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The Club takes on Healthcare - Free Market Style
creepycoug
Member Posts: 22,749
One rare area of common ground between the Centrist Bros and the left wing of @RaceBannon 's Populist Goon Squad is healthcare. We? have generally agreed that it's a BHL Tuff! issue and that is has not been resolved. We? are fearful of state-run health care and death committees; but we agree the current system leaves the vulnerable, vulnerable. It seems in the last years, it is an issue that has been pushed down the list of political priorities. Not discussed at all with the frequency it once was. Did it get resolved and nobody told me?
We? tried to solve this problem for the world in the Tug, but didn't get anywhere. The Club members have the intellectual chops and the even-keeled temperament to give this a go. The Club's wayward son, @UW_Doog_Bot , took a shot at this a couple of years ago. Here's his post. (Seriously), I thought this would be a good discussion for this forum.
https://hardcorehusky.com/discussion/comment/1087413#Comment_1087413
As promised if a bit late. Blame Facebook's ultra shitty search function and my laziness & apathy for convincing people of politics online in general.
Instead of an individual mandate (which is unconstitutional) Congress may pass a tax exemption for every dollar spent on healthcare directly (unlimited, no minimum) or insurance(with a cap) by Citizens. Remove the 10% of income minimum per item on medical expenses etc..
HSA's should be exempt from capital gains and contributions should be tax exempt from income tax. Regular income schedule/capital gains should apply if taken out for other expenditures.
As we already have "Universal Healthcare" although haphazardly and terribly planned through a mandate to treat and a combination of medicaid/unpaid medical bills etc. I actually propose keeping the pre-existing condition clauses of the ACA. I realize this will increase premiums for those of us without pre-existing conditions but it should reduce the amount of money paid to the government to then pay for medicaid expenses and/or help drive down costs for unpaid bills. I also think the concept actually impedes a free market by locking individuals into their current healthcare provider thus not allowing for competition.
One size fits all policies would be eliminated. All young and healthy people should be able to purchase cheap high deductible catastrophic insurance if that's all they want to purchase. Overall, that would bring in more people into the "universal" net and reduce one of our major failures which is catastrophic bills having to be paid by the state or the hospital. This would reduce costs to the rest of us paying normal premiums.
Caps on donations to charities serving high risk pools should be reduced(think St Jude's Children's Hospital) and I actually view federal funding of research hospitals as a good thing as well as prize funds for cures/breakthroughs in research. Pure research(where you might not know what you will get) is a place where the market forces aren't necessarily great without patent or other government protection. We should also stop letting the rest of the world bully our pharma industries as we are essentially subsidizing all medical pharma research for all the "socialized" medical programs of the world. I'd probably also be fine with rolling high risk pools into medicaid but putting them on a voucher system so that they can purchase their own medical care in an open market with competition.
Open up competition across state borders for Health Insurance to help manage costs through competition. Create some standardized rules/best practices around administration etc. through use of the interstate commerce clause. We already do this in plenty of industries. Think DOT or clean air act, mandates are federal, rules are made and enforced at a state level within the guidelines of those federal mandates.
Is this ideal? Fuck no. Would it be an improvement over the current system? I think so. It's full of compromise, doesn't really touch medicaid or medicare, and is *maybe* politically feasible. Probably not in today's hyper-partisan atmosphere though.
Disagree with something? Great! That's what I've got so far. It's a working draft. I'm happy to take feedback and improve it with your help. Policy wonks welcome.
We? tried to solve this problem for the world in the Tug, but didn't get anywhere. The Club members have the intellectual chops and the even-keeled temperament to give this a go. The Club's wayward son, @UW_Doog_Bot , took a shot at this a couple of years ago. Here's his post. (Seriously), I thought this would be a good discussion for this forum.
https://hardcorehusky.com/discussion/comment/1087413#Comment_1087413
As promised if a bit late. Blame Facebook's ultra shitty search function and my laziness & apathy for convincing people of politics online in general.
Instead of an individual mandate (which is unconstitutional) Congress may pass a tax exemption for every dollar spent on healthcare directly (unlimited, no minimum) or insurance(with a cap) by Citizens. Remove the 10% of income minimum per item on medical expenses etc..
HSA's should be exempt from capital gains and contributions should be tax exempt from income tax. Regular income schedule/capital gains should apply if taken out for other expenditures.
As we already have "Universal Healthcare" although haphazardly and terribly planned through a mandate to treat and a combination of medicaid/unpaid medical bills etc. I actually propose keeping the pre-existing condition clauses of the ACA. I realize this will increase premiums for those of us without pre-existing conditions but it should reduce the amount of money paid to the government to then pay for medicaid expenses and/or help drive down costs for unpaid bills. I also think the concept actually impedes a free market by locking individuals into their current healthcare provider thus not allowing for competition.
