First off, as I like to point out here and there…I lean firmly Libertarian and, in most cases, I look for ways to get the Federal government out of the business of my life. That said, the door was opened to healthcare as a national issue and now we seem to be stuck with the feds playing a role in our health.
No matter the dealings behind the scenes, all of these “healthcare” acts aren’t actually about getting people healthcare…they are about getting people insured. These acts should be nicknamed “Obamasurance” or “Trumpsurance”…seeing as how we are apparently required to have ridiculous nicknames for all bills.
Just to make a point here, as many as 30% of the people in certain surveys didn’t know that Obamacare was the ACA. These same respondents found Obamacare to be nothing short of repulsive, but thought the ACA was necessary to help Americans.
Tangent…if your argument against an action or piece of legislation includes the words “Obummer” or “Dump” (or some other derivative thereof), you have already lost the argument. I get that you hate <insert politician here>…but name calling doesn’t lend anything to your point.
Sadly, that is the state of nearly every subject in the public eye today…what happened to debate and discourse? Where did compromise, listening, and tolerance go? I love that the word tolerance is thrown about as this guiding principle by which we must all abide. So where is this tolerance for differing ideas?
Oh…I see…you want people to tolerate your beliefs and opinions, but why then shouldn’t you tolerate theirs? Uncomfortable, right? Stupid logic stepping in and making sense…
While I am at it…If Obama was responsible for the good things during his tenure, then why is he also not responsible for the bad? Same stands for Trump or any other politician. We are so off-balance that people won’t dare give credit to someone from the opposing party and rarely allow for the possibility that their own side made some mistakes.
OK, OK…I get it…Back to our subject…healthcare. The problem is that we aren’t actually fighting to get adequate care, we are fighting to get adequate coverage. Why? Why all the nonsense to get coverage instead of healthcare? Shouldn’t we be getting the money to the providers who went to school for 12 years to take care of people? Factory direct…cut out the middle man…save money!
Oh…because health insurance is a $990 billion per year industry. I guess any legislation that would work around them would be fought pretty hard. Remember kids, spending money on your representatives to get things to go your way is somehow legal…
So, let’s accept for this discussion that we are going to keep the federal government in our healthcare and that we are also going to retain the health insurance industry in the mix. Can we find some way to provide something to which both sides would be amenable?
If you look at what has transpired thus far, the answer would be no (unlike ancient astronaut theorists who always answer yes…). In the 46 major surveys done since the PPACA (Obamacare’s actual abbreviated title), the for/against is mainly against…though it is almost always close. Each side has something they find must be included/excluded.
Somehow, the best and brightest of our government can’t seem to find a way to put something together that a majority of people could get behind. The right wants to force their morals down everyone’s throat and the left thinks no one should have to pay for anything. There has to be a middle ground…
My wife and I recently had a 5 hour drive and began talking about this subject. We both wondered what was so difficult about healthcare law. We took each piece and began proposing ideas and then trying to shoot them down. Back and forth we went. Because we didn’t have a side, weren’t afraid to be wrong, and left out any name calling, we knocked out what seems to at least be a beginning to a workable plan.
First, we need to allow for greater competition, not in an exchange or something like that, but true competitive options. Second, we must get rid of the idea that everyone needs full coverage all the time. Third, we require a plan that allows individuals to maintain their coverage while switching employers. Fourth, a true model for those who cannot afford coverage. Fifth, keep people from going bankrupt when max payouts are reached. Finally, remove the pre-existing worry.
How do we do this? I know that much like the Social Security remedy, there will be a bandage to pull off…and it may sting, but the longer we wait, the worse it gets. We must remove that argument from the discussion. Otherwise, we stagnate and move nowhere.
Competition. One goal of the ACA was to increase competition among the health insurers. This desire has certainly not been realized. In fact, 70% of the counties participating in the insurance exchanges have only one or two choices. One option doesn’t leave room for a choice, does it? Sure, I suppose that you have a choice of yes or no on the one option…except you get fined for choosing no, so not really free to choose. These insurers are free to price however they see fit and are responsible for many of the reported premium increases.
