CONTENTS
EMPLOYER HEALTHCARE PLANS
OBAMACARE
THE “FORGOTTEN AMERICAN” PLAN
VA HEALTHCARE
WOUNDED WARRIOR HEALTHCARE
“FORGOTTEN AMERICAN” PLAN REQUIREMENTS
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
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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