Tuesday, November 24, 2009

Build a Health Care Bill: Problem 5 – Doctor Shortage

What problems do you think should be solved by a health care reform bill?

Problem 5:
According to Joseph Stubbs, president of the American College of Physicians, there is already a serious shortage of primary care physicians and some parts of the country are currently experiencing the effects of the doctor shortage.

The capacity of the health care system must be expanded. The alternative is rationing or even higher prices.

If you have health care pet peeves write them in the comments section.

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Tuesday, November 17, 2009

Build a Health Care Bill: Problem 4

What problems do you think should be solved by a health care reform bill?

Problem 4:
Bill Roy offered the problem below thru the Facebook Group, "Build a Health Care Bill: We Can Do It Better Than Congress".

"Of future concern to me, a child has a pre-existing condition that employer-based insurance has covered for years. Someday, when that young person graduates from college, with or without a job, will they be able to get insurance coverage?"

If you have health care pet peeves write them in the comments section.

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Build a Health Care Bill: Problem 3

What problems do you think should be solved by a health care reform bill?

Problem 3:
Another problem with health insurance that I’ve experience indirectly is the cost of coverage for low income young adults without access to employer-based health insurance.

When my children reached majority they were no longer eligible for coverage under my employer-based health insurance. But my children’s incomes could not support individual insurance coverage and their employers did not offer health insurance.

So, another problem I want to address is the availability of very basic health insurance with costs low enough so that young working adults, ineligible for Medicaid, will be able to afford the monthly premiums.

If you have health care pet peeves write them in the comments section.

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Sunday, November 15, 2009

Featured Posts

Featured Posts on a Variety of Topics:

Any of Us Would be Angry
Cry Racism!
David & Bathsheba - Obama & the Nobel
Dogwood Blossoms
I Love My Wife
Inflation is Coming
Mm, mmm, mm! Barack Hussein Obama
Poem: In Flanders Fields
Sarah Palin: Preparing for Battle
Tea Parties
The Land of the Free & the Home of the Brave
Too Big to Fail
Torturous Caterpillars

Build a Health Care Bill: Problem 2

What problems do you think should be solved by a health care reform bill?

Problem 2:
Another health insurance issue I've personally experienced is getting coverage for my family when I was self-employed from 1994 thru 1998. Because I was not a member of any qualified group I was ineligible for group health insurance. Individual policies were extraordinarily expensive – but I finally found one with a $2,000 family deductible that I could afford.

So, another problem I want to address is the ability to join or create groups for the purpose of underwriting group health insurance. Current law, I think in all 50 states, prohibits the creation of groups for the purpose of underwriting health insurance. I’d like to see that restriction relaxed.

Do you have a health care pet peeve?

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Link to the "Build a Health Care Bill" Idea Log

Build a Health Care Bill: Problem 1 - Coverage Between Jobs

What problems do you think should be solved by a health care reform bill?

Problem 1:
Employer provided health insurance has been very good - but I’ve been between jobs a couple of times and risked having no insurance for my family because COBRA insurance was prohibitively expensive.

So, one problem I want to address is to enable people to buy temporary group health insurance focused on catastrophic health events. It wouldn't need to cover office calls, vision, dental, psychiatric, or a lot of other things typical benefit packages cover.

Do you have a health care pet peeve?

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Link to the "Build a Health Care Bill" Idea Log

Wednesday, November 11, 2009

In Flanders Fields

In Flanders fields the poppies blow

Between the crosses, row on row,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below.

We are the dead. Short days ago

We lived, felt dawn, saw sunset glow,

Loved, and were loved, and now we lie

In Flanders fields.

Take up our quarrel with the foe:

To you from failing hands we throw

The torch; be yours to hold it high.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields.

- Lt.-Col. John McCrae (1872 - 1918)

Link to Featured Posts

Friday, November 6, 2009

Build a Health Care Bill: Idea Log

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What problems do you think should be solved by a health care reform bill?

Problem 1:
In my personal experience, employer provided health insurance has been very good - but I’ve been between jobs a couple of times and risked having no insurance for my family because COBRA insurance was prohibitively expensive.

So, one problem I want to address is to enable people to buy temporary group health insurance focused on catastrophic health events. It wouldn't need to cover office calls, vision, dental, psychiatric, or a lot of other things typical benefit packages cover.

