Posted on 12/14/2014 4:11:58 AM PST by Kaslin
Now that Republicans will control both houses of Congress, they will have an opportunity to deal with Obamacare. What should be done?
They can begin by repealing the worst features of Obamacare. They can do that by keeping three promises many of them made to voters during the last election: Keep your job; keep your health insurance; and keep your doctor.
The most direct way to get rid of all the anti-job provisions of ObamaCare is to repeal the employer mandate. The most direct way to insure that people can keep insurance they like is to repeal the individual mandate. And the most direct way of insuring people can keep their doctor is to deregulate and denationalize the health insurance exchanges.
Then Republicans can move on to real reform of the health care system. There are seven principles that should be adhered to.
Choice. People should be free to choose a health plan that fits individual and family needs, rather than one designed by bureaucrats in Washington. Men shouldn’t have to buy maternity coverage; women shouldn’t have to buy coverage for prostate cancer tests; teetotalers shouldn’t have to buy substance abuse insurance, and so on. And no one should have to buy coverage for preventive procedures that health researchers have known for years are not cost-effective.
Fairness. If government subsidizes health insurance through refundable tax credits, the credit should be the same for everyone at the same income level. Moreover, I believe a strong case can be made that everyone, regardless of income, should get the same tax credit. For example, we could offer every adult an annual tax credit worth $2,500 and every child a credit worth $1,500. People would get this subsidy so long as they obtained credible private health insurance, no matter where they obtained it—at work, in the marketplace, or in an Obamacare exchange.
With a uniform tax credit, 90 percent of the problems with the Obamacare exchanges would vanish. Signing up for insurance would be easy. Insurance companies and brokers would be able to enroll people outside of the exchanges without asking privacy-invading questions about their income and assets.
Universal Coverage. There will always be some people who will turn down the offer of a tax credit. Instead of having the U.S. Treasury keep those unclaimed credits, some portion of the money should be sent to safety-net institutions in the communities where the uninsured live. Uninsured patients will probably be asked to pay their medical bills out of their own pockets. But if they cannot, the safety-net institutions will have a source of cash to pay for “uncompensated care.”
Note: The tax credit dollar amounts stated above are the Congressional Budget Office’s estimates of the cost of enrolling new people in Medicaid. So one way of thinking about the credits is to see that they will fund insurance that looks a lot like Medicaid. To obtain more accessible care or better care, people would have to add their own fund to the tax credit amount.
Portability. In most states today, it is illegal for employers to buy for their employees what they most want and need—insurance that travels with them from job to job and in and out of the labor market. The Obama administration has made the problem worse – by threatening employers with huge fines if they violate this principle.
Employers can buy group insurance with pre-tax dollars. But they can’t buy individually owned insurance on behalf of their employees. This prohibition means that people lose their insurance when they leave their employer, and this is the primary reason why developing pre-existing conditions can cause families much financial hardship. The prohibition must be repealed.
Transparency: Insurers should be required to make their networks of doctors and hospitals visible at all times and to alert potential enrollees about any restrictions on access to expensive drugs and procedures. This is especially important in light of the shifting of drug costs to the sickest patients as part of an overall “race to the bottom” in the Obamacare exchanges.
Patient Power. Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) are very effective ways to eliminate waste and control costs. That’s why 30 million people now have these accounts. Still, we are not taking full advantage of the opportunities.
Current law imposes rigid restrictions on HSAs. Those restrictions should be lifted so that HSA are allowed to be completely flexible—wrapping around any third-party insurance plan. Then let the market determine the appropriate division between third-party insurance and individual self-insurance in the form of a designated savings account. The private sector also should be able to create special accounts for the chronically ill. A model for this is Medicaid’s highly successful Cash and Counseling program, under which the disabled manage their own healthcare dollars.
Real Insurance. The primary goal of the Affordable Care Act was to give everyone access to healthcare. Yet the way things are panning out, millions of people are losing insurance with very reasonable access to providers and are being forced into an exchange where the typical health plan avoids the best doctors and the best hospitals. In some areas, these plans are dubbed “Medicaid Plus.”
How could things be different? Let people insure against the costs of getting a pre-existing condition. Under this approach, no insurer would be allowed to dump its most costly enrollees onto another insurer without paying the full cost of the transfer. So if an expensive-to-treat patient moves from Plan A to Plan B, the former has to compensate the latter for any above-average expected costs. This “change-of-health-status insurance” would eliminate the financial hardship associated with developing a pre-existing condition.)
I have described this approach to reform as an opportunity for Republicans. But I suspect, many Democrats in Congress would vote for these changes as well. Who knows? Maybe even the White House will climb on board.
Not as long as the law compels free treatment for those who won't pay, it won't.
Right. But that isn't competition.
All action is suspended pending the SCOTUS decision over state exchanges.
All the various topics are already addressed in the several Republican healthcare drafts languishing till the proper time. The debate is going to be over provisions offered in the various plans
Put a Mexican embassy in every Walmart with a Mexican doctor. In Mexico it costs $2 cash to get a prescription. Also include a Southwest Airlines ticket booth for the big stuff.
The best long term approach to healthcare is to start with the axiom that interference in the system might seem to make it better, but actually damages and even destroys it.
