The healthcare plan issue is the difference between socialistic government dictated plans and capitalistic individual based plans.
The healthcare plan issue is the difference between the socialistic approach to healthcare and the capitalistic approach to healthcare. Consequently, the Democrat socialistic healthcare plan must articulate every aspect of their plan for coverage. With a Democrat plan, everyone is covered at no cost to individuals or families, pre-existing conditions are covered for all; costs are paid by the government through taxation, and the price, type and availability of treatment or medication is determined by healthcare bureaucrats. A Democrat healthcare plan requires thousands of pages of regulations to implement and rarely fully understood by the citizenry. A Democrat plan is a government controlled one size fits all plan so every aspect can be articulated.
In contrast, a Republican capitalistic healthcare plan is based on individual choice. Capitalistic plans reduce taxes and allow the individual to choose their personal plan based on their personal health profile and risk tolerance. Consequently, a Republican plan lacks detail and specificity because there is no monolithic one size fits all plan. In reality, there cannot be a Republican Healthcare Plan because Republicans will allow We the People to develop our own personal healthcare plans that fit our personal or family requirements.
As a result, a Republican capitalistic healthcare plan or law must define the parameters that all private healthcare plans must include. At a minimum, the plan or healthcare law must require coverage for all pre-existing conditions, define the maximum age for covered dependents, define coverage limits for, hospitalization, specialist, physician, support staff, and medication related treatment of all diseases and chronic conditions. The healthcare law should also require complete cost transparency related to physicians, facilities, diagnostic procedures and equipment, supplies, medication both prescription and over the counter, and coverage related to eye, dental, and hearing health. The Republican healthcare law should allow home delivered meals, transportation for physician visits, and remote physician care for those who wish to pay for this coverage in their personal plan. This law should also allow individuals and families to form healthcare insurance cooperatives to compete with employers for insurance coverage prices in their area. Healthcare providers must be allowed to provide fully transportable healthcare insurance to customers in all 50 states, Washington DC, and all US Territories creating competition and lowering healthcare insurance costs for individuals and families. Unlimited Healthcare savings plans must be allowed in the Republican healthcare law. The Republican plan must also allow a range of low-cost plans allowing people to have a combination of healthcare savings plans with a range of catastrophic healthcare insurance plans that fit their health profile, risk tolerance, and ability to pay.
The Republican capitalistic healthcare law should also require complete healthcare provider transparency related to quality of care. The professional evaluations and disciplinary citations against all healthcare practitioners at every level and citations against healthcare facilities and their staffs should be publicly accessible to all. This is the only way the public can be sure that their care is the best available in their area. Such transparency would eliminate poor healthcare providers and reduce the overall cast of healthcare because medical liability insurance would go down. No one would go to a poorly rated practitioner or medical facility. Capitalism would eliminate the bad actors. Of course, medical practitioner groups and institution groups would oppose this level of transparency.
Meaningful tort reform is also necessary to control healthcare costs and must be included in Republican capitalistic healthcare laws. I am a good example of the added medical costs of our current tort laws. I was a truck driver with a heart condition. DOT regulations required me to have a tread mill stress annually. This test costs about $700; but my cardiologist would not approve my physical without a myocardial stress test which costs about $3,500. He required this test as a means of litigation mitigation in case I was involved in a heart related traffic accident while driving my truck; and he would be blamed for allowing me to drive with a defective heart. Physicians prescribe innumerable diagnostic tests as litigation mitigation measures. Meaningful tort reform would reduce such testing and reduce healthcare costs with little reduction in the quality of healthcare.
Healthcare and healthcare insurance comprise at least 17% of the US economy. Previously, several expansive and radical capitalistic healthcare and healthcare insurance proposals were discussed at America’s Crossroad. These proposals include A FORGOTTEN AMERICAN’S ALTERNATIVE HEALTHCARE PLAN which discusses employer provided plans, Obama Care, Medicare, Medicaid, VA Healthcare, and a unique proposal for dedicated Wounded Warrior Healthcare, TRUE FREE MARKET HEALTHCARE INSURANCE, IT IS TIME FOR THE HEALTHCARE RESPONSIBILITY ACT, and THE INDIVIDUAL HEALTHCARE TAX CREDIT. This discussion illustrates the fact that it is impossible to formulate a single comprehensive Republican capitalistic healthcare plan which gives individuals, families, and their practitioners complete control over their healthcare. For Democrats, a healthcare plan regulates every aspect of the healthcare system from costs to treatments and treatment accessibility requiring thousands of pages of regulations which are indecipherable to laymen. Accordingly, a Plan giving individuals and families control over the type and cost of their personal healthcare Plan ds not qualify as a healthcare Plan in Democrat circles. Therefore, healthcare based on free market capitalism can never qualify as a healthcare plan to Democrat socialists; and the healthcare plan issue cannot be resolved politically simply because Democrats and Republicans will never agree o the definition the word Plan as it pertains to healthcare.
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Americans need an alternative healthcare plan. As a “forgotten American,” allow me to propose a radical healthcare plan for consideration. Neither Obamacare nor any current GOP Healthcare Plan is either patient centered or free market. Since they barely cover 20% of the total healthcare insurance market, the current alternatives will fail; and we will be left with socialized single payer, VA style healthcare. Maybe it is time to consider at least one other healthcare plan. None of the current plans even offer free market healthcare insurance. Everything either existing or contemplated will leave us with varying degrees of government controlled healthcare insurance. The vaunted strong patient doctor relationship will be non-existent. In my opinion, a true free market healthcare plan is no longer possible due to the high cost of modern healthcare. However, a true free market healthcare insurance system that also provides for strong patient control and patient doctor relationships could be accomplished if several changes to the current or contemplated healthcare plan were adopted.
