OK Folks Here is Our Chance to Be Heard. Lets Help Trump

[TMiller]

Here's my two cents. First, remember Medicare has Part A and Part B. Part A is the hospital charges. Part B is the doctor, surgeon, anesthesiologist, radiologist, outpatient surgeries, etc.

I think Part A should be for all ages and here's why. 1) Hospital Emergency Rooms are required to accept any patient regardless of ability to pay. This means homeless, low income, undocumented aliens, visitors from other countries, etc, must be admitted if a life threatening condition. Most of these people won't pay anyways and is absorbed through taxes that we all pay. 2) Being admitted to a hospital means a serious issue has happened. Automobile accident, heart attack, stroke, something serious has happened. Part A only covers medically necessary procedures. 3) Removing the hospital costs from insurance policies will make insurance more affordable. 4) Young working people under age 65 are paying for older retired people over age 65 (through payroll taxes), so why can't they get a piece of the pie they are paying for. Increase their cost a little (younger people cost less than older people) and let them benefit.

I think Part B should be individual's choice for all ages, whether to go through government benefits or the private market. If an individual does not purchase private insurance, they will automatically be enrolled in Part B, and if they cannot afford to pay for their Part B, a government loan is created under their social security number with mandatory wage garnishment up to 10% of their pay (similar handling as child support). Newborns without insurance are automatically enrolled at birth unless their parents purchase private insurance. Two rates, under age 18 and over age 18. Those age 18-65 will pay the same premiums as over age 65, one premium, one risk-pool, pre-existing covered. Over age 65 may choose private market (more doctor participation) or government as well. All charges for Part B will be balanced out at tax time on income tax returns. The private market should allow us to purchase as high of a deductible as we want, co-insurance we want, stop-loss protection we want, only have the bells and whistles that we want to pay for, have "network" or "non-network" (more expensive) policies that allow us to pay for what we need, and underwriters can charge a premium that correctly reflects the risk. Doctors and surgeons are individual business people and free market will determine who prospers or who goes out of business.

I think drug benefits should be eliminated from health insurance policies. There is an abundance of stand-alone drug insurance and discount programs like goodrx.com. When I have checked goodrx.com, the prices are very similar to insurance prices (and goodrx.com is free).

All individual health insurance premiums should be tax deductible, regardless of filing status. Group policyholders already get tax free health insurance premiums paid by their employers. Composite rating should be eliminated, all should be age/risk rated and included in one risk pool with individual policyholders of the same policy type. An employer may choose whether or not to offer health benefits, regardless of size.

National offerings, no state filings. Allow individuals who move state-to-state to keep their private coverage, even if premiums may be adjusted to reflect cost of care in the region.

Full cost disclosure before medical procedures are performed.

That's my two cents.

 

[somarco]

works perfectly fine for many dental and vision plans. I love my reimbursement dental plan. With the proper regulatory structure

Several things wrong with that red herring.

Most dentists will bill your dental carrier but only 15% or so are in network. That number is even lower in rural areas.

Non-par dentist can and will bill anything they want above the carrier allowance. No protection against OOP.

Swapping one regulatory oversight for another is a wonderful idea. (Insert sarcasm emoji here).

Back to health insurance, remove the network the actual cost of care to the consumer will skyrocket.

Unless of course you have govt oversight. That's what we need. More and bigger govt telling business owners what they can and cannot charge.

Your comments on regulatory issues associated with group are all valid. But think about the tax angle.

I make $100 per week with group insurance. My take home is $70 because my employer pays the full cost of my health insurance.

Employer pays another $50 for my health insurance which is not taxed. No withholding, no FICA, no FUTA, no SUTA, no WC levy.

The $50 my employer pays comes right off his income.

Eliminate group insurance and employer gives me $50/week raise. After taxes I realize $35. Employer cost is $50 + another $8 or so in taxes and WC insurance.

Ignore Ocare for now. What will I do with my $35 raise? Buy health insurance?

No.

I need a new bass boat.

My wife has worked with low income children and adults for close to 40 years. Certain segments of the population see more children as not only additional income but a badge of pride.

Most don't want birth control. Won't use it. Don't know how to use it. Forget to take their pill.

Women that have received implanted birth control have literally cut it out so they could get pregnant.