Let’s open the door to real competition and not through this exchange program where insurers bail out once they see that the revenue/risk doesn’t meet their expectations.
Why should a healthy 24 year old be required to carry expensive coverage? If a person goes to the doctor once a year, why not just make it possible for them to pay cash for that one visit? What if we allowed them to have an option to be insured only for catastrophic illness/injury? The current ACA allows this…why throw it out?
With some sort of catastrophic coverage, people can save on the high cost of insurance yet be covered in case of accident/major illness. What determines catastrophe? That can be left to the insurers to decide…which brings us back to competition. If insurer A requires $10K in charges before they kick in and insurer B requires only $8K for the same premium, who will you choose?
I hear you out there…”But if the cost is over $10K, these young people can’t afford that!” True…but that is where the low risk/low premium come in. Plus, a number of preventative visits are also covered annually.
Like I stated above, we are merely trying to create a platform from which to start the discussions.
What if we removed employer group coverage? Right now, my company makes a deal with a large insurer and my options/prices are determined from their agreement. The prices must be higher across the board because the insurer has no idea how healthy the employees are. They take the limited information they have and create a cost basis. We are all subject to these prices.
What if I had personal coverage that I negotiated with the insurer? What if my employer (or a prospective employer), as a benefit, offered to pay a greater percentage of my coverage (or pay a set amount monthly) directly to the insurer…exactly as they do now? This way, if I change jobs, I keep my existing coverage and take it with me.
How many people have you heard complain that they hate their job, but they can’t afford to lose the insurance? This flexibility allows people to demand better at work, because they can walk and take their coverage with them to a better job.
Starting from some point, there will be no new entries into group coverage…all people enter individual coverage and the groups are slowly diminished over time. People who are in a group currently and like their coverage can negotiate with the insurer to drop from the group and pick up an individual plan with the same amount covered by the employer. If they are healthy enough, they may be able to save a lot of money.
What if insurers could offer me a 5, 10, 20 year or longer option to stay with them long-term? Think of the cost reductions. Much as life insurance is far less expensive the earlier you start, health insurance could follow that same model. In fact, it may be that those young people we talked about carrying only catastrophic coverage, would be tempted to buy in for long term full coverage if the rates are low enough. This also reduces the worry of pre-existing denial. If you carry the same policy wherever you go for many years, you don’t have to apply again, which helps to lessen pre-existing condition worry.
This also gives the leverage to the buyer. If the insured is unhappy or gets a better offer somewhere else, they have the flexibility to move…even if they haven’t switched jobs.
Pricing could be individualized and the healthier people pay lower premiums. What? That isn’t fair? So…an all-around healthy person should pay the same as someone who doesn’t take care of themselves in any way?
This isn’t about pre-existing…this is about conscious life choices. If your diet is Mountain Dew and Ring-Dings…that’s on you. Personal responsibility and all…But let’s talk about this as it seems to come up in every discussion. Fairness. The old adage that the world isn’t fair applies.
Let’s use a simple comparison. Car insurance. The rates for a 16 year old male driver with no accidents are far higher than for a 46 year old with no accidents. Why? Because the statistics show that a 16 year old is far more likely to have an accident. This means they are a greater risk to cost the insurer money and so they charge more to cover the expenditure.
Loan companies charge higher rates to those with bad credit histories. Why? Those with bad credit are more likely to default and cost the company money. But for some reason, when you talk health insurance, people flail their arms about all willy-nilly and scream that it isn’t fair to charge more to those who cost more. I would love for someone to stop the flailing and explain rationally, why these companies shouldn’t be free to charge as the actuarial tables would demand.
If you are unhealthy due to your life choices, then the insurers should be free to charge you more. No?
