Posted on 11/17/2009 12:21:51 AM PST by Secret Agent Man
Been thinking about what I'd put together as a conservative, if I had to correct things in our current healthcare system.
Number of things come to mind, none of which Pelosi or Reid or any of the dems come to grips with. Further making me feel confident I'm on the right track.
1. Health Insurance strongly encouraged to buy, not forced. Strongly encouraged because the alternative is paying for 100% of your catastrophic emergency medical costs, asset forfeiture if necessary. This means coming after any form of wealth you've got to pay your debts. Going after 401k's, going after IRAs, stocks, bonds, houses, cars, properties. Not allowed to declare bankruptcy if you have deliberately decided not to be insured. People will sign a document stating they understand all of the ramifications of not carrying health insurance so that claims of ignorance are not a defense. People not buying health insurance will be treated under the same care guidelines as those in the single, catch-all, basic government healthcare plan. Also able to be used are current state laws allowing debtors to go after the assets of other family members who can be legally responsible for caring for those persons' debts. This would encourage those people who really ought to be insured, to see it's in their best interest to have at least a very basic plan, even if it's just catastrophic coverage.
2. A very basic government plan created to cover people who cannot get insurance, but want insurance. Premiums based on a person's percentange of income and assets. Nobody gets turned down, everyone has to pay something. The only people who are eligible to pay nothing are: those making poverty level or lower; those only living on SS income and have little or no assets; those truly permanently disabled people (not temporarily disabled) on disability/SS and aren't coming off of it. Choices are more limited, but basic care needs will be covered. This is meant to be a safety net, not a luxury package. Being in a system that allows people to choose different care levels from a mix of various private insurance company plans and one government plan, means people are not going to be cared for equally. Nobody gets turned down, but what options are available to you depends on the plan you have (or don't have). This is the fairest (not perfect) option if we are to have a system that doesn't mandate everyone carry insurance. It assures a basic level of care everyone can expect, and elevates care levels depending on the private insurance company and the plan you've chosen.
Private plans will most likely provide better levels of care than the government plan, but they can also provide less if they offer those plans at lower rates than what the government plan premium cost is. This will allow for plans, for example, that may offer less benefits and less coverage of certain things than the government plan does, but they of course, will do so at a lower cost. For a young person who perhaps just wants catastrophic coverage, but nothing else, there could be a private plan that offers only that, but isn't as expensive as the basic government plan because that covers copays, some drug costs, etc. The government plan does not limit the ability of private companies to offer plans with more beneifts covered for higher premiums, or lower benefit plans, for lower premiums, than the government plan.
3. If you have decided you do not want to purchase insurance - not even a very basic catastrophic coverage policy - and need emergency medical care, you will be billed and are responsible for 100% of your bill. Asset recovery will be enforced. If you have no assets, when judged able, you will be required to work off your debt in some form of compensation. If you do not have health insurance you will be treated according to the plan guidelines for the government healthcare plan, in order to give you the necessary care you need. This strategy is also intended so as not to drive up such a person's costs more than necessary and make it harder for them to pay for their care. If you carry no insurance on purpose, you will not be allowed to discharge your medical debts through bankruptcy. Homes, vehicles, savings accounts, retirement accounts, 401k's, etc - all will be able to be discovered and collected on to repay the medical bills owed. This is a last resort; the goal is to get people to at least carry a minimal, very basic catastrophic care plan so they can avoid bankruptcy. We don't want to see people go bankrupt, but if they choose to not carry ANYTHING, then their medical bills are 100% their responsibility and they cannot legally sneak out of them. Period.
3a. People who decide not to buy and regulary carry insurance, and then need emergency care, can still opt into a plan, but they will be charged more for their care for that emergency. If you don't carry insurance and then all of a sudden require emergency care, you (or a healthcare power of attorney) can opt to enrioll you into the government insurance plan or any private plan that would allow you to enroll at the point the emergency care is needed (wouldn't count on too many doing that!) , but for that particular emergency incident and related follow-up care, the healthcare plan can opt to apply a sizeable penalty multiplier to their rates (or reduce the percentages covered by their plan) to make up for the fact the person is only paying into the system when they need expensive care and resources, and are not being as responsible for themselves as those who pay for coverage for themselves and their families on a regular basis.
The proper and encouraged thing for these people would be to buy a bare-bones catastrophic coverage healthcare plan, rather than no plan at all. If these people continue to opt in and out of insurance coverage on a regular basis, ie only opting for insurance when they need emergency care and lots of resources, the multipliers for their cost of insurance can be increased, and become permanent.
