The Solution to the Health Care Problem

The health care debate rages on. President Obama took yet another opportunity to make his case, and yet all the media can focus on was Representative Wilson's outburst, "YOU LIE!" (Never getting around to letting there audience know that Rep. Wilson (R) was, in fact, LYING.) So Democrats keep trying to compromise, the Republicans keep trying to obstruct and the media remains complicit with the RIGHT WING but still refusing to inform people about the ACTUAL BILL, in favor of repeating RIGHT WING LIES... like those death panels on page 425? Yeah: THEY AIN'T THERE! But you won't get that form the media who would rather report on a fight than actually INFORM people.

So once against the media's forfeiture of credibility, the Republican's lack of brains and the Democrat's lack of balls have doomed us all. And that's not even to say that I LIKE Obama's bill, it's just better than anything ELSE I've seen so far...

Except for MY SOLUTION. Which would solve everything, and satisfy everyone. Over on MediaMatters, even the conservative posters had to concede to it's quality. So here's MY PLAN:

PART ONE: The Government's Role

The primary role of the GOVERNMENT, meaning the LEGISLATURE is to DEFINE the COVERAGE. Put in the simplest terms: Everyone & everything is covered. You could make this 100%, with NO out of pocket expense or could have a SMALL (~$20) co-pay, just to deter some idiot going to the ER for a hangnail.

Now... Just some common sense details: No, I wouldn't cover elective/non-reconstructive cosmetic surgery. I wouldn't cover any 'alternative medicine' (which is all BS anyway!); and I'd also be sorely tempted to exclude lifestyle drugs (Cyalis/Viagra/Levitra?) but I guess I could be persuaded to include those. Abortion would be covered. If you don't like that? Grow up. Seriously. (I'll address why this is the case in another post, "Questions Answered about My Plan, because people have asked.) And mental health would get the same level of coverage as everything else. There's no reason to treat the brain any differently from any other organ that has something go wrong with it. (Currently most Ins.Co shaft mental health drugs big time.) Many things not currently covered, like Speech therapy to treat Autism, would also be covered.

The exact details on every little things can be worked out later, but the GUIDING PRINCIPLE is: If you're sick, and we can heal you, your healed. No fuss, no muss and little to no out of pocket expense! No one dies of anything we can fix, and no one EVER goes bankrupt for getting sick. Period.

PART TWO: So who actually RUNS it?!

Utilizing the enormous network of health care cast negotiators that already exists, the program will be managed by the insurance companies, much in the way they do now. The big difference is that they can't refuse coverage. Everyone gets treated, and the hospital (doctor, etc...) gets paid for everyone they see. DONE.

They will adjust their premiums to figure out what it would cost and then bill the government for that service. What stops them from just GOUGING the government? Simple: COMPETITION. They will have to bid to cover people. And once they get someone they have them for LIFE. SO: Every time a baby is born, they will want to snatch up as many babies as they can since, once born and vaccinated, most babies represent about 30 years of little to no cost. Since they'll be paid to cover them ANYWAY, they'll want as many of those babies as they can get. If their price is to high, their competitors will snatch them up and their current case load just gets older. (Which in the health care world is a disaster! If you can get paid the same for babies as for the over 65's, YOU WANT THEM!)

So they will negotiate prices. The difference between what they negotiate and what the government pays - THEY KEEP. So there's still a profit motive and opportunity. (But for PROVIDING care, not DENYING it!) Going back to PART ONE, to maintain "universal coverage" and to avoid both rationing and robbing people of control over their own care, they will be required to reimburse doctors/hospitals/etc... at a level that (for example) insures that any given person will have a choice of at least three doctors within 50 miles of their home (100 miles in rural areas) that will perform a given test or procedure at no additional cost to the patient. (Save for ~$20 co-pay, if applicable.) Some Doctors can still charge more, if they think the market will bear it, but the difference will have to be paid by the patient. But the standard payment will have to be enough to make sure I have at least three Doctors to choose from with no additional expense. This gives doctors an incentive not to gouge insurance companies because there will be great pressure for them to be among the "free" providers - or at least very close to "free."

Now - I've also thought about how to reimburse at a higher level for specialists. First off, we'll need some way of identifying who the specialists are. It could be years of service, education, experience... whatever. The HOW isn't really important. It would likely been done however it's done now. So let's say someone has a complicated case and needs a specialist. Teh specialist won't be working for the regular rate. So does that mean that the patient now has to pay? NO. Here's how it would work: Specialists get reimbursed at a higher rate, to the point where the "choice of three" doctrine is maintained. So who decides is you get to see the specialist? Not the government (as you may be suspecting, but) YOUR DOCTOR. That's right. You see the regular doctor. When he sees your complicated case, assuming he's not a specialist himself, he'll think "No way am I dealing with THAT, for what they're paying me!" (Since he's only getting the base rate) and he'll refer you to a specialist or three. If a doctor is willing to give up the chance to make a little money (because he judges that what's really needed is beyond what he's getting paid, and thus he'll be at a loss) that's good enough for me. Off to see the specialist!

PART THREE: So how do we PAY for it?

OK, you guessed it: The government will pay the insurance bills with increased taxes. But stay with me now! It's not nearly as bad as you think. In fact, YOU MAY NOT EVEN NOTICE. And corporations may even prefer it!

The increased taxes will be offset by the fact that you're no longer paying premiums. This new tax would be structured such that most people's take home pay would not be affected + or -. This tax would be partially based on income (to give a break to anyone making under median income) but would also vary with martial status and number of children, much the way your premium does now. But the guiding principle here is that your take home pay will be as close as possible, to what you're taking home now.

Corporate taxes increase will increase to, such that the revenue generated will be the same as what is currently being paid in premiums - this is meant to be revenue-neutral. The benefit of this is that in the form of a tax, it will not have to be paid by struggling firms, who would otherwise still have huge, fixed health care costs, and more of the bill will be footed by companies doing really well. Who could just as easily have a tough year next year, and be in the other boat themselves. (Don't believe me? As late as the 1990's it was UNTHINKABLE that GM, still the worlds largest and richest corporation at the time, would EVER declare bankruptcy.) So while ExxonMobil might not like the increased taxes now, 5 years from now (let's say) when they're approaching red ink, rather than BIG FIXED COSTS for health care, their cost will be... NOTHING! And that can easily be the difference between making a profit and taking a loss!

PART FOUR: So what controls costs?

Cost are controlled automatically, through market forces in a more functional manner than they are today: Doctors will charge what the market bears, but will have an incentive to be among those that are "free" to the patient. Insurance companies will be in competition with each other to bid for new babies to cover. Free market principals apply, but will be used to insure coverage, as well as control cost. But rather than let supply and demand drive price, we'll use price to drive supply, and competition to keep Price down.

YOU see a DOCTOR. The DOCTORS deal with the INSURERS. The INSURERS deal with the GOVERNMENT. And the GOVERNMENT bill YOU (and your EMPLOYER.)

That's the basic structure. I'm going to do a separate post on strengths and benefits and also for any questions I get here, and for questions I've gotten from the MediaMatters posters.