Before suggesting an alternative healthcare plan, a discussion of the United States government role in healthcare is appropriate. Nothing in the Constitution of the United States specifies that either the United States or State government is responsible for any individual’s healthcare, well-being, welfare, or education. Specifically, Article I, Section 1 states, All legislative Powers herein granted shall be vested in a Congress of the United States. Accordingly, only those powers specified, herein granted, in Article I, can or should, be enacted by the Congress of the United States. Individual healthcare, well-being, welfare, or education is not among the legislative Powers granted in Article I, Section 8 of the Constitution. The first paragraph of this section,
The Congress shall have Power To lay and collect Taxes to pay the Debts and provide for the common Defence and general Welfare of the United States,
refers to revenue collection necessary to pay for or maintain the general welfare of the United States government, as defined in the remainder of the section. This section ds not say, provide for… the general welfare of the”people or citizens,” the section says, “provide for the… general welfare of the United States.” Furthermore, Amendment X states,
The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
Consequently, the words and original Intent of the Constitution dictate that individual healthcare, well-being, welfare, and education are not the responsibility of the United States government; but they are the responsibility of the States respectively, or the people. Article I through Amendment XXVII of the Constitution provide the Constitutional details for the United States government to protect We the People and implement the general guidelines and objectives described in the Preamble, or introduction, to the Constitution.
However, Marxist, socialists, progressives, liberals, and the Democrat Party on left generally consider the Preamble to the Constitution as part of the implementation instructions rather than an introduction providing the general guidelines and objectives of the Constitution. The Preamble states that the United States should promote the general Welfare, and secure the Blessings of Liberty to ourselves and our posterity. The Merriam Webster On-Line Dictionary defines promote as follows: to contribute to the growth or prosperity of or to help bring into being. Neither the word contribute nor help connotes the concept that the United States government is required through legislation or responsibility to provide Welfare of any type. The archaic Merriam Webster On-Line Dictionary definition of secure follows: overconfident, easy in mind, confident, assured in opinion or expectation, having no doubt. Again, nothing in the definition of secure implies that the United States has the responsibility to provide, through legislation, welfare of any type. We the People are confident and assured that our Constitution will allow each individual to work to secure the Blessings of liberty. This phrase in the Preamble indicates that the United States Constitution provides a legal, political, social, and economic environment that contributes to and helps We the People secure (or have confidence regarding) the Blessings of Liberty. The emphasis of the Preamble is that the Constitution provides a framework by which We the People can secure the Blessings of Liberty for and by ourselves and our posterity. We the People individually determine how we are blessed by the liberty to pursue all that life offers to each of us. Nothing in the Constitution indicates that the United States government must or should provide anything but general, not any specific type of Welfare.
EMPLOYER HEALTHCARE PLANS
Since both Obamacare and any GOP plan are doomed to failure because only around 20% of the population will be covered, discussion of the current state of the healthcare plan in the United States seems appropriate. No segment of our healthcare insurance industry bears any resemblance to a free market, including employer provided healthcare insurance. No category of healthcare insurance is free of some form United States government control or subsidies. Over 50% of the people in our country benefit from a subsidized employer provided healthcare insurance. In each employer based healthcare plan, the value of the insurance is not considered as taxable income for employees, a government entitlement or subsidy; and businesses are allowed to deduct their employee insurance costs as a business expense, another government entitlement or subsidy. Thus, each employer provided healthcare plan is subsidized by the United States government and is an entitlement.
Additionally, each employer based healthcare plan is not a free market system for the employee and ds not guarantee meaningful, long term patient doctor relationships. Normally, employees must choose from at most three healthcare plan insurance providers that have contracts with their employer. Often employees must settle for the insurance offered by their employer for only one healthcare plan. Additionally, employees are usually limited to the HMO or PPO practitioners participating in their employer contracted healthcare plan. If the employer finds a better healthcare plan provider, the employee must change to the new plan and associated medical practitioners.
An individual or family healthcare plan has many advantages over employer provided healthcare plan insurance. Neither Obamacare nor any GOP plan provides any employee/patient control over their patient doctor relationship or other service providers for those participating in an employer provided healthcare plan.
OBAMACARE
In 2017, 12.2 million new individual consumers enrolled in Obamacare exchanges; but only slightly more than 20 million people were enrolled in all Obamacare programs including the Marketplace, Medicaid expansion, and young adults staying on their parents plan in 2016. This represents only 10-15% of the US population. Approximately 8.5% of our population has no healthcare plan. Consequently, Obamacare and any GOP individual healthcare insurance plan is attempting the build financially solvent individual healthcare insurance exchanges or markets serving about 20% of the total population of the nation, any State, or locale. In addition, a large proportion of the people served by both plans fall in the lower 30-40% of income earners. Some self-employed people in this group have higher incomes. With these small exchanges, markets, or patient pools, both of these plans are doomed to fail. Consequently, it is not surprising to me that Obamacare is failing!
THE “FORGOTTEN AMERICAN” PLAN
In my opinion, the only way to create a true, free market healthcare plan and insurance system that maximizes individual patient control and strong patient doctor relationships is a radical, comprehensive restructuring of the entire healthcare insurance industry in the United States. Accomplishment of this restructuring would require elimination of all vestiges of United States and State government as well as employer control over the types and cost of individual and family healthcare plan coverage offered by private insurance carriers. Employer paid healthcare insurance plans would be eliminated and converted to individual and family plans. Non-subsidized Obamacare plans would also be eliminated and converted to individual and family plans. Individuals and families receiving Obamacare subsidies and those receiving Obamacare coverage through Medicaid could continue these benefits until they are phased out by the respective states as new markets provide effective and economical individual and family healthcare insurance plans.
