Possible Health Care solution?

[soulcougher73]

After reading the first page of Shira's post about Obamacare and SCOTUS it reminded me that all we do is bicker back and forth on the same talking points over and over. I myself lean more towards the UHC side but im not 100% sold on it either and am willing to make compromises that best reach the desired solution. This idea is a very rough draft and not thoughtout in any great length ..yet. But i did want to bump it off you guys for your thoughts. Maybe you'll like it, maybe its lame. But what better way to learn than to get others inputs/ideas.

My (most likely not original) idea:

What if we had a system set up where everyone working paid into a UHC plan provided by the government via taxes, BUT we still have private health care/insurance you could buy into as well if you wanted to. IF you buy your own health care/insurance coverage for the year you can get the taxes paid into the UHC system back at tax time if you didn’t use it for that fiscal year. And if for some reason your private insurance denies you treatment or drops you, you are still covered under the UHC plan but you will only get your tax money back for the months you paid for private insurance. That way nobody is ever without care.

In this system the government would butt out of the private industry and let them run their business as they saw fit. We’d have multiple forms or competition in the private sector. They would have to compete against UHC by offering better services to justify their extra costs to their customers as well as compete against other private companies offering the same type of services.

I see this as a win/win for all ideologies involved. The UHC crowd gets their UHC from the government paid via taxes of the working class. And the people who don’t want UHC can still purchase their own insurance/care from whatever private business they so choose all without paying into the UHC system. Well sure you are giving them an interest free loan but you do get back what you paid into it at tax time.

I’m tired of hearing the same ole arguments here from both sides and I’m trying to come up with some kind of compromise plan that will not leave anybody without health care. Unless there are a few of you out there that willingly admit you don’t care if you deny people coverage and let them die. If you don’t want that then we have to come up with some solution to the problem that makes the most sense.

This is a very rough idea of a "possible" solution. Can be tweaked to make it better. No i dont have numbers etc. just running with the idea in my head at the moment.

 

[Anarchist420]

Not a good idea because it's the government distorting the market by providing a service.

Also, I don't want to see anyone die.

 

[PrinceofWands]

On initial read I'm all for it. I have no problem with UHC (nationalized and socialized, paid for direct from taxes), or true single payer (from citizen to medical provider direct with NO ONE else involved). I do have a problem with any form of 'insurance company' in the middle.

 

[Fern]

At first blush we still have the same/original problem.

I.e., you still have a mandate that people must purchase HI. The problem, as in the current SCOTUS case, is under what Constitutional provision can Congress claim this power?

I.e., you are setting up a national HI program which mandates people must participate, (however you provide an exception for those purchasing HI from a private insurer). But what is the basis for Congress's power to (1) set up a national HI program and (2) force participation?

It does not seem to me the power of taxation, because the tax return is only used as a vehicle to return govt premium payments to those (legally) not participating. And purchasing or not purchasing does not affect the amount of income taxes you pay.

Fern

 

[soulcougher73]

Not a good idea because it's the government distorting the market by providing a service.

Also, I don't want to see anyone die.

Ok. But do you have another non-goverment way to insure people dont die by not being treated or cared for? I dont want that either but we have to do something about the issue that makes the most sense and is most feasible.

 

[soulcougher73]

At first blush we still have the same/original problem.

I.e., you still have a mandate that people must purchase HI. The problem, as in the current SCOTUS case, is under what Constitutional provision can Congress claim this power?

I.e., you are setting up a national HI program which mandates people must participate, (however you provide an exception for those purchasing HI from a private insurer). But what is the basis for Congress's power to (1) set up a national HI program and (2) force participation?

It does not seem to me the power of taxation, because the tax return is only used as a vehicle to return govt premium payments to those (legally) not participating. And purchasing or not purchasing does not affect the amount of income taxes you pay.

