the govt plan (or is it only private insurers that can't deny someone for a pre-existing condition?)

On the govt side, are you saying only those paying into the system get any kind of coverage? If so, I don't understand excluding illegal immigrants, especially from the private plan. If they have the money, and they pay, they should get health care. Actually, looking at it again. Correct me if I've misunderstood, but are you saying illegal immigrants basically get no health care here, at all, even if they can pay for it or have private insurance? That's pretty draconian. I think we may have found something I'm more liberal than you on.
 
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Stewart

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Math is not your friend here. You used an "arbitrary number" and a flat tax rate of about the same as Medicare (which is WAY underfunded) yet is only available to those at age 65 (or disabled). Considering that the average Medicaid patient now costs we the sheeple about $7,000 per year (that program now covers about 20% of the US population).

Medicare Tax and the Unearned Income Medicare Contribution Tax

https://www.cms.gov/Research-Statis...arialStudies/downloads/MedicaidReport2011.pdf

Using current Medicaid data as a forecast for an at large plan isn't a good idea. That high number is skewed because Medicaid is also responsible for the long term care of elderly patients who are more expensive. As well poor subsets that are Medicaid other clients are more likely to have poor health and thus cost more, skewing that figure again. To blanket cover a population would have a lower figure. I don't have the numbers for an actual figure.
 

Stewart

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The Good Captain Said Stuff....
CC, my main concern with your plan would be opting out of the Medicare taxes. Such a system would probably be unsustainable and would create a problem of socializing the losses of the insurance companies. I think the solution might involve an Obamacare mandate with a variable tax rate based on insurance status for higher income earners. i.e a 2% base rate and a 1.8% for people earning over $65,000 who don't have private insurance (figures mine and not in any way actuarial based.) This would help to keep the insurance companies happy.

Really, healthcare needs a complete structural overhaul though, for the government to come in and simply take it over with the current approach to medicine would lead to abject failure. At least standardization of care is needed.


I don't agree in additional #1 and 2, but that just might be the liberal in me. #1 should at least be conditional.
 

ttwtt78640

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Using current Medicaid data as a forecast for an at large plan isn't a good idea. That high number is skewed because Medicaid is also responsible for the long term care of elderly patients who are more expensive. As well poor subsets that are Medicaid other clients are more likely to have poor health and thus cost more, skewing that figure again. To blanket cover a population would have a lower figure. I don't have the numbers for an actual figure.

Just using ball park (SWAG) figures would suggest that 20% are too poor to pay, 20% are too old to pay (already on SS/Medicare) and 20% are too young to work or pay yet, so that leaves 40% to carry the load of all medical care in the nation. ;)
 
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