Government involvement should be limited to ensuring that healthcare plan providers treat people fairly and ethically, cover preexisting conditions for those changing healthcare insurance providers, and cover children under age 26 who are students or have incomes below the individual poverty level. Although it could be a leap too far, no PPO or HMO type restrictions should be placed on individuals and families in the proposed healthcare plan system. Each healthcare plan should allow people to select the practitioners and care facilities of their choice in every state where their insurance provider participates in the markets. This would insure high quality patient doctor relationships. All taxes, mandates, including the linkage between Medicare costs and private healthcare costs, penalties, and other regulations of Obamacare, unrelated to fair and ethical healthcare plan practices must also be eliminated.
Elimination of employer paid plans, in combination with those in Obamacare and the uninsured, would create a potential individual and family healthcare plan free market involving at least 70-75% of the US population. With exchanges or insurance pools this large, insurers would be able to eliminate life time coverage limits. Since coverage would be for individuals and families, preexisting conditions would not be an issue because lapses in coverage would not normally occur. Changes in employment or location would not affect individual and family insurance coverage. When individuals or families change insurance carriers, the old insurance carrier would provide a letter of continuing insurance as required now, and the new carrier would be required to cover all preexisting conditions.
Several steps would be necessary to accomplish this change. First, healthcare plan carriers must be allowed to offer insurance coverage in all 50 states like property casualty and life insurance carriers. Healthcare insurance carriers would be regulated in accordance with the laws of each state to account for differing state to state populations and economic situations. This would ensure total nationwide healthcare insurance portability, the largest possible insurance pools, competition among carriers, and the lowest possible free market costs to individuals and families. Second, states may require a reasonable amount of time to adjust their regulations to accommodate these changes. This could be done concurrently and in consultation with healthcare plan insurance carriers planning to compete in their state. Carriers must also have adequate time to develop a variety of plans to meet the needs of the people of our county in each of the states they plan to serve. The time allowed must be set in the legislation eliminating employer healthcare plan insurance and Obamacare. Third, employers must be required to provide a net wage or salary increase equal the amount they pay for employee healthcare plan insurance coverage at the time of the conversion. The new total labor cost, including the healthcare plan adjustment, would remain a deductible cost of business. Once state regulators and carriers have approved the healthcare plan insurance available in each state, employee pay raises could be increased by a reasonable amount if individual and family plans are more expensive than the cost of previous employer plans.
Medicare, Medicaid, and VA healthcare are United States government provided entitlement healthcare programs covering about 30% of the US population. These programs can require participant premiums, copays, and deductibles. A significant proportion of the population currently receiving healthcare through these government programs should be transferred into the proposed individual and family healthcare plan insurance market place.
Many individuals currently enrolled in Medicare are already enrolled in Medicare Advantage Plans or Medicare Supplemental Insurance Plans involving private carriers. Healthy retirees usually participate in Medicare Parts A & B incurring no premium costs. Privatization of Medicare would eliminate the entire Medicare bureaucracy. After the Social Security Administration certifies individual qualification and level of coverage for eligible private healthcare plans insurance and the individual enrolls, the plan would be funded. State regulations would govern administration of these Medicare funded plans. Privatization of Medicare would further expand the national individual healthcare plan insurance free market, increase coverage options, increase competition, and reduce costs. Privatization of Medicare along with other changes currently under discussion should increase the probability that Medicare would remain solvent for future generations.
VA HEALTHCARE
Although, a significant number of veterans have individual or employer provided healthcare insurance and do not utilize Veterans Health Administration services, most veterans and all military retirees qualify for VA a healthcare plan. Some must pay modest co-pays for VA healthcare or prescriptions. To provide services, the system depends on annual discretionary congressional funding resulting in potential yearly changes in enrollment category requirements and top income enrollment thresholds. VA healthcare has eight eligibility and priority categories that determine access to the system. Preference is given to military retirees and veterans with service-connected disabilities, categories 1-3. Statutes require that Veterans Health Administration facilities treating privately insured veterans with no service-connected conditions are reimbursed for the services by the private carriers. Low income veterans and those experiencing financial setbacks can request hardship waivers for out of pocket VA costs. The lowest priority is given to wealthier veterans with no service-connected conditions or disabilities, category 8. The wealthiest veterans with incomes above a threshold level and no service-connected conditions or disabilities are not eligible for VA healthcare services. Therefore, each VA healthcare plan is means tested.
For military retirees, their spouses, eligible children, and eligible surviving family members, a variety of retiree healthcare benefits are available. Although military retirees can receive VA medical benefits and use VA facilities as space allows, retirees are advised that VA medical care has many limitations and eligibility requirements. VA medical care should not be their only source of healthcare. The most common source for military retiree medical benefits is TRICARE, a provider that covers retirees from all uniformed services. TRICARE and TRICARE for Life, for those over 65, allow use of a civilian healthcare plan. Retirees are also encouraged to obtain supplemental healthcare plan insurance for copays, deductibles, and dental needs which can be costly. Retirees are also encouraged to sign up for Medicare when they become eligible.
