Tuesday, December 29, 2009

Build a Health Care Bill: Ideas Submitted by a Reader

The following health care reform ideas were forwarded to me by a reader:

The idea that we need reform in our health care system is not as controversial as the proposed health care measures that are before congress. I am on Medicare and buy a supplemental insurance policy. My Medicare payments for my wife and myself last year were $8400 and this year they are estimated to be more. The supplemental was over 6k and these costs did not count deductibles, co-pays and the amount charged by doctors. Additionally, 85% of my Medicare payments were taxed and since our income was over 125k, the tax amounted to about 30% for a whopping government payment of close to 11k.

The reform package that is so called revenue neutral would add somewhere between 20 and 30 million people to the public option. Let's grant that revenue neutrality is a fact for the moment and also agree that Medicare is going bankrupt in 8 years,. What prevents Medicare from going bankrupt? In elementary school all of us learned that adding 0 to a term which is going negative won't change the result.

A true reform could be written in 100 pages or less and would include the following:

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.
There are several other tenets of real reform should that I have included on my blog, Keeperofthefaith.wordp...

My plan has 9 bullets, costs the Gov. $60b over ten years. If the fraud and abuse savings the congress and the president claim possible in Medicare and the revenue neutral assertion really materialize, then the cost curve will truly bend by $340b over ten years. If not, then by definition the costs will be known and can at least be budgeted.

This plan in the end would address most of that which concerns us, makes the reform understandable to our citizens and removes it from the political agenda that furthers either party's power. Approaching this problem with a real desire to solve it rather than both logic that doesn't compute and legislation that even the most diligent among us either can't or won't understand should be an absolute requirement of our elected officials. If it turns out not to be, I say we should replace them all regardless of party, the training they had before they got elected, sex, race, religion or sexual orientation.

Comments or ways to improve the ideas presented are welcome. As are any other problems you think should be addressed by health insurance reform legislation.

Contribute your ideas as comments to this blog or in the Discussion Board of the Facebook Group "Build a Health Care Bill: We Can Do It Better Than Congress". Or, if you received this by email you can reply by email.

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Tuesday, December 22, 2009

Build a Health Care Bill: Problem 2 – Self-Employed Coverage – Part 1

Problem 2:
Self-employed people, and those working for companies that don’t provide health insurance, need the ability to join or create groups for the purpose of buying group health insurance.

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.

Additional ideas for solving this problem or ways to improve the ideas presented are welcome. As are any other problems you think should be addressed by health insurance reform legislation.

Contribute your ideas as comments to this blog or in the Discussion Board of the Facebook Group "Build a Health Care Bill: We Can Do It Better Than Congress". Or, if you received this by email you can reply by email.

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

Thursday, December 17, 2009

Build a Health Care Bill: Problem 1 – Coverage Between Jobs – Part 1

Problem 1:
In order to cover periods of temporary unemployment, enable people to buy inexpensive 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.

Additional ideas for solving this problem or ways to improve the ideas presented are welcome. As are any other problems you think should be addressed by health insurance reform legislation.

Contribute your ideas as comments to this blog or in the Discussion Board of the Facebook Group "Build a Health Care Bill: We Can Do It Better Than Congress". Or, if you received this by email you can reply by email.

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

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

Monday, December 14, 2009

Build a Health Care Bill: Problem 1 – Coverage Between Jobs – Part 1

Problem 1:
In order to cover periods of temporary unemployment, enable people to buy inexpensive 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.

Additional ideas for solving this problem or ways to improve the ideas presented are welcome. As are any other problems you think should be addressed by health insurance reform legislation.

Contribute your ideas as comments to this blog or in the Discussion Board of the Facebook Group "Build a Health Care Bill: We Can Do It Better Than Congress". Or, if you received this by email you can reply by email.

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

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

Tuesday, December 8, 2009

Build a Health Care Bill: Problem 4 – Childhood Pre-Existing Conditions – Part 1

Problem 4: Childhood Pre-Existing Conditions
If a child has a pre-existing condition that employer-based insurance has covered for years; 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.

Additional ideas for solving this problem or ways to improve the ideas presented are welcome. As are any other problems you think should be addressed by health insurance reform legislation.

Contribute your ideas as comments to this blog or in the Discussion Board of the Facebook Group "Build a Health Care Bill: We Can Do It Better Than Congress". Or, if you received this by email you can reply by email.

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

Tuesday, December 1, 2009

Build a Health Care Bill: Problem 6 – Rapidly Rising Costs

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

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.

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

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