• Leave employer-provided insurance in place. Close to three-quarters of the country gets health care through work, and studies show many people like their coverage. A House version of the bill seeks to broaden that coverage by imposing new taxes on large employers who don't offer health insurance.
Employers who don't offer health insurance should not be taxed. But companies that do offer health insurance should receive tax credits based on the level of coverage they provide their employees. This would mean all health coverage would be rated by an independent, possibly non-government board. Like the MPAA. Give the buyer more power by coming up with a standardized rating system and eliminate the information asymmetry between insurance companies and patients.
• Health insurance exchange. To help people who have to go out and buy insurance on their own, the plan creates an exchange, a virtual marketplace where individuals and small businesses can comparison-shop. The government would regulate the exchange so that insurance companies can't discriminate against people with pre-existing conditions, or charge wildly different amounts for similar coverage. (They will be able to set rates based on age, however.)
Great idea -- give the buyer more information. Government's involvement could be problematic. The Fed should not dictate rates, just provide clear information to the consumer which would make the insurance companies offer more completive pricing.
• The public option. One of the options on the exchange will be a public option, run by the government, that offers basic coverage. President Barack Obama has said the public option will keep private insurers honest by competing with them so they can't charge unfair rates for the basics. Many experts believe that the public option will be the least expensive option on the exchange.
This looks good on paper -- the economics of having a not-for-profit insurer offering basic coverage makes good sense in terms of keeping the market competitive. The downside of course is that it will be government run and therefore a potential train wreck of waste and abuse. State governments have gotten fleeced trying to do this. It would need to be run by people with a tremendous amount of experience in providing public health services and avoiding the types of fraud and waste that can go on.
• More for the poor. The plan expands eligibility for programs like Medicaid and the State Children's Health Insurance Program. Some people of modest means will receive "affordability credits" to buy plans on the health insurance exchange.
The safety net. Absolutely for children. All children should have regular check-ups and get adequate health care without having to sit in emergency waiting rooms for 6-8 hours. This is complicated because what we're talking about is 'free' health care paid for by tax-payers. We are a compassionate society but the size and scope of the safety net needs to be carefully monitored so that we do not disincentivize the adults to pick themselves up and get back on track.
• An individual mandate . This requires people to buy insurance, unless they qualify for a hardship exemption. The expectation is that everyone will be covered, either through their employer or through the exchange. People who don't buy insurance will have to pay a penalty on their taxes.
The State of California requires everyone who drives to have liability insurance. I'm not sure how this would work with health insurance. I'd like to hear more pro/con views from experts.
• Electronic records. To reduce inefficiency and duplication of services, the government will invest in electronic health records, so doctors can see which tests and procedures patients have already had.
Absolutely. People should be able to carry their entire health records, X-rays, tests, etc. around on USB flash drive or scannable card. The health care providers hate this because it would eliminate many back office jobs--(you know the 'nurse' talking to her boyfriend on the phone while you're waiting to pay your deductible or make an appointment.) This will also cut down on wasteful procedures and trips to the lab to pickup old test results and bring them to a new doctor. I once went to pick up my son's x-rays at one doctor and they told me to bring them back in a week. Why?! There not your's, they're mine! The time and efficiency benefits are undeniable. The Problem -- Government's involvement and huge privacy issues.
• Research on better treatments. A comparative effectiveness research center will conduct and publish scientific research to find which treatments are the most effective. The government hopes easy-to-access information for doctors, patients and insurance companies will reduce procedures and treatments that don't really work, wringing waste from the system.
Doctors do a pretty good job of this on their own. Competent, honest doctors don't send you all over town for tests you don't need. How about making referral kickbacks between doctors and medical groups illegal? I'm all for more information to the consumers, but Government's involvement is always a concern.
• Medicare. The bill makes many changes to how Medicare pays doctors and other health-care providers. Taken as a whole, the new rules aim to pay doctors for good patient outcomes instead of paying them per procedure, also called "fee-for-service."
We could phase out Medicare and just make the public option free to people over 65. But why have just one government office building when you can have two? The counseling every 5 years for people over 65 is a very sensible way to make sure every patient gets the care they want and need. I really hope it's not being tossed because Sarah Palin talked out of her ass. Paying Dr.'s for 'good patient outcomes' -- remember what happened Chicago teachers were given bonuses for higher test scores? The helped their students cheat on the test; in some cases filling in the tests for the students. You much be very careful with how you incentivize people. I'd like to hear more about how exactly this would work.