The bottom line is that in America, since it is not legal to force people to carry insurance, unlike other countries, we allow people to be as responsible or irresponsible as they want. However, there are consequences for being irresponsible, and such irresponsible people that "take advantage of the system" and buy coverage at the point of a serious emergency that needs lots of care and money, the consequence is that any healthcare plan that covers them can charge them at significantly higher rates/decrease the percentages of care covered, so that they pay more for the resources they are using, to recoup some of the costs associated with people who deliberately decide not to buy healthcare insurance. Further, the hospitals and plans can also tap into any assets such and individual has in their HSA, incoming wages, and certain portions of their bank accounts. These practices of going after assets in these manners, can only be done against people who decide not to carry any insurance.
4. Portability if lose job. Need to get away from tying specific plans to people's work, and treat health insurance like every other insurance we carry. People pick their own insurance plan, like they do with car and home and life insurance. Businesses and employees, as part of hiring arrangements agree upon, as part of benefits, what percentage, if any, the company will pay to supplement that employee's health insurance premium. Or they can offer a straight out dollar allowance that the employee can use to pay part or all of their premiums. If the premiums for their particular plan are less than what the company offers to pay, the remainder will go into a health savings account for that person and accumulate for future medical emergencies or bills, or copays, or prescriptions, etc. If it is less than what the premium is for that person's plan, the person has to cover the remainder of the premium. The employee also will have the option of switching to any other private or government plan at any time, as he/she sees advantageous to do so. Businesses will be able to write off whatever dollar amounts they spend on employee healthcare coverage as a cost of doing business, if they choose to offer health insurance to their employees. Employees will also be able to write off 100% tax-free of premium costs. Also, there will also be a sliding scale that people can write off certain percentages of drugs, copays, visits, tests, treatments. Having to use healthcare and spend lots of money for treatment, people should not be burdened by government having to pay taxes on their care, that further pushes someone towards poverty/bankruptcy.
5. Portability across state lines. Insurance able to be sold nationally rather than state by state. Reduce complexity of policies from 50 different state versions to one national version. Greatly reduce processing and administration rules and decision making. Hopefully will reduce the current 20% of costs going to administration down to about 10% or less. Allowing the same policies to be sold nationwide is critical to portability, and processing, and reducing insurance costs to consumers by reducing administration costs. Many other countries have admin costs of 5%, 8%, 10% - in the US it is 20% and this step would greatly simplify plan administration across the country.
6. Pre-existing conditions. Nobody can be excluded for pre-existing conditions. However pre-existing rate multipliers for care in the (or those specific) health area(s) can be applied by private plans to adjust a person's premium to take these into account. There wil have to be limits set between negotiations between government and the private plans as to how high these premiums can go, much like how rate increases utility companies ask for are decided by public service commissions. Periodically these multiplier rates will be reviewed and the public and the companies can offer both sides and data examined to see if further changes up or down are justified.
7. Dental and vision are part of healthcare options. They can be included as integral parts of a plan. Basically the best way to handle these are as line items allocated certain dollar amounts for visits and procedures and devices (allowances for procedures, copays, etc) within an overall larger healthcare plan. Largely because people want to pick their own dentist and optometrists, and its easier for the insurer to say we'll cover this much for vision and dental, etc, than to get more complicated than this. Need to keep it simple. Insurance companies already know basic figures on what certain things cost for dental and vision, they can come up with coverage percentages or payment schedules for certain things and people will have the freedom to pick whatever dentist and vision person they want without having to have separate dental and vision plans fro their overall health insurance plan. Basically the health insurance plan will provide an allowance or percentage payment, something like this - for dental and vision and the person can decide which doctor or dentist to go to.
8. Health savings accounts. People can set aside certain percentages of pre-tax dollars - up to 10% of their salary in HSAs (20% if they have certain known serious conditions - cancers, diabetes, permanent diseases that require expensive treatment) to help pay their part of their premium, or pay for bills they are 100% responsible for if they have no insurance and don't want it. These funds will accumulate every year and will be a private account for that individual and will roll over to future years if they are not used. Health savings account dollars are not taxed and are not considered part of a person's wages for tax purposes, as we want to encourage people to set aside pre-tax money for their own health issues that might arise. Especially those people that decide NOT to purchase insurance.
9. Illegal immigrants coverage. Illegal immigrants would be able to buy individual health insurance policies just as they may be able to buy other forms of insurance. They must use real names and real identity information, and must fulfill all the insurance company's information requirements just as any other buyer of insurance must provide. If they cannot do this, or if identity theft or other fraud is committed, like with other policies they would be voided, and they cannot buy the insurance, there will be no waiving of information requirements for illegals. Further if a state has laws that do not allow illegals to purchase or enter into insurance agreements, they cannot purchase a health insurance policy. As non-citizens, they are not eligilble for enrollment in the US government-run plan.
Contract law will be 100% in force in the case forms are filled out with false information. If they have no insurance asset forfeiture collections will be enforced against them in order to attempt to recover the costs of covering them. They are responsible for paying their premiums just as they would with any other personal insurance plans they have. Any kind of fraudulent use of their healthcare policies will result in hospitals rejecting their plans until the matter is cleared up (ie people who are not the insured posing as the person to get healthcare) and they would be treated under the same manner as a person who has no health insurance and therefore 100% responsible for their bill. They would have to work out the problem with their insurer, not the hospital.