In my opinion, veterans receiving VA healthcare and military retirees with TRICARE lacking service-connected conditions or disabilities could be transferred into the proposed free market individual and family healthcare plan insurance system. To be fair to this unique group of citizens, the United States should ensure that their out of pocket costs would not increase. These costs could be offset by permanent insurance premium, copay, and deductible supplements or tax credits. Veterans and military retirees, who enlisted under the current system, should be able to choose between VA healthcare, TRICARE for retirees, and private healthcare insurance. Transfers should not be done without a guarantee that all commitments to veterans and military retirees would be fulfilled. These veterans and military retirees must also be eligible to return to the VA healthcare system or TRICARE when a newly manifested condition or disability is attributed to their military service.
Because of our Nation’s unique commitment to our veterans and military retirees, this proposed change in their healthcare should not occur until the proposed private individual and family healthcare insurance market is operating effectively and a full range of private coverage healthcare plan insurance is available. However, if this proposal were to be adopted, subsequent military enlistees must be advised that the new private individual and family healthcare plan insurance system would provide medical coverage for veterans and military retirees not incurring service-connected conditions or disabilities at the successful completion of their military service. Veterans and military retirees in this group incurring service-connected conditions or disabilities would receive medical care through the Veterans Health Administration. This change would further expand the national individual healthcare plan insurance free market, increase coverage options, increase competition, and reduce costs of both the individual market and veteran and military retiree medical costs.
WOUNDED WARRIOR HEALTHCARE
A “Forgotten American’s” wounded warrior healthcare plan.
Perhaps the most important advantage of this change would be to allow the Veterans Health Administration to concentrate on military retirees and veterans with service-connected conditions and disabilities, our wounded warriors. The savings from this change would be available for research, construction of more rehabilitation facilities, specialized therapists, and expanded post-traumatic stress syndrome and other mental illness diagnosis and treatment. The proposed change in veteran and military retiree medical care would result in significant reduction in patients served as well as the size and cost of the entire VA bureaucracy. Another advantages of the change would be related to applicant classification which would be reduced from eight eligibility and priority categories to three at most. This current, cumbersome and complex, classification system undoubtedly contributes to the long and often dangerous delays in processing veterans and retired military personnel into the VA medical system. Most of the current categories are not related to service connected medical issues which would be the primary mission of the newly organized Veterans Health Administration. The proposed changes in VA Healthcare might go a long way to finally provide our military retirees, veterans, and wounded warriors the medical care promised to them by We the People of the United States of America.
“FORGOTTEN AMERICAN” PLAN REQUIREMENTS
To complete the radical, comprehensive restructuring of the entire healthcare plan industry in the United States, three additional components of the system require change. First, the young and the healthy must contribute to the financial stability of the proposed individual and family healthcare insurance system without imposing a mandate. My suggestion is a “Healthcare Responsibility Act.” The idea is that every individual or family must be legally responsible for all of their healthcare plan costs either with their personal assets, appropriate healthcare insurance, or a combination of the two. This law would make every individual, family, or their estate legally liable for payment of their entire healthcare costs without litigation or bankruptcy relief requiring major asset liquidation and/or a lifetime payment plan to cover all of their healthcare costs. With such severe consequences, people would be far less likely to avoid securing adequate healthcare plan financing or insurance.
Secondly, providers must be legally required to publish the costs of prescriptions and their services for patients to compare with other providers. In addition, information regarding the quality of prescriptions, the care provided by each practitioner, hospital, and clinic must be easily available to the general public. This would also work to eliminate or reduce poor quality care, corrective procedures, and related litigation. This concept would result in open competition for healthcare services creating true free market competition among providers by allowing each individual or family to shop for providers based on the price and quality of healthcare services. This requirement would result in real provider patient based care and an overall reduction in the costs of healthcare plan insurance.
Thirdly, tort reform is essential to control healthcare costs. One of the most important reforms would be reasonable limitations for loss and punitive damages to control the costs of healthcare plan insurance. The sheer size of most of these settlements fuels the tort industry which often results in frivolous law suits and unnecessary legal fees that further increase all healthcare costs. Tort reform should also require the loser to pay all court costs. My experience as a former trucker is a perfect example of both these issues. After a heart attack, safety laws required an annual rather than biannual physical. At that time, laws specified that the physical include a $700 stress test, treadmill, but my cardiologist would not release me for work without a $3500 myocardial stress test. The difference, charged to my healthcare plan insurance, was necessary for my cardiologist to mitigate potential litigation if I was subsequently involved in a heart related traffic accident. Tort reform is essential to further decrease the cost of healthcare insurance.
Technology has drastically improved prescription efficacy, diagnostics, and available treatments. It has also caused costs to rise to the point that healthcare plan insurance is essential for patients to afford the benefits of these advancements. Government interference in healthcare as a protagonistic regulator, price fixer, and provider has virtually eliminated any vestige of free market healthcare insurance. The result is nearly uncontrolled increases the healthcare costs and resultant healthcare plan costs. The attempt to control costs without radical, comprehensive changes to the entire system will fail. In my opinion, the alternative being proposed would create what everyone claims to want, a free market, patient doctor oriented, healthcare plan insurance system where We the People control our healthcare.
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No true free market healthcare insurance market exists in the US today.
None of the existing or proposed healthcare plans are actually free market systems; and none of the healthcare insurance proposals are free market systems. Contrary to popular opinion, government is involved in employer paid healthcare plans both through regulation and through subsidies to both employers and employees. With Obamacare, government involvement in individual healthcare insurance became the law of the land. Medicare, Medicaid, and Veterans healthcare were already the law of the land. Currently, government controls every aspect of healthcare. Nothing remotely resembling a healthcare free market exists in the United State of America.
