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A Free Market(ish) Approach to fixing Healthcare
UW_Doog_Bot
Member, Swaye's Wigwam Posts: 14,188
in Tug Tavern
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.
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
In before HFS.
I dig the compromise. Keep the pre-existing condition protection and further incentivize smart health finances like HSAs (though inevitably a chunk of people will fail to utilize this, it'll still have a material impact on cutting costs). The state "competition" idea should be a political no-brainer, I honestly have no idea why that's not brought up more. The easiest way to slash costs quickly would be to implement a system where you don't need 50 different entities of the same insurance company. No shit you have admin bloat when you have different rules and pricing structures every time you cross state lines.
Anywise, I'd 100% get behind this kind of system. Obviously it's far from a cure-all, but it's the kind of incremental progress that good legislation needs to look like.
What is the stat? Something like 75% of medical cost incurred in the last three weeks of life....that’s just fucking stupid to pump that kind of jack into keeping granny around for another couple days. Actuarially, somebody is covering those costs and it sure as fuck isn’t the old dead people - it gets passed on to the rest of the insurable pool.
We didn't and she spent 6 years in memory care. She had that covered with her investments but I'm sure her medical insurance took plenty of hits.
We need better end of life management. I actually feel bad that we didn't do it
She may have lost her memory but she was pissed. Wouldn't talk to me
Something to look forward to for you kids
https://issuesinsights.com/2019/06/19/trump-just-revolutionized-health-care-and-nobody-noticed/
What's the incentive for someone to not spend as much money as possible in their last few weeks of their life now? It's not coming out of their pocket.
Keep insurance companies, allow them to compete in all states AND instead of just mandating a minimum reserve, also mandate a maximum reserve. Many insurance companies have reserves that are 2 to 3 times what there worst case projected payouts would be for a year. If the insurance company is above those reserves then they would need to rebate their insureds. Doing those two things would decrease premiums noticeably.
Also, make long term care available at a young age and create incentives for young people to get it by discounting the traditional insurance premiums if they do. If you have young people paying into a pool for 40-50 years before they die, this will help alleviate the hospitals and providers getting stuck with the bill when people pass. It would be a lot like Life Insurance, the younger you are when you get it, the cheaper it is.
As for hospitals, doctors and surgeons. Let's get those costs in line by putting cost caps on certain necessary procedures and also get put some serious caps on the cost of meds. ( that's a whole different animal of course) Let's also get some competition for the mal practice insurance that providers need to carry so that they can still make a decent living while charging lower prices for their services.
Now if you knew you could use that money to extend your life for a few weeks at the end of your life or leave to your kids or wife what would you choose?
How many people would save even more than that if every dollar you put in up to a certain dollar amount was pre-tax money? You need to give people incentives to curb their medical care expenses and right now there are none.
Ex. Cost caps sound great from a consumer's first view except that they will simply create a shortage of supply by reducing the number of providers. Long term net loss.
Now, let's not talk about my "quality" of health care...
edit: Sorry about your second cousin @PurpleBaze but he really shouldn't have been in that Toyota
Also you think that forcing providers, whom already have their patients held hostage due to in network requirements, to charge a fair market rate would somehow send providers fleeing to learn how to code?
Chinteresting.