Solution Ideas:
Background
There are some legal obstacles to allowing the unemployed to buy group health insurance focused on catastrophic health events. One obstacle is the prohibition from forming groups for the purpose of buying health insurance. This prohibition exists in most states and may exist in all 50 states.

Another obstacle is coverage requirements enforced by state insurance regulators. The coverage requirements differ from state to state but in all cases they require coverage of health care that exceeds the definition of a “catastrophic health event”. In all cases they unnecessarily increase the cost of insurance and push people into making the choice to forego health insurance during periods of unemployment.

Idea #1.
State Employment Agencies could create insurance groups and negotiate group catastrophic health insurance policies with private insurance companies. They could then enroll the unemployed in their group health insurance plan at the same time they sign up for unemployment benefits.

Idea #2.
Modify COBRA to allow a former employee to downgrade the coverage to “catastrophic health events” only.

Idea #3.
Enact incentives for organizations to offer health insurance options, especially catastrophic event health insurance to members.

Idea #4.
Enact a Federal exception to state insurance regulation to allow temporary catastrophic event health insurance that does not contain the mandatory coverage required by the various states.

Idea #5.
Enact incentives for the states to enact exceptions to their own insurance regulations to allow temporary catastrophic event health insurance that does not contain their mandatory coverage’s.

Problem 2:
Another health insurance issue I've personally experienced is getting coverage for my family when I was self-employed from 1994 thru 1998. Because I was not a member of any qualified group I was ineligible for group health insurance. Individual policies were extraordinarily expensive – but I finally found one with a $2,000 family deductible that I could afford.

So, another problem I want to address is the ability to join or create groups for the purpose of underwriting group health insurance. Current law, I think in all 50 states, prohibits the creation of groups for the purpose of underwriting health insurance. I’d like to see that restriction relaxed.

Solution Ideas:
Background
Current law, I think in all 50 states, prohibits the creation of groups for the purpose of underwriting health insurance. And, individual insurance is inherently more expensive than group insurance.

Idea #1.
State Employment Agencies could create insurance groups and negotiate group health insurance policies with private insurance companies. They could then enroll the self-employed and those not covered by employer sponsored group insurance in a State Employment Agency group health insurance plan upon a declaration that they do not have employer sponsored insurance.

Idea #2.
Create incentives for organizations to form insurance groups and offer health insurance to members.

Idea #3.
Create incentives for the states to enact exceptions to their own insurance regulations; exceptions that allow people who are not members of an insurance group to form health insurance groups so they can become eligible for group health insurance.

Problem 3:
Another problem with health insurance that I’ve experience indirectly is the cost of coverage for low income young adults without access to employer-based health insurance.

When my children reached majority they were no longer eligible for coverage under my employer-based health insurance. But my children’s incomes could not support individual insurance coverage and their employers did not offer health insurance.

So, another problem I want to address is the availability of very basic health insurance with costs low enough so that young working adults, ineligible for Medicaid, will be able to afford the monthly premiums.

Problem 4:
Bill Roy offered the problem below thru the Facebook Group, "Build a Health Care Bill: We Can Do It Better Than Congress".

"Of future concern to me, a child has a pre-existing condition that employer-based insurance has covered for years. Someday, when that young person graduates from college, with or without a job, will they be able to get insurance coverage?"

Solution Ideas:
Idea #1.
The first thing that comes to mind when thinking about this problem is the mandate currently proposed by Congress that would require insurance companies to write policies regardless of pre-existing conditions. This was tried by Massachusetts’ state run health insurance system and it contains a huge moral hazard problem.

Healthy people could, did, and still do, go without health insurance in Massachusetts secure in the knowledge that when they become ill or injured they can buy insurance after the fact that will pick up the tab for their health expenses commencing immediately upon signing the contract – even if they’re hospitalized at the time of signing. This, of course, is a recipe for financial disaster for any insurance system. It’s also the reason proposed legislation contains a mandate that everyone must have health insurance – a mandate with tax penalties to be enforced by the Internal Revenue Service and backed up by jail time tax in the event of non-compliance.

