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Health coverage in the USA seems to be an intractable problem. The fact that most folks (but whose numbers are steadily decreasing) get employer-provided coverage - an historical accident because of the wage caps in place during World War 2 - is the main stumbling block from the people seriously supporting the most obvious solution of Medicare-For-All. The main idea of the ACA was to in essence make an "employee" pool out of everyone not in employee pool (or government-provided coverage) so as to allow them to have the same type of insurance situation. However, because of the nihilistic Republicans and their infantilized base, an imperfect ACA was the result, with the main reasons for its current shortcomings being a weak mandate and the fact that the folks in employee pools are much healthier than those outside of it (i.e., only healthy folks are hired, and very sick folks quit because ... well, they're sick!)
So politically we are at the point at which folks DEMAND good, cheap coverage, but they still want the ability to not purchase coverage until they need it (because these folks are IDIOTS), and of course they want to be able to see the use the most expensive providers and take the latest & greatest Rx. Yes, and every woman wants to marry Prince Charming, and I want to have every woman who has ever appeared nude in Playboy Magazine in my bed ...
If folks' opinions are carefully analyzed, it can be deduced that *healthy* folks want to have the lowest-cost plans that don't cover much, and they want to be able to be good shoppers with their own money, and not support the bad shoppers who are not getting good deals - and that *sick* folks just want any kind of coverage they can get their hands on that they can afford. Of course, taxpayers in general don't want to pay too much, but hey, something's got to give ...
So here's my proposal:
[1] Have the ACA plans pared down to eliminate the stuff that conservatives are always ******ing about like birth control, non-medically-needed abortion, mental health, the latter of which just becomes completely socialized like public schools (i.e., folks can always spend their own money on better mental health care), but have the government subsidize the very lowest cost plans (i.e., the ones that are cost-conscious HMOs that are very similar to Medicare or Medicaid) so that the price is comparable to what the typical local large employer is paying for its employees for a similar plan. This takes away the issue that so many folks have that their ACA plans are more expensive than employee plans, as they are getting the same kind of deal that such employees get. Of course, this will make all higher-cost ACA plans skyrocket even more, but who cares? Yes, this is socialism, and there will definitely need to be subsidized, but the whole reason for the subsidy is because of the crybabies' demand that they not be subject to the mandate, but still have the ability to buy coverage when they get sick. The premium tax credit & cost-sharing subsidies remain intact. Also keep the teeth on the ability to buy coverage only at the yearly signup period.
[2] Let there be a plans outside of the ACA plans that any of the "Wild West" ideas that the conservatives can dream up, and allow folks to buy into them instead of the ACA plans to satisfy the mandate, or even just eliminate the mandate entirely. Have the regulation on these plans be pretty bare-bones, only guaranteeing that no junk insurance or other scams are being sold. Force some reasonable minimum level of payout of benefits in the same way that there is a minimum amount of auto liability coverage; this is politically palatable.
[3] Force providers to have transparent and equal (i.e., the same price no matter who the payor is, so no more "rack rate" & discount) pricing - but also have the government be the ultimate guarantor of uncompensated coverage - with the provider accepting the "Medicaid rate" for such guaranteed coverage, and without the provider having the ability to balance bill the patient - so that providers don't have to play the game of jacking up prices to make up for the uncompensated care. (The provision to limit the ability of a provider to balance bill stops the game of "I'm not in your plan so pay me the 'rack rate'" dead in its tracks.)
[4] Make uncompensated care debt subject to stronger collections, so that the folks have to think twice about going into a "Wild West" plan. Perhaps even make such debt similar to student debt, although not quite that stringent. The federal government would be the creditor as it would also be the ultimate guarantor.
[5] Allow folks that are now only offered the option of Medicaid the same options as everyone else (but that would include the comparable subsidies), and even offer such folks free cash to play with with the "Wild West" plans so that if they can eke out savings, they make money! (NOTE: Although I think this would be a bit foolish, it would be very politically palatable to the conservatives and major bargaining chip.) As for the regular Medicaid, I would have no problem with states having more control, and since such Medicaid folks would have the same options as everyone else, it really wouldn't matter if states with governors like Pence want to play workfare games. (The great irony in all this is that because the subsidies for the Medicaid-eligible folks would be so high with the regular ACA subsidies, Medicaid was used to control costs, but intelligent folks already realize that Medicare-For-All would be the best system.)