On a slightly related note, Samoa Airlines is now charging customers by weight. Why? Because more weight uses more fuel and more fuel means more expense. Why should a 100 pound person pay the same as a 400 pound person when that 400 pounder is much more expensive to fly in relation to fuel costs? It isn’t the number of seats that airlines use when planning for fuel purchases, it is the number of pounds they must lift into the sky.
I see a doctor twice a year. I do this only to refill my prescriptions for asthma medication. If they could give me a permanent refill, I would only go in case of extreme emergency. Shouldn’t my premium reflect this?
On the other end of the spectrum, a person I know goes every time they sneeze. “Uh oh! I should see a doctor because it is covered!” This becomes the drain on both the healthcare system and the insurance system. Why not lower the up front costs across the board and raise the usage costs? Those who use more, pay more. That is how almost every other business (other than all you can eat buffets) works.
What if we offered pricing in bundles? Premium A comes with 4 annual visits, B with 8 and so on…Just like the world is already accustomed to doing with their cell phones, we build a consumption based model. 1GB, 10GB, unlimited…use more than your plan and you pay for it.
Here’s a question…why do we force everyone 65 and over on to Medicare? I know many people over 65 that can afford (and would prefer) to keep their own coverage…even if the rates were raised due to age. Why are we creating this forced reliance on the government for our care as we age….oh….dependence on the government for our seniors means more leverage when budget dollars are up for grabs. Take from Medicare and grandma can’t see her doctor.
It can’t be that nefarious, can it? The government can’t be holding our elderly population hostage in a battle for budget dollars, can they? Sadly, that appears to be the case. There is no other logical argument for forced Medicare. If you have one, I would love to hear it…
Imagine the savings if even 20% of the people (estimated number who would if they could) on Medicare came off. Especially since they are the people who require the most healthcare spending. We will spend over $600 billion (yes, with a b) on Medicare in 2017. 20% of that (and subtracting the average premiums those participants pay) is $107 billion dollars in savings.
So…what if we put that money towards the people who truly need the help. By allowing people to keep their coverage past 65, those extra funds can be redirected into programs to assist lower-income families with healthcare needs…or as bankruptcy protection for those who maxed out payments.
Bankruptcies in the US are down for the 7th straight year (and are at the lowest number in 30 years), with about 400,000 families filing for complete debt relief (Chapter 7). Of those, about 46% claim to be medical related. So, 180,000 or so personal bankruptcies are due to medical costs with the average amount of debt being $17,000. Even if we assume that 100% of this debt is medical, we are looking at just over $3 billion per year in uncovered medical expenses even with insurance. Easily covered in our new found Medicare savings.
If we applied the remaining $100B to assist the states with Medicaid, we could ease the burden per state by about 20%. Imagine if each state had 20% of its Medicaid budget to put back into other necessities. California would save almost $17B…or about 15% of the total state budget.
Again, maybe not a perfect plan, and we haven’t fixed everything…but it has nothing to do with party lines, it has everything to do with attempting to provide a solution to one of the major problems in the country today…a solution that our elected officials should have been able to come up with if they weren’t so busy name calling.
If the ACA has taught us anything, it is that when one side shoves its platform through, the other side will do everything it can to rip it out and replace it with their plan at the first opportunity. There will be no compromise, there will be no working to leave the good parts…just spite and anger and revenge. Is that how we want to be governed? Not me…and I hope not you either.
Maybe all the Republicans and Democrats and Whigs and Tories and whatever else we have running around Congress today could stop serving their party and start serving the people. Whether I voted for you or not, you are *our* representative (regardless of your bumper stickers to the contrary) and I expect you to work in the best interest of all the people…not just the ones you pander to for re-election.
Unlike the politicians and talking heads out there today, I accept and welcome criticism or rebuttals. The only way we solve problems is to listen to opposing view points and refine our ideas to serve the greatest number of people in the best possible way.
Above the Nonsense 