Let Americans Have Lower-Cost Choices for Health Care Payment Coverage

“why weren’t most hospitals bankrupt before 1965”

They were a lot smaller and cheaper to run.

Hospital employees were generally poorly paid back then, closer to the minimum wage.

I read about a nurse making $180,000/year in San Francisco in article about California housing prices yesterday.

A comparable nurse might have made $3,200/year in 1965.

Your replies at 15 and 16 reflect government’s involvement in the financial aspect of modern medicine, whereas I think a good many FReepers are concerned first and foremost with the innumerable regulations imposed by the government.

This country’s entire governmental system was created with fewer words than 0bamacare’s regulations on what hemorrhoidal creams are covered under plans designed for senior citizens. Okay, I made that up, but it gets the point across that government being daddy to everyone makes us more “subjects” and less “citizens”. We could use a bit more liberty and freedom.

If government at all levels federal and state would stop dictating coverage all this and more would be available. There would be ala carte policies available and people would buy as much coverage as they felt they needed or could afford.

But every special interest disease group has lobbied legislatures to include their pet condition as mandated coverage and pretty soon you can’t buy ala carte coverage.

The only thing government needs to regulate is basic fiduciary statutes as would be done for any insurance company.

And make premiums 100% tax deductible for those who buy insurance on the private market instead of from their employer.

“la carte policies”

I’d love to have lung cancer coverage for $12/month, but no insurer would sell me just lung cancer coverage because that’s my #2 risk now.

My #1 risk is getting hit by a motor vehicle.

My proposal has limited “a la carte” features.

However, expect to have to buy a bundle of riders, for pretty much the same reason I can’t buy two channels of cable TV at $1 per channel per month.

If you just buy say up to $600/year of office care, you might have to pay a flat $35/month for it, the average cost of the insurer to cover it and a small profit.

If you buy it in a bundle, the average cost to you might drop to $300/year, because you might be overpaying $100/year for something else in the bundle that isn’t of average value to you.

“The only thing government needs to regulate is basic fiduciary statutes as would be done for any insurance company.”

That would be fine for higher income people.

But if lower income people are going to get federal money for federal subsidies, the federal government is not going to want to pay a $100/month subsidy for the “cable TV anti-depression plan” offered by Comcast with free vaccinations and one doctor visit annually.

As long as there is no federal penalty and coverage minimum, you could buy any coverage your state allows to be sold. You might also be able to buy coverage over the Internet from a foreign insurance company.

There are two major issues we are concerned with:
1. getting rid of the PPACA penalty
2. affordable coverage for those of modest incomes

If you can pay for your own coverage, issue 1 is your only problem.

We have to make progress on issue 2 too. Some of us have modest incomes.

It has to be understood that Republican leaning voters are a minority. We need to win votes from leftist-leaning voters by solving their problems.

To say successfully vote for a reduction in growth in Medicaid and then be tossed out of office in 2018 would actually get us no place but in the doghouse.

We have to steer the medical industrial complex to a less costly structure. It has to be done in modest steps that have little negative impact and strong positive impact.

“cover my own expenses less than 20K/year”

Most people hate to pay a medical bill.

People will pay $500/year for cell phone service but will scream bloody murder if they had to pay $10 under Medicaid to see a doctor to get a $4 life-saving prescription.

“NOT INSURANCE OPTIONS - but ‘healthcare options’ for medicaid citizens.”

As has been noted in the past, we really aren’t talking about insurance.

Most states want private companies to handle Medicaid.

The reason is that bureaucrats really aren’t good at getting value for money, especially when it comes to drugs, fraud prevention and patient management.

Private companies are often much better at getting value than governments are.

We want millions of individuals to choose and have cost-efficient coverage. Only then can states, bound by the equal protection of the law idea, can also choose cost-efficient coverage.

Medicaid is required by federal law to at least equal typical private coverage.

They were a lot smaller and cheaper to run.

Why do you think that was?