As for tort reform, I wouldn't have a problem with it so long as it doesn't screw anyone over because his physician damaged him. As for selling policies across state lines, if the states are allowed to continue to regulate coverage - which one would presume that the conservatives are in favor of because of states' rights - then this idea is a complete mirage as nothing prevents an insurer from setting up a subsidiary in any state; I would not be in favor of allowing the "race to the bottom" of states like Delaware or South Dakota having minimal regulations just to usurp the ability of states to regulate. I haven't touched on Rx reform, but that is an independent issue that should be addressed no matter what happens.
So that's what I have now. I probably have failed to address some issues, and of course responders here are welcome to add to this.
EDIT: I should add that the Public Option could be added to [1], especially for those markets in which there is not a well-established private-insurance HMO. (In my own market, there is such an HMO run by a major insurer, and it seems to be have been better run than the co-op, so I'm thinking that the Public Option is not a necessity for such a market.)
Health coverage in the USA seems to be an intractable problem. The fact that most folks (but whose numbers are steadily decreasing) get employer-provided coverage - an historical accident because of the wage caps in place during World War 2 - is the main stumbling block from the people seriously supporting the most obvious solution of Medicare-For-All. The main idea of the ACA was to in essence make an "employee" pool out of everyone not in employee pool (or government-provided coverage) so as to allow them to have the same type of insurance situation. However, because of the nihilistic Republicans and their infantilized base, an imperfect ACA was the result, with the main reasons for its current shortcomings being a weak mandate and the fact that the folks in employee pools are much healthier than those outside of it (i.e., only healthy folks are hired, and very sick folks quit because ... well, they're sick!)
So politically we are at the point at which folks DEMAND good, cheap coverage, but they still want the ability to not purchase coverage until they need it (because these folks are IDIOTS), and of course they want to be able to see the use the most expensive providers and take the latest & greatest Rx. Yes, and every woman wants to marry Prince Charming, and I want to have every woman who has ever appeared nude in Playboy Magazine in my bed ...
If folks' opinions are carefully analyzed, it can be deduced that *healthy* folks want to have the lowest-cost plans that don't cover much, and they want to be able to be good shoppers with their own money, and not support the bad shoppers who are not getting good deals - and that *sick* folks just want any kind of coverage they can get their hands on that they can afford. Of course, taxpayers in general don't want to pay too much, but hey, something's got to give ...
So here's my proposal:
[1] Have the ACA plans pared down to eliminate the stuff that conservatives are always ******ing about like birth control, non-medically-needed abortion, mental health, the latter of which just becomes completely socialized like public schools (i.e., folks can always spend their own money on better mental health care), but have the government subsidize the very lowest cost plans (i.e., the ones that are cost-conscious HMOs that are very similar to Medicare or Medicaid) so that the price is comparable to what the typical local large employer is paying for its employees for a similar plan. This takes away the issue that so many folks have that their ACA plans are more expensive than employee plans, as they are getting the same kind of deal that such employees get. Of course, this will make all higher-cost ACA plans skyrocket even more, but who cares? Yes, this is socialism, and there will definitely need to be subsidized, but the whole reason for the subsidy is because of the crybabies' demand that they not be subject to the mandate, but still have the ability to buy coverage when they get sick. The premium tax credit & cost-sharing subsidies remain intact. Also keep the teeth on the ability to buy coverage only at the yearly signup period.
[2] Let there be a plans outside of the ACA plans that any of the "Wild West" ideas that the conservatives can dream up, and allow folks to buy into them instead of the ACA plans to satisfy the mandate, or even just eliminate the mandate entirely. Have the regulation on these plans be pretty bare-bones, only guaranteeing that no junk insurance or other scams are being sold. Force some reasonable minimum level of payout of benefits in the same way that there is a minimum amount of auto liability coverage; this is politically palatable.
[3] Force providers to have transparent and equal (i.e., the same price no matter who the payor is, so no more "rack rate" & discount) pricing - but also have the government be the ultimate guarantor of uncompensated coverage - with the provider accepting the "Medicaid rate" for such guaranteed coverage, and without the provider having the ability to balance bill the patient - so that providers don't have to play the game of jacking up prices to make up for the uncompensated care. (The provision to limit the ability of a provider to balance bill stops the game of "I'm not in your plan so pay me the 'rack rate'" dead in its tracks.)