Idea #2.
Another possibility is to allow the young adult to indefinitely piggy-back on the parent’s health insurance. This would postpone the problem but in most cases the time will come when the parent’s health insurance is terminated and the adult child will face the original situation.

Idea #3.
Allowing the child to spin off an individual health insurance policy from the parents insurance company without pre-existing condition limitations could also work. However, this option runs into the portability and individual policy cost problems. Still, if the portability and individual policy cost problems are also solved the spin off policy idea might be viable.

Problem 5:
According to Joseph Stubbs, president of the American College of Physicians, there is already a serious shortage of primary care physicians and some parts of the country are currently experiencing the effects of the doctor shortage.

The capacity of the health care system must be expanded. The alternative is rationing or even higher prices.

Problem 6:
Pretty much everyone has experienced the ever rising cost of health insurance premiums. Most employers increase employee co-pays and deductibles every year by amounts that exceed the annual inflation rate. This year Medicare premiums will increase even though inflation has been negative.

Some of the increases in health care costs come from new procedures and drugs curing and controlling illnesses and injuries that were untreatable just a few years ago. Some of the increase is due to violence and drug abuse and some from our increased longevity. Some portion of the cost increases are related to the growing number of medical malpractice lawsuits and their ever increasing punitive judgments. And some portion comes from state legislatures and insurance regulators requiring that health insurance cover non-traditional conditions.

There are other sources of health care cost increases. To identify each one and develop mitigation strategies without limiting improvements in medicine or medical care to individuals – that is the problem.

Other Ideas:
a] A clinic system for the poor [25k/yr or less income] to which they would pay $100/yr. The Gov. would initialize this system with $10b.

b] A risk pool for catastrophic illness to which all could belong for $250/yr/family and to which insurance companies would contribute 0.5 % of gross profit/ yr. The government would budget $5b/ yr to this pool and it would be independently held by a coop that would make investments that were risk constrained, but not government bonds.

c] Businesses would underwrite tax free amounts up to $6k/yr to each employee for health insurance which would be a business expense. Any amount above this would be taxable.

d] The small business association would be allowed to purchase insurance across state lines similar to AARP.

e] Mal- practice awards would be limited to $250k plus medical expenses. Any doctor found to be guilty of malpractice 2 times in 3 years would have to go back to school for a year and be re-certified before continuing to practice. Lawyers' fees bringing such suits would be limited to 20% of award and if the suit was judged to be frivolous would have to pay the legal fees and court costs for both parties. These suits would be decided by a three person panel consisting of a judge, a lawyer appointed by the ABA and a doctor appointed by the AMA or the association to which the doctor being sued belongs. All decisions would be final.

If you have health care pet peeves write them in the comments section.

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Build a Health Care Bill

This is a Content Index of our Health Care Reform Proposal:

We Can Do It Better
Idea Log
Problem 1: Coverage Between Jobs
Problem 1: Coverage Between Jobs - Part 1
Problem 2: Self-Employed Coverage
Problem 2: Self Employed Coverage - Part 1
Problem 3: Low Income Young Adults
Problem 4: Childhood Pre-Existing Conditions
Problem 4: Childhood Pre-Existing Conditions - Part 1
Problem 5: Doctor Shortage
Problem 6: Rapidly Rising Costs
Ideas Submitted by a Reader - 12/29/09

Link to Health Care Articles on the Web

Tuesday, November 3, 2009

Build a Health Care Bill: We Can Do It Better Than Congress

Congress has made a hash of health care reform. Taxes, mandates, government run options, Medicare cuts, delayed start up and many other consistent “features” of the various bills proposed in the House of Representatives and in the Senate run counter to the will of the majority of the people.

I propose that we can do better. I mean you and me and everyone who reads these words - us.

What about our current health insurance systems and structures concern you? What do you think are the most important changes we should make?

I believe we can have the non-partisan conversation and debate that would have taken place in Washington if there were real representatives of the people in Congress. Unfortunately, we have power-hungry political hacks infesting Congress. Unfortunately, we can expect only more of the same insanity.

But, if we have an open discussion of what we have and what we want, we can develop a real health insurance reform that will work for America.

Let’s start by determining what issues to tackle. Tell me what you think are the important health reform topics.

Return to the "Build a Health Care Bill" Content Index

Special Report: Universal Health Care