A brief history of insurance provides context for this discussion. Marine insurance covering ships and cargo, one of the first types of insurance, appeared in the early 13th century. Originally, groups of marine shippers cooperated to underwrite, or insure, the ship owners in the group. By 1712, a group of about 150 shippers met at Edward Lloyd’s Coffee House in London to underwrite the groups shipping efforts. The first fire insurance predates marine insurance by about 100 years. While the predecessors of life insurance were offered in 1588, it took about 100 years for the first life insurance company to start the industry. By the middle of the 19th century, life tables were the basis of premiums, life insurance was offered as an employment benefit by a few companies, and companies started selling individual policies available to all who could buy them.
Healthcare insurance started as a means for employers to cover the costs of on-the-job injuries to their employees by about 1875. In the United States, the first employer paid healthcare insurance was for Texas teachers. Initially, individuals established and funded prepaid hospital accounts to cover major healthcare costs negotiated for the teachers. By 1929 the idea evolved into the first Blue Cross plan. The healthcare insurance industry grew rapidly immediately before and during WWII when the National wage freeze was enacted. Employers were allowed to offer healthcare insurance as an employee benefit to attract and keep employees. The employers were allowed to deduct to cost of the programs as an expense, and the cost of the benefit was not added to employee taxable income. These tax benefits are a government healthcare insurance subsidy or entitlement. Both employers and employees continue to benefit from this government entitlement.
Before healthcare insurance was available to the majority of the U S population, healthcare was practiced in a basically free market environment. Patients negotiated the cost of care with the doctor providing care on a case by case basis. Hospital and clinic costs were established, but patients could negotiate costs and or payment plans when they were not able to pay the costs when treatment was completed. Patients could easily determine all the costs for the doctor care, medications, supplies, and hospital or clinic. Patients could also learn about the quality of care provided by their physician and the hospital or clinic they used. This is a simplified description of a true healthcare free market. Nothing like this has been the general healthcare experience in the United States for at least 100-150 years.
Establishment of a true free market patient based healthcare insurance system would require drastic changes. The first and most critical change would be to provide individuals and families complete control over the choice of their healthcare insurance plan. This would require elimination of employer provided healthcare insurance as part of employee benefit plans. Consequently, all healthcare insurance would consist of individual and family healthcare insurance plans. To accomplish this, legislation must require that employer contributions for employee healthcare costs be added to employee gross income at the start of the program. This change in the healthcare insurance system would be an important first step in establishing strong patient doctor healthcare relationships and patient centered healthcare.
The second, and equally critical change in our healthcare system, would be a means of ensuring that the young and healthy contribute to the financial stability of healthcare insurance pools without imposing œmandated healthcare insurance. One idea to accomplish this is “The Healthcare Responsibility Act.”The idea is that every individual or family would be responsible to ensure that they have the ability to pay for all of their healthcare costs either with their personal assets, appropriate insurance, or a combination of the two. Enactment of a healthcare responsibility law like this would make every individual, family, or their estate legally liable for payment of their entire healthcare costs without bankruptcy relief. With severe consequences like this, people would be far less likely to avoid securing adequate healthcare financing or insurance. Finally, the linked discussion of healthcare responsibility ends with this statement, Every good and effective economic plan should consider all the alternatives, including the wild and crazy idea that everybody should be financially responsible for their healthcare and the healthcare of their family.
A third requirement or change necessary to ensure viable free market healthcare insurance would be the requirement that each provider attract a group of young, healthy clients consistent with the proportion of these clients in the general population. This should ensure that insurance providers would have adequate financial stability to provide unlimited healthcare coverage for life. Under this concept pre-existing conditions would not be an issue since the individual and family carry their healthcare insurance for life. The same continued insurance provisions required for employer based coverage existing now would continue for people changing from plan to plan under the new individual based system. Pre-existing conditions would not be an issue. Under this concept each healthcare insurance provider would be required to provide a range of catastrophic healthcare insurance plans and healthcare saving and investment accounts for this critical group of clients. The saving and investment accounts should require a minimum balance in each savings account, a top rated bond account segment with a required minimum account principle, and allow an account for more aggressive investing. This idea would allow individuals to grow their personal healthcare savings account quickly to the required level. This group would also be eligible for traditional healthcare insurance plans.
The fourth change necessary to establish a truly free market healthcare system would be abolishment of pricing contracts between service providers and healthcare insurance providers. This change would allow each individual or family to shop for providers based on the price and quality of healthcare services. This change would also result in real provider patient based care. Providers would have to publish the costs of their services for patients to compare with other providers. In addition, information regarding the quality of care provided by each practitioner, hospital, and clinic would have to be easily available to the general public. This concept would result in open competition for healthcare services creating true free market competition among providers. The result would be an overall reduction in the costs of healthcare. Two healthcare segments currently operate with a system of this nature, Lasik and cosmetic surgery although they are not insurance financed.
Replacement of employer based healthcare insurance with individual and family system and required personal financial responsibility for the cost of personal healthcare are unlikely changes to the healthcare system in the United States. It is my opinion, however, that without these changes nothing resembling a true œfree market healthcare insurance system is possible. These changes would be rejected by those on the left seeking single payer government healthcare who would also consider the harshness of the proposed personal responsibility as extreme and heartless. The healthcare insurance industry, physician groups, and conglomerate owners of hospitals and clinics would also be opposed to these ideas. Fiscal conservatives and other capitalists would probably applaud these ideas.
