I have another of my occasional pieces up at the Guardian’s Comment is Free site, trying to make sense of American health care for an international audience. I take aim at how the cautious nature of the main Democratic front-runners health care proposals doesn’t match their fiery rhetoric — Comment is free: The cautious approach.
Even though Iraq seems to have sucked all the oxygen out of American
political life at the moment – even Cindy Sheehan has given up and gone
home – healthcare does remain the largest domestic issue.
Several weeks have passed since the Democratic candidates for
president had a debate about healthcare. It’s interesting that despite
an attempt by probable Republican candidate Fred Thompson to take on
documentary filmmaker Michael Moore over the topic, none of the front
runners on the Republican side have made much mention of healthcare at
all. This is doubly curious as one of them, former Massachusetts
Governor Mitt Romney, left office having at least partially helped
make his state the most advanced healthcare reform " laboratory" of
them all. But apparently among the conservatives and evangelicals who
dominate the Republican primaries, the issue of universal healthcare is
not seen as a great vote-getter – a worldview the Republicans might
come to regret. Continue.
With each new crop of politicians, including Clinton, I propose a universal health plan that will really work. I realize it is too much of a radical departure for our politicians and bureaucrats, but I keep trying. Take a look and see what you think.
I. Insurance policies: Each standardized and computerized policy would have all of its benefits and costs stated in a prescribed and itemized order and worded exactly alike throughout the industry and the nation. The emphasis of the policy would be preventive care rather than crisis. This policy would have no more than four pages with each benefit in an itemized format so the average policy holder could understand what she/he had purchased.
II. Claim forms: Each standardized and computerized claim form would be an itemized list of benefits and costs, stated in a prescribed order and worded exactly alike throughout the industry and the nation. The provider could check off each procedure and mail the form to the claimant’s insurer for payment.
III. There would be no necessity for the U. S. Government to participate beyond a standardized policy because it would contain the basic benefits.
Title Gross Income U. S. Government
1. Standard $ 0 to 10,000 100% of the cost
10,000 to 15,000 75% of the cost
15,000 to 20,000 50% of the cost
20,000 to 25,000 25% of the cost
Because the policies and claim forms are computerized the assistance from the U. S. Government is greatly simplified. It would only require an addendum to the existing IRS computer program so the entry of a citizen’s standard data would trigger the appropriate insurance voucher to be cut and mailed to that taxpayer. The voucher would be nonnegotiable except for insurance with a complying carrier. Illegal aliens and others who don’t participate in the tax system, wouldn’t be able to participate in the insurance program either. Those, because of lack of income , do not file tax forms could use the short form to become part of the system.
Those citizen, who wanted and can afford additional benefits, will use their resources to purchase them, however, because the polices are standardized they too will understand the policies and be assured they are getting the benefits they are paying for.
IV. Benefits of this proposal:
1. Simplified insurance coverage for every American Citizen at great savings to the American taxpayer.
2. Decreased bureaucracy, the only additional personnel would be the short term employment of the programers needed to add the addendum to the IRS computers.
3. Elimination of medicare, medicaid and workers’s compensation costs because this program would cover all three programs and virtually eliminate all three bureaucracies.
4. Reduced costs to insurance companies and medical providers.
5. Eliminates the need for secondary insurance for those under medicare.
6. Medical coverage peace of mind for all americans.
7.The simplified filing process would result in prompt payment of medical claims thus saving the credit ratings of many Americans.
8. Absolute portability because the policies would be individually owned.
9. Elimination of corporate sponsored health insurance, except, for the insured’s portion of the premium that is negotiated in the labor contract.
10. Illegal aliens as well as others not complying with the Internal Revenue System would find themselves outside the provisions and benefits of this program.
If I were to list all of the benefits, it could become as long and as complicated as the many plans emanating from the halls of congress.
Again, the dollar and percentage figures used in the examples above are used as references only and are not meant to be taken as absolutes; the page lengths of the insurance contracts and the claim forms are absolute!
I think most people who have employer provided health insurance are satisfied with it. They worry about losing it if they lose their job, and they also worry about rising costs (for both their employer and themselves). The first issue could be dealt with by providing default coverage like the Federal Employee Health Benefit Plan for those who are unemployed, work for a business too small to afford health insurance, or are retired but not yet eligible for Medicare. Premiums could be geared to income with a reasonable cap that approximates the actuarial value of the insurance or up to 10% of income (less for low income people), whichever is lower.. Rising costs will not be controlled merely by shifting those costs from employers to taxpayers. We need to find ways to safely reduce utilization which I’ve written about numerous times before.
There is also an issue of young, healthy people who do not want to pay for health insurance because they think they won’t need it. What they want is an inexpensive policy that will pay for preventive care, a few doctor visits and lab tests and, maybe, modest hospital benefits. Their attitude seems to be that even if they are in a motorcycle accident or have a heart attack, etc., the system will take care of them anyway even if they don’t have insurance. If they are ultimately bankrupted by the bills from a high cost medical event, they think they are no worse off than they are now.
An employer mandate for all but the smallest employers is a sound approach. Provide health insurance or pay into a subsidy fund. Community rating and guaranteed issue can only work if individuals are required to buy insurance with the premium capped at some reasonable percentage of income. They cannot be allowed to just wait until they get sick to sign up for coverage.
We can get to universal coverage in a way that is consistent with out values and our culture without turning the whole system upside down and inside out. Hopefully, it will happen by 2009.