One size fits all policies would be eliminated. All young and healthy people should be able to purchase cheap high deductible catastrophic insurance if that's all they want to purchase. Overall, that would bring in more people into the "universal" net and reduce one of our major failures which is catastrophic bills having to be paid by the state or the hospital. This would reduce costs to the rest of us paying normal premiums.
Caps on donations to charities serving high risk pools should be reduced(think St Jude's Children's Hospital) and I actually view federal funding of research hospitals as a good thing as well as prize funds for cures/breakthroughs in research. Pure research(where you might not know what you will get) is a place where the market forces aren't necessarily great without patent or other government protection. We should also stop letting the rest of the world bully our pharma industries as we are essentially subsidizing all medical pharma research for all the "socialized" medical programs of the world. I'd probably also be fine with rolling high risk pools into medicaid but putting them on a voucher system so that they can purchase their own medical care in an open market with competition.
Open up competition across state borders for Health Insurance to help manage costs through competition. Create some standardized rules/best practices around administration etc. through use of the interstate commerce clause. We already do this in plenty of industries. Think DOT or clean air act, mandates are federal, rules are made and enforced at a state level within the guidelines of those federal mandates.
Is this ideal? Fuck no. Would it be an improvement over the current system? I think so. It's full of compromise, doesn't really touch medicaid or medicare, and is *maybe* politically feasible. Probably not in today's hyper-partisan atmosphere though.
Disagree with something? Great! That's what I've got so far. It's a working draft. I'm happy to take feedback and improve it with your help. Policy wonks welcome.
Comments
Come on!
@MikeSeaver
@HoustonHusky and the other economis bros will jump in. I'm sure of it!
Where da fuck is @UW_Doog_Bot anyway? @DerekJohnson said he'd be along momentarily. That was 3 mos. ago.
I think it's difficult to discuss this because so many people refuse to even entertain the idea that the U.S. healthcare system isn't the gold standard in the world. All they hear is how we get the best care in the world, so changing the system would result in a lower standard of care. I don't understand how anybody could look at the data and come to that conclusion, though:
I've really liked this graph since I saw it in 2011, as it really puts things in perspective, comparing per-capita spending, results (in the form of life expectancy at birth), and number of doctor visits per year. So cost, quantity, quality all on one graph:
Not exactly crushing it in infant mortality, either:
I don't think US health insurance or health delivery is gold standard regardless of other nations which IMHO are irrelevant to this anyway. The US is a big old melting pot of a lot of different people including a lot who left those other countries
I would like a better insurance and delivery system. I would like to keep the standard of care which again IMHO is pretty darn good if you can get it
I think the last attempt got us or me for sure, further from that goal.
I'll take my answer off the air
Anyway, Churchill's Foreign Sec'y, Anthony Eden, is in the US meeting with someone, and he's having severe pancreas issues and needs surgery. Wants to do it in Boston because it's the best place in the word for that surgery. But not because of capitalism. He says to Churchill, he says, "because of the high fat diet in the US"; so we're good at fixing things caused by being like @CFetters_Nacho_Lover and @CfettersNachoLover . According to the pasty Brits.
So, I wonder, but don't necessarily know or believe, if we're good at some things and other countries are good at other things. Are we good at some medical technology because of the nature of our demographics and not because of the system? IDK. Maybe it doesn't matter.
Anyway, thought I'd throw some causation analysis in for fun.
Dirty secret over there is that there is a 2-tier system...there is a base (pretty crappy) care everyone gets and then there is a private/premium option which is much better and all the affluent folks buy into. And with that he still has flown over to the US a few times and paid cash for things he and his kids have needed...even the premium care had its limitations. A good example for the "premium" health car in Holland is that he had to argue tooth and nail for them to give his wife an epidural when they were having their 2nd kid as the hospital didn't do that because of cost. Always like bringing that example up when a mom tells me how much better health care is over in Europe.
A version of that is probably a better system, but don't think it would/could ever happen as no one would accept the baseline govt coverage and all of its limitations.
FDR really screwed up when he tied health care to work (part of wage controls way back when)...messed with a lot of things but not sure how it will get undone without a big crash/financial reset.
There's a lot of other waste in the pharmacy/PBM/drug space that could be fixed, but the above is the lowest hanging of fruit.
I am going to skirt dangerously to Tug talk here, but the fact that the US is not only footing the in pharma but in things like biomedical devices is definitely problematic. We might not have the best standard of care, but we’re still the best in scientific/medical research. That research ain’t cheap and the cost has to be passed on to somebody.
That’s why when people start comparing the US healthcare system to other countries, I get a little upset. There are some very unique problems that the US has to deal with that other countries do not. It’s fine to look to these places for ideas, but trying to replicate Canada or anyone else probably won’t work.
The royal family apparently eschews garlic. Literally forbidden in the Buckingham palace kitchen. Hey Britty, try it sometime. It might make your disgusting food taste a bit better.
Anyway, I digress.