On the other hand, these changes could be a catylist for creation of a true œfree market healthcare insurance system. Other suggestions by conservatives for creation of a œfree market system could follow quite logically. High risk healthcare insurance pools should be an option if catastrophic plans do not provide adequate overall financing. Allowing interstate healthcare insurance markets to exist would increase competition and reduce insurance costs and possibly preclude the need for individual healthcare insurance purchasing pools. Allowing localized individual purchasing pools or cooperatives could provide for greater purchasing power if interstate plans do not adequately reduce costs. Perhaps the best application for creating pools of individuals would be to increase the purchasing power of the groups for prescription medications. However, taking advantage of insurance provider’s experience to negotiate prescription medication prices for their clients would be appropriate due to the large number of prescription medications and producers.
Three additional groups of healthcare clients must be discussed in relation to a true œfree market healthcare insurance system. The first group is senior citizens like me covered by Medicare. In my opinion, we should be included in the individual and family healthcare system being proposed. To be viable, current Medicare participants should be guaranteed that their premiums, co-pays, and deductibles would not increase. Since this system would increase the number of participants paying premiums in the individual healthcare insurance pool, it should increase the funding of the pools. Although seniors have high rates of catastrophic and chronic health issues, around $500,000 in my case, most of my friends and associates are relatively healthy. The actual cost benefit analysis of including this group in the general pool rather than a high risk pool would determine the feasibility of this idea.
The second remaining group deserving special consideration regarding formation of the proposed individual healthcare insurance system is veterans who fall into three distinct groups. The first group is veterans like me who are eligible for veteran’s medical benefits but never registered with the Veterans Administration. In my case, I had employer provided healthcare insurance for most of my adult life until becoming eligible for Medicare. The second group of veterans worthy of consideration for the proposed individual and family healthcare insurance system is veterans not suffering from injuries, illnesses, or conditions directly related to military service currently receiving their healthcare through the Veterans Administration. Moving this group into the proposed individual system would reduce the burden on the Veterans Administration healthcare system and increase the number of participants in the proposed individual healthcare system adding to the financial strength of the system. As with Medicare, this change in veteran’s healthcare must ensure that veterans do not pay any costs that they do not pay under the current Veterans Administration system. This change would also increase funding and personal available to care for the third group of veterans. Veterans who have documented conditions related to their military service. This would allow the Veterans Administration to concentrate on veterans with significant injuries or conditions requiring specialized treatment and care unique to combat and military service. These veterans deserve the best specialized healthcare available in the United States.
The final group to consider is individuals and families who require financial assistance to secure healthcare insurance. Most of these individuals are currently uninsured or are in the Medicaid system and receive government subsidies that pay most or all or their healthcare costs. This group should also be part of the proposed individual healthcare insurance system. Their premiums, co-pays, and deductibles should be subsidized at the level of their financial need without any increases in their present costs. This group, in accordance with their ability, should be required to enroll in the healthcare system or be held accountable for the cost of their healthcare even though government pays most of their costs when enrolled. Including this group in the individual healthcare insurance would also increase the size of the overall insurance pool providing a stronger financial base which should reduce overall participant costs.
Currently, most insurance is licensed and regulated state by state. States should have the latitude to develop their healthcare insurance system in accordance with the overall health of their population, cost of living, and economy. However, the system developed by each state must be compatible with the minimum national healthcare system requirements. The proposed system must require state to state healthcare insurance portability including pre-existing condition coverage guarantees and adequate cost information for participants to make informed decisions regarding interstate moves or transfers. Given these considerations, most of the systems detailed development and administration should occur at the state level, and most of the national funding should also be distributed to the states. This would allow states to adapt their systems to the needs of the citizens of each state.
Realizing how audacious it is for a young geezer like me to suggest a complete overhaul of healthcare in the United States of America, this œfree market healthcare insurance proposal is made without apology. Major changes to one sixth of our economy, affecting all of our citizens should consider all the alternatives. This proposal is an alternative to the mess of government control currently offered in Washington DC.
We the People need Washington DC to fix the system. Just Geter Done Right.
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Employer contributions to employee healthcare costs constitute a de facto healthcare tax credit since they are not included as taxable income for employees. The proposed individual healthcare credits simply provide “equal protection (or benefit) of the laws” according to Section 1 of the 14th Amendment to the Constitution. Both are, in reality, subsidies or entitlements.
If the individual healthcare tax credit is an entitlement then employer healthcare contributions are entitlements.
Consequently, conservative constipation over healthcare tax credits for individual healthcare costs is hypocritical. Conservatives claim that the healthcare tax credits constitute a new entitlement. If the tax credits for individual healthcare costs constitute an entitlement, then not taxing employees for employer contributions to employee healthcare costs is also an entitlement. The issue is extremely important for the self-employed and small businesses that are too small to provide employer based healthcare insurance. Both of these groups are economically disadvantaged in comparison to those receiving employer healthcare benefits. Conservatives in both the US House of Representatives and the Senate should recognize this reality as a matter of simple fairness.
The healthcare tax credit for individual healthcare costs does not solve the healthcare issues caused by Obamacare or the issues of healthcare in the United States. This nation needs a healthcare system that effectively deals with the entire system that gives control of healthcare to patients and doctors not corporate executives and government bureaucrats.
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One reason that Republicans snatched defeat from the jaws of victory was that they chose the wrong slogan for elimination of Obamacare. The idea of replacement is framed by Democrats as replacing a failed monstrosity with a new replacement monstrosity. As with everything else, Democrats demand a single comprehensive healthcare plan. The Republican failure to have a united front on a clearly articulated Obamacare replacement plan provided fuel for Democrats and the media on both the left and right to oppose Obamacare repeal and replacement. Consequently, doubt and speculation rather than clarity prevailed. Going forward the question remains, “Will Republicans ‘snatch defeat from the jaws of victory?'” Can Republicans solve the nation’s healthcare issues?