Fern

I tend to look at healthcare probably under the general welfare clause. I think most of us agree we cant turn people away and let them die. So with that in mind we have to come up with something to combat that. Because healthcare is so random. Never know when youll get sick or cancer or a million other things. A forced participation makes sense. In a sense you're all covered all the time because their is no way to accurately predict health issues.

What about someone who doesnt want to participate and doesnt buy insurance because he assumes he healthy but breaks his leg falling down a flight of stairs? If you are not going to turn him away or deny him care then you may as well mandate everyone partcipates so we dont get the free loaders riding the system on another persons dime.

Again..just bouncing ideas around in a way to compromise/appease the most people.

 

[FoBoT]

that is sort of how the Health Savings Accounts work now

my company already forced everyone into high-deductible health plans so it was best for me to start using an HSA

i don't really support any Federal laws/plan in this area though

 

[xBiffx]

I tend to look at healthcare probably under the general welfare clause. I think most of us agree we cant turn people away and let them die. So with that in mind we have to come up with something to combat that. Because healthcare is so random. Never know when youll get sick or cancer or a million other things. A forced participation makes sense. In a sense you're all covered all the time because their is no way to accurately predict health issues.

What about someone who doesnt want to participate and doesnt buy insurance because he assumes he healthy but breaks his leg falling down a flight of stairs? If you are not going to turn him away or deny him care then you may as well mandate everyone partcipates so we dont get the free loaders riding the system on another persons dime.

Again..just bouncing ideas around in a way to compromise/appease the most people.

I would caution using the general welfare clause because you are opening up pandora's box. What is considered general welfare if you put health insurance under this. Seems you are setting the precedent that anything the government thinks you need becomes general welfare. Slippery slope because that will change vastly over years, decades.

Also, is it general welfare or is it directed welfare? Those who already carry HI because they choose, don't benefit from this one bit. Sure you can say costs are perhaps lower but when they just pay a copay/deductible, the end costs doesn't really matter. Perhaps they might see a drop in premiums but that's not a guarantee. So its no longer general welfare but only welfare to those who don't already have/can't afford insurance.

 

[Ninjahedge]

The problem is two fold.

1. Insurance companies. These guys are not interested in your health as primary. They are interested in how much money they can get off of insuring your health. That is not a, well, HEALTHY way of doing this. They will take a slice of a pie that really should not have anyone's private parts in.

2. Predictability. As a 25 year old that ran track and was able to put up 1.5X his body weight in the bench, jump 2M over a bar, yadda yadda yadda, I did not see my (mis-diagnosed) cancer coming. Something that would have hit me between college grad (grad school) and employment socked me ONE MONTH after getting insurance through my first job. It would have hit me and my family for well over $250K.

THAT is why we need this. So that the one stone you chuck over the side of the empire state building does not kill a bus full of nuns and causes it to run into a group of pre-schoolers on a field trip.

99% of the people that oppose this "mandatory" program would NOT refuse health care in a situation more pressing than breaking a finger, and I would bet more than half would even take it for that.

People are self serving greedy insecure individuals that will take what they can get and somehow be insulted when asked to pay for it (siting that they haven't taken it YET).

The main problem we have in the wash now is that we STILL have insurance companies in the mix ($$) and we have some convoluted "must pay" system that needed to be invented because of the Republicans Tax moratorium they have signed in (that oddly does not endeavor for them to CUT THEIR OWN SPENDING OR REPEAL PREVIOUS "TEMPORARY" CUTS). that moratorium forced the funding out of the term "taxes" when it is actually a better way to get the payment....


What? What he say?


Think of it this way. NJ pension funds are a good example. They were GREAT until whats-her-face decided to do two things.

1. Put a pause on state contributions to the fund. "We will pay later". And then come back saying "OMG! We can't pay! why do you want to kill NJ by demanding money we promised you!!!!>?".

2. They dipped into the kitty that was SUPPOSED to be only for the pension funds, and now that fund is...well... underfunded.