9a. Anchor babies. Closing the loophole. Anchor babies are babies born to illegal immigrant parents and thus, under law recognized for hundreds of years, are citizens of the country of their parents, not of the country they happen to be born in. If one parent is American, the parents need to determine at birth which citizenship status the child will have, and that will determine coverage eligibility. If the American parent has a plan that covers the illegal spouse and child, they will receive that coverage. If the American parent has no plan or is on the government plan, the illegal spouse and child will receive government level healthcare coverage and will either have to pay a portion (if in the govt plan) or the entire bill (if not on the government plan). The child's citizenship status, if they decide it is to have American citizenship, will not be made official until all prior outstanding healthcare bills are paid in full.
10. Tort reform. Higher standards of criteria to put forth malpractice lawsuits. Gross negligence and going against good and normal medical practices. Limiting potential damages to certain levels based on factors as quality of life, time left to live, what procedure is in question, and how egregious and negligent the care (or non-care) given, was. But the days of anyone bringing frivolous lawsuits are at an end. If it is found that the doctor was not negligent and such, plaintiff is responsible for court costs and lawyer fees for both sides.
11. Shyster/Ambulance Chaser lawyer databases. WIll keep track on lawyers as to how many cases they bring before courts that are deemed frivolous, as well as how many cases they bring where their clients are found to be responsible for court costs for the doctors they are suing. Patterns will be examined and courts may begin to start reprimanding lawyers for wasting the courts' time with frivolous lawsuits and start fining the lawyers on an ever-increasing scale for doing so. Continued abuse and waste of court time can lead to larger fines up to law license suspension or revocation. Ambulance-chaser ads of any kind, such as but not limited to, ads promising big payouts, fast settlements, and implying they'll do the same for you, can be taken into account by the court in its determination of fines, suspensions and revocations of lawyers' licenses.
12. Paying Doctors and Nurses for actual Work Done. Doctor and nurses' pay based on billables (ie actual work they've done) and success percentages and agreed upon hourly rates and other tangibles, not intagibles.
13. Medical Liability Insurance tax write off. Doctor and nurses' liability insurance as a 100% write-off as a cost of doing business. Can be written off on personal taxes. There will be a section on all tax forms where you can enter in costs for medical malpractice insurance paid for the year and deduct it off your AGI.
14. Online doctor rating systems. Ratings by peers, ratings by past and present patients, accessible to anyone. Doctors will have the ability to enter comments and replies to patient statements, without having to go into great medical detail, but also without fear of violating doctor-patient confidentiality. In other words they won't get sued if they talk about issues a client has already posted publicly about.
15. Abortion. Abortion will not be covered in the government plan. Prenatal care will be covered in the government plan. The government is charged with protecting life, protecting citizens, protecting those that are at the mercy of society. Children are the future of any country; abortion destroys the country's future, one life at a time. Abortion services may or may not be included as basic parts of private insurance plans, or it may be set up to be a supplemental part of a private insurance plan. Private plans can set themselves up to cover or not cover any legal medical procedures as proscribed and permitted by federal and state laws. The government plan will not cover euthanasia, or abortions. The government plan is not a cadillac plan, it is a very basic plan and will not cover exotic things such as sex change operations or cosmetic surgeries that are not injury related (and no you can't burn the top of your bald head and expect hair replacement procedures), or getting your viagra or buying you a bigger vibrator because you burnt the motor out of your old one.
16. Tax deductions for healthcare buyers. To encourage people to purchase a bare bones catastrophic care plan, all healthcare plan premiums are 100% deductible. All prescribed medical devices and prescriptions are 100% deductible. There will be no taxes placed upon any care or prescribed medical devices. We want to make it less burdensome for people to deal with medical costs, and not taxing them on their medical bills is a good start at actively applying that principle. Getting government OUT of the way, getting government NOT to tax people because they are sick. That mentality only pushes people more towards poverty. Special section will be on all tax forms where you enter in your costs paid for the year and that amount reduces your AGI number. Simple calculations. Your insurance plan will provide you after the end of the year with all the medical costs you've accumulated for the past year, as they will have this information in your file..
- As of 11/17/09, this is currently what I have down so far. Please, constructive criticism only, this is a real undertaking for me. Thanks in advance for your help and comments.
My brothers were born with serious cleft pallets and my parents were dirt poor. The March of Dimes paid for their cosmetic surgeries and to this day we all support this organization financially. Co-ops can be set up to handle preexisting conditions but only if you are continually covered.
Thanks for the reply, I’ll have to do more research on the co-ops (not familiar with them other than I’ve heard the term) and the whole issue if there should even be a government plan offered in the first place.
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