We the People need Real Healthcare Solutions Now not Obamacare lite.
In my opinion, the Republican slogan concerning Obamacare should be Real Healthcare Solutions Now. This would place the important issues at the forefront. The slogan, “Real Healthcare Solutions Now, would provide emphasis for a campaign to verbalize exactly how healthcare should be improved and perfected both in relation to the pre-Obamacare healthcare environment and the healthcare failures caused by Obamacare. A monster bill or law covering all the ills of healthcare would be counterproductive and ineffective in solving all the pre-Obamacare and Obamacare caused issues.
Two critical issues that plagued healthcare before Obamacare are transparency within the medical profession in relation to quality and cost of healthcare and tort reform. Providing the people of the United States with high quality, economical healthcare would require that each of these issues be effectively addressed. First, the medical profession should be totally transparent or patients will never have control of their own healthcare. Patients should be able to easily determine and compare the quality and cost of care that they would get from every doctor, analytical procedures, and clinics and hospitals where they will receive care. CBS News reported that clinics, hospitals, and their emergency rooms utilize some specialists and practitioners, like anesthesiologists, that are out of network and not covered by the same insurance plan. The report noted that the patients were not informed about the situation and were billed for the entire cost. Such a situation should be illegal. If a hospital or clinic is covered by your insurance, all of the practitioners at the facility should be part of each plan. The cost and quality of prescription drugs should also be easily comparable for the general public. Unfortunately the medical profession has succeeded in getting state and federal laws that make this type of information difficult for the public to access so that they can ensure the quality and cost-effectiveness of care they receive.
Secondly, tort reform is essential to control healthcare costs. As a former big truck driver, I am a perfect example of this issue. After a fairly severe heart episode, safety laws required a physical annually rather than biannually. At that time, laws specified that the annual physical include a $700 stress test, treadmill. However, my cardiologist would not approve my physical without a $3,500 myocardial stress test where the law simply specifies a treadmill. The difference, charged to insurance, was necessary, from my cardiologist perspective, to mitigate potential litigation if I was subsequently involved in a heart related traffic accident. I also have two all metal artificial hips which, in a small minority of patients, can cause surrounding tissue damage and prosthetic replacement. The daily barrage of attorney advertisements seeking clients for litigation regarding medication side effects and in my case the artificial hip side effects demonstrate the great potential increase in costs associated with litigation. It is not difficult to imagine how much this tort environment increases the cost of healthcare. Healthcare laws should address these issues.
In my opinion, every individual and family in the United States of America should be legally responsible for payment of their healthcare costs. This could be accomplished by my proposal for “The Healthcare Responsibility Act.” Admittedly, it is a wild and crazy idea to think that everybody should be legally responsible for their healthcare and the healthcare of their family. Under this concept, there would be no healthcare insurance mandate; but individuals and families would secure healthcare insurance if they knew that they would be legally responsible for all their healthcare costs whether or not they were responsible enough to secure healthcare insurance and/or fund a healthcare savings account. To ensure their financial future, the young and healthy would secure state or federally defined legal minimum health insurance coverage. This concept would help insure that the insurance provider pools had adequate funding to cover those with pre-existing conditions and children under 26 years of age with their parents insurance.
As a young, 70 year old geezer, my pre-Obamacare healthcare experience was extensive. Before we lost her, my wife and I were never without family healthcare insurance which covered ACL replacements on each of our son’s knees, surgeries on both of my knees and two fingers, my initial heart care, and her cancer care which exceeded $250,000. Subsequently, in New Mexico, while attempting to start a ministry/business, my heart condition precluded private individual healthcare insurance. My premium through the New Mexico Health Insurance Alliance (NMHIA), a state run program for uninsurable entrepreneurs, was nearly $700 a month. Premiums were high because the pool was limited to uninsurable entrepreneurs with businesses in New Mexico, a rather small group. Monthly copays for three branded prescriptions totaled $120, and practitioner copays ranged from $10 to $40 per visit. In my opinion as a citizen, healthcare insurance was my responsibility. Both of my hip replacements, abdominal hernia repair, and prostate cancer surgery were covered under this Insurance totaling less than $1250 in copays. Without this insurance these procedures would have cost between $250,000-$500,000. NMHIA is an example of a state licensed healthcare insurance co-op or pool limited to an individual state resulting in very high premium costs unlike the suggestion for insurance co-operatives discussed below.
The best way to ensure high quality cost effective healthcare is an open, transparent, free market healthcare system. Establishment of the rules and regulations, as well as cost administration, should be a state by state responsibility because the population health status, cost of living, and business costs vary in each state. Suggestions abound to achieve this goal. In the individual and single family healthcare market, allowing healthcare insurance policy coverage without state by state restrictions and allowing every provider to sell policies in all 50 states, is one suggestion. To accomplish this option, the national government would need to mandate uniform regulations among all 50 states. In a mobile society like ours, this idea would also allow complete transportability between states. In addition, allowing individuals and single families to form interstate insurance co-operatives would allow these groups to compete more effectively in the insurance market place. The same rules should also apply to employer provided health insurance which would probably reduce employer costs for large multi-state corporations with high interstate employee transfer rates.