Keeping the funds SEPARATE would be GREATLY beneficial to a HCP. I would RATHER see my $1000/yr go into a fund that I can have, possibly, a direct voice in shaping to cover specific needs, rather than some arbitrary % that could be shifted from one year to the next.

You would not get a system that would be in trouble because a road cost too much, or a war was being fought.



The thing that annoys me the most about this whole "debate" is that we keep arguing about it like either side is truly representing us.

Each side has only one foot in our boat. The other, along with just about all their other vital parts, are in special interest boats that are simply using their legs to drag us where they want.

 

[Fern]

I tend to look at healthcare probably under the general welfare clause.

On second thought, that might work. If I understand it correctly, and haven't studied it lately, the General welfare clause is used to justify govt expenditures. E.g., why/how the fed govt can create and fund NASA or the CDC (Center for Disease Control).

So you're talking about creating a new 'health care tax' and the public HI program which I believe would be similar to SS.

I think it would be challenged. Briefly looking at material from the Constitutional challenge to SS has not been helpful. The quotes from the opinion affirming it are mostly about policy benefits (aside from the affirmation of the Hamiltonian view of the General Welfare Clause).

What bothers me about creating a govt HI program is that sufficient private HI providers exist; unlike with the SS program at that time.

Problems like denial of coverage for those with pre-existing conditions can be remedied through regulation. I see no Constitutional problem here.

But you are creating a govt HI program not to fill a void, but as a mechanism for compulsory participation in the HI market. I think that may be a significant distinction wrt SS.

Fern

 

[lotus503]

After reading the first page of Shira's post about Obamacare and SCOTUS it reminded me that all we do is bicker back and forth on the same talking points over and over. I myself lean more towards the UHC side but im not 100% sold on it either and am willing to make compromises that best reach the desired solution. This idea is a very rough draft and not thoughtout in any great length ..yet. But i did want to bump it off you guys for your thoughts. Maybe you'll like it, maybe its lame. But what better way to learn than to get others inputs/ideas.

My (most likely not original) idea:

What if we had a system set up where everyone working paid into a UHC plan provided by the government via taxes, BUT we still have private health care/insurance you could buy into as well if you wanted to. IF you buy your own health care/insurance coverage for the year you can get the taxes paid into the UHC system back at tax time if you didn’t use it for that fiscal year. And if for some reason your private insurance denies you treatment or drops you, you are still covered under the UHC plan but you will only get your tax money back for the months you paid for private insurance. That way nobody is ever without care.

In this system the government would butt out of the private industry and let them run their business as they saw fit. We’d have multiple forms or competition in the private sector. They would have to compete against UHC by offering better services to justify their extra costs to their customers as well as compete against other private companies offering the same type of services.

I see this as a win/win for all ideologies involved. The UHC crowd gets their UHC from the government paid via taxes of the working class. And the people who don’t want UHC can still purchase their own insurance/care from whatever private business they so choose all without paying into the UHC system. Well sure you are giving them an interest free loan but you do get back what you paid into it at tax time.

I’m tired of hearing the same ole arguments here from both sides and I’m trying to come up with some kind of compromise plan that will not leave anybody without health care. Unless there are a few of you out there that willingly admit you don’t care if you deny people coverage and let them die. If you don’t want that then we have to come up with some solution to the problem that makes the most sense.

This is a very rough idea of a "possible" solution. Can be tweaked to make it better. No i dont have numbers etc. just running with the idea in my head at the moment.

I actually think this is a very nice way to progress to UHC. Purest wont like it because major health care companies dont like competition from soemone without a profit motive.

 

[woolfe9999]

Continuing private insurance after instituting a government plan for all will maintain the current bureaucracy that is larding up costs - multiple payers means billions of pages of medical bills. Single payer achieves efficiency by being just that - single payer.

 

[Ausm]

Bottom line if we had single payer Big insurance would die! This will never happen because Big Insurance has paid off our Lawmakers. Also I forgot to add our Politicians get FREE healthcare for life so basically they don't give a rat's ass about anyone who doesn't pad their pockets.