So the way out of the morass is simple, create natural incentives for people to leave it.
For example, some doctors in private practice reject Medicare and Medicaid, and also reject *insurance* for ordinary healthcare. By doing so, and insisting that patients pay with cash or check, they can offer prices that are 50% lower. And at the same time, the doctor makes *more* money. This is because they just need one person to do the paperwork, not an entire staff.
So this is a natural incentive for both doctors and patients. And the best thing government can do is *not* interfere with it. Though they *might* make it even more popular by legally streamlining it.
There should be serious consideration to forbidding insurance for routine medical care. It would benefit the vast majority of patients, and an alternative system could be devised for the minority.
Another great thing to do, that would radically increase the efficiency of the healthcare system, is to get rid of the wretched HIPAA and Health Information Technology for Economic and Clinical Health (HITECH) Act.
They are both abominations and dehumanizing efforts to federalize personal information for government use. There is no conceivable legitimate reason for 35 government agencies to be able at will to wade through your health records.
In a nutshell, the restoration of Doctor-Patient privilege.
Your medical life is NOT government’s business. They need to butt out. Likewise, government has no right to keep a database of people’s DNA, unless they are convicted felon criminals. NOT their job.
Eventually, Medicare should both be decoupled from Social Security, and both should be discontinued “from the bottom up”, which means no new enrollments in either, and no more FICA taxes.
There are many other ideas out there:
The BOLD Republican Plan for Health Care
http://www.cchfreedom.org/cchf.php/852
Waivers were very popular in the late 1970s, a simple (and obvious) answer to the lawsuit crisis.
Unfortunately, by the mid-80s, courts were ruling consistently that you could not waive your right not to be mistreated.
The ACA was never intended to answer the question “What is the best, least expensive way to protect healthcare in America?”
Very true, there is no way to save this country unless Americans can get over one idea and that is, “The government ought to do something.” I have heard it all my life but in reality, in most cases, government really ought to do nothing except get out of the way. Programs like the laughably named “Affordable Care Act” simply should not exist because they should never have been proposed, anyone who understands how things work in the real world would never expect anything positive to arise from such a law. If anyone is surprised at how badly it is turning out he should start devoting as much time as possible to the study of human nature and try to grasp just why it is that you get more of what you reward and less of what you punish.
You nailed it.
I have to assume most of it's for a reason. But I just can't believe that so many healthy people who've led such healthy lives are that needy of medical manipulation.
Let the several states do their own thing.
“They can begin by repealing the worst features of Obamacare.”
Classic Republican response. Lets tinker around the edges with what is acceptable to our corporate masters.
Medicare is a monster, destroying everything in its path.
It certainly isn't making it easy for seniors to keep control of their bodies and make informed objective decisions.
Not quite. While it is often repeated that the "real goal" of this monstrosity was to self destruct and pave the way to single payer commie care, the people who run the world have a much different agenda, a more fascist agenda, and when all is said and done the crony insurance companies will still have the individual mandate and will still collect taxpayer money, and most of the provisions which burden larger corporations will be overturned. It is feudalism and you will be required to be a serf on Aetna's or Cigna's plantation. But you're right, it has nothing to do with healthcare.
My doctor takes cash and charges me much less if I don't involve the insurance, nor should I, since the whole point of insurance is to mitigate the expenses of health emergencies, not to pay for every little visit for annual checkups and the occasional flu or stitches. The country has gone mad, and everybody who is not an insider to the scheme is unhappy.
Far too practical a solution (though that was once widely in place and still is in many areas)! It would be deemed to damage the "Self Esteem" of those using the system, as usual, screw the people who pay taxes to support the sinking ship!
Another thing is to fight the Trial lawyers. A few days ago, I saw an ad for a law firm that if you took Viagra and got skin cancer call this number. Those trial lawyers are scum.
Get rid of health ‘insurance’...
“Add to your list a repeal of the up to thirty year patent term for drugs. Reduce it to three years with no renewal. “
Is it really 3 decades now? Seems excessive.
But with just three years, drug companies may not recoup their expenses developing the drugs. So will not be putting in the effort to develop them. There has to be a financial incentive.
“BTW most actual research into new drugs is done by academic institutions at public expense. Drug company expenses occur mostly from navigating regulatory hurdles.”
I didn’t know that. Figures though. Big government intervention is stifling many other forms of business as well.
We are becoming more fascist daily, all behind the scenes from our representatives, with the EPA, OSHA, FERC, FDA, etc.
Yeah. With the renewals they can get it is.
drug companies may not recoup their expenses developing the drugs. So will not be putting in the effort to develop them
That is what is always claimed, but there is zero evidence to support it. The truth is they are just old fashioned monopolies, just like any other. Their primary incentive is to reap economic rents. Without patents the incentive to develop new drugs would be profit, same as any other industry.
Surely a better way to approach the problem of development expense would be to simply ask why it costs so much to bring new drugs to market, instead of looking around for some pockets to pick.
Now, of course, medical research has general applicability; but that is something which the free market can provide, as it has provided. There may arguably be a Federal role in supervising medicines that move in interstate commerce; but the present level of Federal control, even there, has become excessive, and should be reexamined, from multiple perspectives.
William Flax
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