[4] Make uncompensated care debt subject to stronger collections, so that the folks have to think twice about going into a "Wild West" plan. Perhaps even make such debt similar to student debt, although not quite that stringent. The federal government would be the creditor as it would also be the ultimate guarantor.
[5] Allow folks that are now only offered the option of Medicaid the same options as everyone else (but that would include the comparable subsidies), and even offer such folks free cash to play with with the "Wild West" plans so that if they can eke out savings, they make money! (NOTE: Although I think this would be a bit foolish, it would be very politically palatable to the conservatives and major bargaining chip.) As for the regular Medicaid, I would have no problem with states having more control, and since such Medicaid folks would have the same options as everyone else, it really wouldn't matter if states with governors like Pence want to play workfare games. (The great irony in all this is that because the subsidies for the Medicaid-eligible folks would be so high with the regular ACA subsidies, Medicaid was used to control costs, but intelligent folks already realize that Medicare-For-All would be the best system.)
As for tort reform, I wouldn't have a problem with it so long as it doesn't screw anyone over because his physician damaged him. As for selling policies across state lines, if the states are allowed to continue to regulate coverage - which one would presume that the conservatives are in favor of because of states' rights - then this idea is a complete mirage as nothing prevents an insurer from setting up a subsidiary in any state; I would not be in favor of allowing the "race to the bottom" of states like Delaware or South Dakota having minimal regulations just to usurp the ability of states to regulate. I haven't touched on Rx reform, but that is an independent issue that should be addressed no matter what happens.
So that's what I have now. I probably have failed to address some issues, and of course responders here are welcome to add to this.
Let's keep things fair, shall we?
Eliminate insurance for anything that makes it easier for men to have sex too.
No insurance for vasectomies, no insurance for any type of treatment to alleviate erectile dysfunction.
Eliminate insurance for anything that makes it easier for men to have sex too.
No insurance for vasectomies, no insurance for any type of treatment to alleviate erectile dysfunction.
Yes, eliminating this would be fine too; anything that is of questionable medical need would be out. BTW, vasectomies have never been covered by ACA insurance.
I would like some discussion on the merits of this idea on the whole, not just minor sniping about what would be covered.
Oh, something else I would add is allowing folks more access to Rx without having to see a physician. Birth control & erectile dysfunction Rx would definitely fit this bill (although I could see emergency rooms filled with horny self-medicating men suffering from side-effects).
I don't know if this is in every state, but I find that if I get a Rx i don't actually get possession of it.
Instead the clinic has the patient nominate a particular pharmacy and they send the Rx there.
So the actual Rx is never in the patients hands.
Why?
It basically makes it impossible to shop around for better prices for prescriptions.
We can get rid of ACA, Medicare, Medicaid and any or all insurance and it is not going to fix the fundamental problem we have, which is cost.
We spent $3 trillion on healthcare in the US in 2015. That is money paid to service providers, not insurance costs. That comes out to $10,000 per person. If we had true insurance with no government subsidies, we would each pay at least $10k per year. A family of four would pay $40k per year.
The fact that most people do not pay that amount is because most healthcare is subsidized, paid for with tax money. So, basically we can eliminate ACA but the $3 trillion dollar bill is still there to be paid, and unless we give less care to those who cannot afford to pay for it, the cost of ACA premiums will just get shifted to more taxes. So we can pay for healthcare with taxes, or with premiums. Choose your poison.
We really need to lower that $3 trillion total if we want more affordable healthcare. Unfortunately that means more control over what we are charged. Republicans hate having the government control anything so that won't happen. So we will continue to pay that $3 trillion one way or another. Nothing is free.
Many of the OP proposals do not change the cost of healthcare, only who pays for it. It is rearranging deck chairs - no real change, it just looks different.
Yes, eliminating this would be fine too; anything that is of questionable medical need would be out. BTW, vasectomies have never been covered by ACA insurance.
I would like some discussion on the merits of this idea on the whole, not just minor sniping about what would be covered.
Yes they are and they have been covered by medical insurance for years and years and years, however, tubal's have not always been covered, nor have birth control pills, etc.
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