 

[lotus503]

Continuing private insurance after instituting a government plan for all will maintain the current bureaucracy that is larding up costs - multiple payers means billions of pages of medical bills. Single payer achieves efficiency by being just that - single payer.

But it woudl give the small government crowd a way to opt out and keep private insurance.

If they want to overpay for a subpar product I think its their right

 

[Acanthus]

Not a good idea because it's the government distorting the market by providing a service.

Also, I don't want to see anyone die.

but they are big inefficient monstrously sized programs, how could they ever price compete with those lean and mean free market corporations?

 

[Anarchist420]

Ok. But do you have another non-goverment way to insure people dont die by not being treated or cared for?

Since when does UHC treat everyone successfully? Don't people die in the U.K because they have to ration care? Medicare has saved lives for sure, but it has also costed people their lives.

There is no perfect solution from a utilitarian perspective, I'll grant everyone that. However, the most ethical solution is one where no one is forced, at gun point, to give up their liberty for someone else's defense or health.

 

[Fern]

A post I made in another thread that really belongs here.

If your question is how do we force participation in HI vis-a-vis the Constitution I think the answer is obvious.

The power to tax is the govt/Congress's greatest power. They can use that IMO and avoid Constitutional problems.

But we'll need to forget penalties.

Instead, you compel people to buy HI. You raise everyone's tax, raise the rate, by an amount approximating the cost of HI. Then, you give everyone a credit for the cost of their HI purchase. Those purchasing HI will therefore not suffer a higher income tax. Those not purchasing HI will have a dilemma: Pay the higher income tax or buy HI. This would strongly compel HI purchase.

For those that don't, the govt could easily calculate the amount of the forgone HI 'tax credit' and aggregate those funds in a separate account.

The govt could take this money and create something I'll call "Uinisuricaid". Hospitals that are forced to serve people with no HI and are unable to collect through normal means can apply to the Uninsuricaid Fund for reimbursement so those with insurance don't bear the costs.

(BTW: I find it annoying that people automatically assume those without HI do not pay their bills 100% of the time. Hospitals, like any other business, have to means to collect from those who do not automatically pay their bills.)

You could tweak this as desired. E.g., the HI tax credit could be phased out at higher income levels, and the credit could be based upon family size (larger family is more expensive HI policy).

But as with the OP's suggestion I think you have a major political problem. Obama promised no new/higher taxes on those making less than $250K and both of these suggestions blow that right out of the water. We can see this campaign promise has caused the administration a great deal of concern. One day the 'penalty' is a 'tax'. The next day they argue the opposite. It just depends which concern, Constitutional or campaign, bothers them the most on any given day.

Fern

 

[woolfe9999]

But it woudl give the small government crowd a way to opt out and keep private insurance.

If they want to overpay for a subpar product I think its their right

The opt out only works if private health insurance is abolished. They could then allow doctors to opt out of the system and only take fee for service patients. Anyone could then go and pay fee for service for those doctors if they didn't want service from providers who are in the system. The opt out would have to be permanent or for a long time so that they couldn't switch back and forth at will.

 

[Hayabusa Rider]

The opt out only works if private health insurance is abolished. They could then allow doctors to opt out of the system and only take fee for service patients. Anyone could then go and pay fee for service for those doctors if they didn't want service from providers who are in the system. The opt out would have to be permanent or for a long time so that they couldn't switch back and forth at will.

Under what Constitutional authority does the government have this right?

 

[Fern]

Continuing private insurance after instituting a government plan for all will maintain the current bureaucracy that is larding up costs - multiple payers means billions of pages of medical bills. Single payer achieves efficiency by being just that - single payer.

He's talking about a solution to achieve basically what Obamacare does.

Under that, we still have multiple payers.

You're going further, and into the realm of SP. That is a different thing and IMO, presents some different problems.