Hospital employees were generally poorly paid back then

I doubt it. Inflation was much lower then.

The point is, we didn't have a healthcare crisis before 1965. Government CREATED the crisis, and now their spokesmen, - I hope you're not one of them - decry the effects of dismantling government interference with healthcare which problems government caused. Government's answer for their failure is ALWAYS more government.

And that is just the economic argument. The legal argument is much more straightforward and understandable: federal government interference in healthcare is unconstitutional. Nowhere does the Constitution give the feds authority to interfere with healthcare. So federal interference with healthcare is tyranny, defined as unconstitutional federal acts.

For economic and constitutional reasons, the feds need to get OUT of healthcare and let the marketplace run the show as it did before 1965 and America had the best healthcare in the world. As in other things so in healthcare, America is not about poverty-stricken, failed governmental socialist tyranny, it is about freedom which leads to wealth and prosperity.

“Small monthly charge for most needs.”

Dr. Primary Care: Mr. Griffin, you have cancer. Here’s my bill, $120.

Hospital Doctor: Mr. Griffin, we’re going to put you on the new $125,000/year cancer drug. Aetna won’t be glad to have met you.

Medicine is more than primary care folks.

Again, nothing is going to make the cost come down except by ending all government interference in insurance plan coverage. That is what drove the cost up into the stratosphere.

It doesn’t matter what kind of tinkering you do, as long as politicians are buying votes with other people’s money by legislating mandatory coverage of this, that and the kitchen sink, the cost will continue to go up.

It’s time for the government to get out of the insurance game and work on bringing down the cost of actual medical care by increasing the number of doctors.

The economic illiteracy of all this sturm and drang is staggering. We are doomed.

I would change the subsidy bit to:
3. Providing a federal subsidy of:
a. 42%, plus
b.
I. 3% for rider a if bought, plus
II. 5% for each of the riders b-e bought, but not more than half of the cost of each of the drug riders bought outside of a bundle, plus
III. 1% for each rider f-k listed above bought, plus
c. 1% for each hospital day above 5, up to 4, plus
d. .5% for each hospital day above 9, up to 7, of the person’s PPACA “silver plan” maximum allowable amount.

The hospital subsidy was reduced to encourage lower pricing, to free up funds to make the purchase of key riders more desirable and drug coverage broader.

The not more than half language is to encourage insurance companies to offer drug coverage of real value.

“If government at all levels federal and state would stop dictating coverage all this and more would be available. There would be ala carte policies available and people would buy as much coverage as they felt they needed or could afford.”

You have described a big problem well.

The hospitalization could easily be broken apart:
EMTALA birthing
EMTALA physical, non-birthing
EMTALA mental
essential newborn congenital surgery
operative tumors
palliative cancer surgery
open fractures of major bones
closed fractures of major bones.

Except for the EMTALA mental&birthing and essential newborn congenital surgery, I’m pretty sure that I would want to buy coverage for all.

A person my age of 58 wouldn’t be paying much for EMTALA birthing or congenital surgery anyway.

And if I had severe mental problems, I certainly would not want a hospital hounding me for an unpaid $1,000 deductible.

“To this day, Senator Murkowski believes health care reform must be addressed due to the continued, dramatic increases in insurance premiums each year and an individual exchanges that has be reduced to only 1 provider, Premera, due to the unsustainable course of the ACA as is. Yet, there are many provisions of the ACA that have worked for Alaska that Senator Murkowski believes should be retained. Those provisions are:
•Prohibitions on the discrimination for pre-existing conditions
•No annual or lifetime limits
•Coverage up to age 26
•Continuation of coverage afforded under Medicaid Expansion
•Maintaining access to Planned Parenthood facilities
....”

https://www.murkowski.senate.gov/issues/issues-and-priorities/health

“Quality healthcare is critical to maintaining the health and well-being of our citizens. This issue is especially critical in Alaska, where health care costs can be up to 70 percent higher than in the lower 48.”

https://www.murkowski.senate.gov/issues/issues-and-priorities

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