In my opinion, the solutions for our healthcare issues being proposed will never create a truly patient doctor centered free market healthcare system. Currently, each component of healthcare has different rules and regulations. Only a small portion of the total healthcare market was covered by Obamacare. The total healthcare segment of our economy includes employer based healthcare which is over 50% of the market, Veterans Administration healthcare, Medicare and Medicaid, and the uninsured. Each has it problems and patients do not control their care in any. Until problems of the whole system are addressed by a true free market solution , problems will continue.
A healthcare plan that includes the requirement for healthcare cost and quality transparency, tort reform, creation of interstate insurance purchasing power, insurance co-operatives, and legal requirement for individual and family responsibility for all the costs of their healthcare would provide significant steps toward providing healthcare that is patient based rather than more costly, ineffective government mandated healthcare plans. Passage of legislation covering each component of healthcare should result in a more perfect healthcare system than a single healthcare omnibus bill, an Obamacare like disaster. Republicans in Congress and the Trump Administration must quickly settle on a unified, patient centered healthcare plan, or they will snatch defeat from the jaws of victory.
We the People need
Real Healthcare Solutions Now.
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Healthcare is an individual responsibility not a Constitutional right. “The Healthcare Responsibility Act” would settle the the issue.
If I cannot buy fire insurance after my house burns down, why is it my right to buy healthcare insurance after surviving a heart attack? In my opinion, my healthcare is my responsibility. Free care is not my right! Every individual and family is responsible for their Health and the costs associated with that care, not the government. I am a lower middle class young geezer who always carried health insurance for my family. We did without to ensure we had health insurance which paid for at least $500,000-$750,000 in family care.
The fact that many healthy young people in the United States do not feel the need to have health insurance is one of the main problems regarding funding health insurance and care. Many people in this group choose to pay the relatively small fine rather than buy health insurance. The fine is well below the amount they would pay in premiums. As a result, programs are underfunded, insurance companies are unprofitable, and withdrawing from state insurance pools. Companies remaining in the pools are forced to increase premiums and/or deductibles and co-pays to remain profitable. The situation is untenable for the long term. It seems to me that this problem will remain regardless of the solution attempted next. People will not pay for something they think is unnecessary.
One possible solution could be called “The Healthcare Responsibility Act.” This proposed solution would make health a personal responsibility with severe legal, financial consequences for the irresponsible. Under this plan, financial responsibility for healthcare would be a legal responsibility for every individual and family in the United States; but purchase of health insurance would not be a legal requirement. The solution would provide a wide range of options for the young and healthy and those of all ages with severe health issues, like me. As an example, minimum, responsible health insurance for a young healthy person could be defined as catastrophic health insurance and a minimum health saving account to cover routine medical needs for 1 to 2 years. Each state should define responsible coverage levels based on their cost of living .
“The Healthcare Responsibility Act,” as envisioned, would be part of the legislation to repeal and replace The Affordable Care Act, Obamacare. “The Healthcare Responsibility Act” would have two components. The first component would be a federal law outlining the responsibilities of United States citizens and the consequences for failure to meet minimum responsibilities set by each state under the act. The national act could also include components such as guaranteed coverage for pre-existing conditions and covering family members up to the age of 26, although the act could result in economical coverage for younger citizens below age 26.
The second component of “The Healthcare Responsibility Act” would be to delegate responsibilities for the definition of “healthcare responsibility” to each of the 50 states based on their individual income levels and cost of living. Consequently, states would have the authority to define the minimum level of responsible health insurance coverage their citizens would be required to maintain, minimum health savings account amounts required, or a sufficient combination of the two. Each state would also define the minimum income level where individuals and families would be responsible for their healthcare costs. The threshold income levels would be based on overall state income levels, the number of people insured, available health insurance plan costs, and the cost of healthcare in each state.
This would be accomplished when each state determined the percentage of individual or family gross income paid for healthcare costs that constitutes an unacceptable financial burden. Individuals or families for which health insurance constitutes a state defined unacceptable burden could receive subsidies. Low income individuals or families could be eligible for Medicaid or a similar totally private program. At every level of income, individuals would be responsible to either enroll and contribute the applicable payments for the health insurance available and/or health savings accounts based on income.
Failure to be enrolled or purchase appropriate health insurance or maintain an adequate health savings account would be deemed irresponsible behavior. Under this law, this failure to maintain adequate healthcare financing would constitute a violation of the law. The individual or family would be fully responsible to pay all the healthcare costs for the care they received. They would not be allowed to use bankruptcy to avoid the repayment of costs even if they paid part of their gross income for the rest of their life. Additionally, their estate would be liable to its full extent for the repayment.
Everyone should be responsible to secure the means or subsidies to pay for their healthcare. “The Healthcare Responsibility Act” would mandate personal payment for healthcare costs.
“The Healthcare Responsibility Act”, as proposed, has extremely severe penalties for irresponsible healthcare behavior and actions. These consequences would also make it irresponsible for any individual not to secure minimal levels of health savings and insurance policies. Failure to act responsibly regarding health and all of the costs associated with care would place both individuals and their family’s future in financial jeopardy. In view of the consequences, it seems that no one with a sound mind would fail to act responsibly in relation to their own or their families’ healthcare. With virtually all of our nation’s population insured, the cost of caring for the previously uninsured would no longer increase the premiums for the insured. This should reduce costs for everyone. In my opinion, these benefits would also be a huge step forward in solving the problem of inadequate funding for health insurance corporations.
“The Healthcare Responsibility Act” is suggested as an alternative for solving part of our health insurance and health financing problem. Every good and effective economic plan should consider all the alternatives, including the wild and crazy idea that everybody should be responsible for their individual and family healthcare.
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