The opt out only works if private health insurance is abolished. They could then allow doctors to opt out of the system and only take fee for service patients. Anyone could then go and pay fee for service for those doctors if they didn't want service from providers who are in the system. The opt out would have to be permanent or for a long time so that they couldn't switch back and forth at will.

Under his plan there are private HI companies and a govt plan.

If you opt of the govt plan you must participate in a private HI plan.

Hence the opt out only works if you have private HI companies.

Fern

 

[woolfe9999]

Under what Constitutional authority does the government have this right?

This is a theoretical discussion of what health care system would work best, not a discussion of the legalities of any such system. If you think we need a constitutional convention for such a system and it turns out you're correct, then that's what we need. Of course, that will never, ever happen before Armageddon so if we really do need a constitutional convention for any significant change to the current system then we're stuck with it.

 

[woolfe9999]

He's talking about a solution to achieve basically what Obamacare does.

Under that, we still have multiple payers.

You're going further, and into the realm of SP. That is a different thing and IMO, presents some different problems.



Under his plan there are private HI companies and a govt plan.

If you opt of the govt plan you must participate in a private HI plan.

Hence the opt out only works if you have private HI companies.

Fern

Right, I understand. I AM going into the realm of single payer because it is better than what he suggests. Any system involving multiple payers is bureaucratically inefficient. That includes Obamacare.

 

[Fern]

-snip-

My (most likely not original) idea:

What if we had a system set up where everyone working paid into a UHC plan provided by the government via taxes,

Just noticed the bold part.

Your proposed solution does nothing to ensure universal coverage.

Those not working, or working but whose wages are too low to cover withholding for HI will not covered under your plan.

One of the primary aims of Obamacare is to achieve universal coverage. It doesn't actually do it, but it gets closer. I don't see how your plan does even that.

Fern

 

[Hayabusa Rider]

This is a theoretical discussion of what health care system would work best, not a discussion of the legalities of any such system. If you think we need a constitutional convention for such a system and it turns out you're correct, then that's what we need. Of course, that will never, ever happen before Armageddon so if we really do need a constitutional convention for any significant change to the current system then we're stuck with it.

I'd suggest a combination of tax incentives such as making premiums fully deductible. Then look at practitioner habits and allowing a standard of practice not based defensive medicine. Redundant tests are made just to reduce chances of malpractice suits which reach 100 percent for internal medicine specialists over their career. If we insist in on limiting costs then practitioners need protection. I believe that other nations do this. Provide incentives for cost saving measures. Devise a secure national database to provide accurate and timely information to providers. The immediate savings and treatment benefits are huge. The value of knowing what was done and when, along with current and past disease states and therapies cannot be overstated. That's a start.

 

[Fern]

Continuing private insurance after instituting a government plan for all will maintain the current bureaucracy that is larding up costs - multiple payers means billions of pages of medical bills. Single payer achieves efficiency by being just that - single payer.

Right, I understand. I AM going into the realm of single payer because it is better than what he suggests. Any system involving multiple payers is bureaucratically inefficient. That includes Obamacare.

Regarding billing.

In my personal experience Medicare/Medicaid billing was the most expensive/least efficient.

I would also think, as currently under Medicare/Medicaid, we would continue to track procedures and costs etc. We would be discussing a HUGE departure from current practice if we move away from itemized billing reports. For another, we couldn't track info and we certainly couldn't track fraud (over billings, false billings etc.).

To me it seems there is a rather simple solution to billing/reporting inefficiencies that does not require a single payor system.

Just have the govt and private insurers agree upon ONE billing format that HC providers must use. The creation of a standardized format on a single software eliminates inefficiencies.

It wouldn't be difficult for the govt to then create the software and distribute for free to all HC service providers for use. In fact, the govt has already done that (develop and distribute billing software but it was for Medicare/Medicaid).

The problem would be on the private side where they must adjust/modify their accounting systems to assimilate the billing data from the govt's app.

Fern