Stewart
Cammunist
- Joined
- Oct 20, 2011
- Messages
- 986
- Reaction score
- 271
- Location
- Australia
- Gender
- Male
- Political Leaning
- Centrist
With so much distaste being expressed for the PPACA (Obamacare,) I challenge the enlightened and interested members of DP to come together and debate in fair terms the next steps for Healthcare Reform.
Obamacare has been repealed in it's entirety, it's gone. Completely obliterated. It is up to you to determine what features we implement in this law. Can we produce a bi-partisan solution to the healthcare problem or are such attempts doomed?
All proposals should attempt to address two issues:
Cost Healthcare services in America are really expensive. Really Expensive. Currently it outspends (in reference to GDP) all other OECD countries by a large margin... If the growth in healthcare spending seen in the last decade continues into 2020, it will have grave consequences.
Access While all other OECD countries have guaranteed access to Healthcare, there remains large gaps in coverage and approximately 1/6 Americans is without Health insurance.
Challenges:
Medicaid and Medicare aren't secure in the long run and large unfunded deficits are expected over the next two decades.
Due to inelastic demand and a restricted supply, you cannot expect market solutions to work. Healthcare, at least essential healthcare services if fundamentally different from even other necessities of life such as food and shelter. These can be obtained cheaply, healthcare services cannot.
To produce a high performance healthcare system it is important to get the private/public mix correct. While liberals argue that Government should play the dominant role in healthcare provision. Conservatives believe emphatically that it's only role should be regulation. How do you bridge this ideological gap. Government is better at getting people into coverage, while private enterprising can provide higher quality care, government is far better at getting people into coverage. Getting the mix correct is essential, too little government and waiting lines increase, too much private and cost accelerates and inequality is created.
To help you out I'll start:
I propose a two tiered implementation. Rather than changing everything at one point, introducing things over time would be a much better idea. For instance:
2016
Some PPACA provisions (children on parental insurance, removal of annual and lifetime caps, pre-existing conditions mandatory coverage, community rating)
Establishment of a framework for interstate selling of Insurance (work with state to reduce barriers)
Insurance providers have the option of enforcing waiting periods of up to two years for people who are out of coverage for greater than one month, must have at least 10 months of insurance in the preceding 12 months (this will prevent 'gaming' the system)
For those who are unemployed, the government will cover 70% of the premium under cobra (3 months only.) To be funded by removing the home interest tax deduction.
Price transparency, a provider will be required to provide the patient with an estimated cost of all procedures. Providers should charge both insurance company and patients the same price regardless of means of payment.
Expansion of Medicaid to end inequality amongst poor groups and subsidization of health premiums for poor people, no idea how I will fund this one.
IPAB to remain, however increase it's numbers to include Drs and other healthcare professionals to work together with economists and health policy experts.
Establish a medical board staffed with Drs and other medical professionals with the objective of creating national standards for medical care that would include recommended treatments. This would help to reduce the overuse of medical resources as detailed in the Dartmouth Health atlas.
Repeal EMTALA - It's more socialized than anything in Australia!
Health Insurance reform, maximum time to play claims of 31 days. Streamline payment process through IT, various reforms.
2020-25?
Repeal medicare, medicaid replace with a proper NHI ( Single-payer) program.
Do I do enough to control, constrain costs, probably not. But the problem that is the cost to us represents income to to other people. The Cost problem is ingrained into the healthcare system.
Obamacare has been repealed in it's entirety, it's gone. Completely obliterated. It is up to you to determine what features we implement in this law. Can we produce a bi-partisan solution to the healthcare problem or are such attempts doomed?
All proposals should attempt to address two issues:
Cost Healthcare services in America are really expensive. Really Expensive. Currently it outspends (in reference to GDP) all other OECD countries by a large margin... If the growth in healthcare spending seen in the last decade continues into 2020, it will have grave consequences.
Access While all other OECD countries have guaranteed access to Healthcare, there remains large gaps in coverage and approximately 1/6 Americans is without Health insurance.
Challenges:
Medicaid and Medicare aren't secure in the long run and large unfunded deficits are expected over the next two decades.
Due to inelastic demand and a restricted supply, you cannot expect market solutions to work. Healthcare, at least essential healthcare services if fundamentally different from even other necessities of life such as food and shelter. These can be obtained cheaply, healthcare services cannot.
To produce a high performance healthcare system it is important to get the private/public mix correct. While liberals argue that Government should play the dominant role in healthcare provision. Conservatives believe emphatically that it's only role should be regulation. How do you bridge this ideological gap. Government is better at getting people into coverage, while private enterprising can provide higher quality care, government is far better at getting people into coverage. Getting the mix correct is essential, too little government and waiting lines increase, too much private and cost accelerates and inequality is created.
To help you out I'll start:
I propose a two tiered implementation. Rather than changing everything at one point, introducing things over time would be a much better idea. For instance:
2016
Some PPACA provisions (children on parental insurance, removal of annual and lifetime caps, pre-existing conditions mandatory coverage, community rating)
Establishment of a framework for interstate selling of Insurance (work with state to reduce barriers)
Insurance providers have the option of enforcing waiting periods of up to two years for people who are out of coverage for greater than one month, must have at least 10 months of insurance in the preceding 12 months (this will prevent 'gaming' the system)
For those who are unemployed, the government will cover 70% of the premium under cobra (3 months only.) To be funded by removing the home interest tax deduction.
Price transparency, a provider will be required to provide the patient with an estimated cost of all procedures. Providers should charge both insurance company and patients the same price regardless of means of payment.
Expansion of Medicaid to end inequality amongst poor groups and subsidization of health premiums for poor people, no idea how I will fund this one.
IPAB to remain, however increase it's numbers to include Drs and other healthcare professionals to work together with economists and health policy experts.
Establish a medical board staffed with Drs and other medical professionals with the objective of creating national standards for medical care that would include recommended treatments. This would help to reduce the overuse of medical resources as detailed in the Dartmouth Health atlas.
Repeal EMTALA - It's more socialized than anything in Australia!
Health Insurance reform, maximum time to play claims of 31 days. Streamline payment process through IT, various reforms.
2020-25?
Repeal medicare, medicaid replace with a proper NHI ( Single-payer) program.
Do I do enough to control, constrain costs, probably not. But the problem that is the cost to us represents income to to other people. The Cost problem is ingrained into the healthcare system.