Wife now works in the school system with kids who are mostly in foster homes. Most of them qualify for what is affectionately called by foster parents as the crazy check.

Many of these kids are (understandably) psychologically damaged goods because of the physical and mental abuse they suffered. Some were crack babies.

The welfare system is terribly broken. The war on poverty failed. We have more people on the govt teat now than ever before and most will never get off. The plantation of the old south has been replaced with the govt plantation.

They go to classes in churches and community outreach to learn how to maximize their benefits.

Free birth control is not high on their list of priorities.

Those that are willing to accept contraceptives don't have to wait in lines because there are none.

 

[Key2Success]

Just think what could have been done with that $1 trillion that went towards phantom "shovel-ready" jobs!!!

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"The fact that we are here today to debate raising America's debt limit is a sign of leadership failure. It is a sign that the US Government cannot pay its own bills. It is a sign that we now depend on ongoing financial assistance from foreign countries to finance our Government's reckless fiscal policies. Increasing America's debt weakens us domestically and internationally. Leadership means that, 'the buck stops here.' Instead, Washington is shifting the burden of bad choices today onto the backs of our children and grandchildren. America has a debt problem and a failure of leadership. Americans deserve better."

The Quote of the Decade:
~ Senator Barack H. Obama, March 2006

 

[Ann H]

My wife has worked with low income children and adults for close to 40 years.

Wife now works in the school system with kids who are mostly in foster homes.

Many of these kids are (understandably) psychologically damaged goods because of the physical and mental abuse they suffered. Some were crack babies.

Somarco, when you go home tonight, be sure to tell your wife, "Thank-you" for working for our most vulnerable little ones for such a long time.

 

[virginiainsurance]

Mimic the model for car insurance in states like Maryland.

First: Don't require private companies to insure the uninsurable and sick (car insurance doesn't cover a prior car crash, and should not cover pre-ex health issues either) BUT create a government pool that will insure and subsidise the sick like maif (Maryland auto insurance fund). Private companies profit and make good profit but tax payers and govt make sure the uninsurable still have coverage.

Step two: keep the mandate to require insurance just like car insurance.

The market for car insurance is very competitive and everyone can find coverage without bankrupting private companies, I'm not sure why we don't use that model for health insurance if the goal is to insure everyone.

 

[somarco]

, I'm not sure why we don't use that model for health insurance if the goal is to insure everyone.

For starters, car insurance is mostly short tail claims. Health insurance is long tail.

If you want to use a P&C analogy, try WC. It is more akin to health insurance than most other casualty lines.

 

[Ann H]

Mimic the model for car insurance in states like Maryland.

First: Don't require private companies to insure the uninsurable and sick (car insurance doesn't cover a prior car crash, and should not cover pre-ex health issues either) BUT create a government pool that will insure and subsidise the sick like maif (Maryland auto insurance fund). Private companies profit and make good profit but tax payers and govt make sure the uninsurable still have coverage.

Step two: keep the mandate to require insurance just like car insurance.

The market for car insurance is very competitive and everyone can find coverage without bankrupting private companies, I'm not sure why we don't use that model for health insurance if the goal is to insure everyone.

I've never seen a car insurance claim cost $750,000, unless it was the liability portion.

I've never seen people repair the same car for decades in a row. They just get a new car. It's hard to get a new human body.

 

[Key2Success]

It's hard to get a new human body.

Actually, it's not......but it is quite expensive.

 

[prencik]

It looks like really good idea for a new healthcare system, at least on paper. I wonder if you guys have any input on this plan:

The Purple Health Plan

The Purple Health Plan

We, the undersigned, support the following principles governing fundamental healthcare reform and endorse immediate implementation of the Purple Healthcare Plan.

Principles of Healthcare Reform

1. All Americans need a basic health plan and should be free to purchase supplemental health insurance coverage.
2. Healthcare should be privately provided with people free to choose their doctors and hospitals.
3. All who can pay for their health plans should do so through a combination of existing tax payments and health plan co-payments.
4. The government's projected healthcare costs must be strictly capped and affordable on a long-term basis.
5. Health plans should be affordable regardless of one's pre-existing health conditions or risk.
6. The system must provide strong incentives to prevent overuse of healthcare services and discourage bad healthcare behavior.
7. Medical malpractice reform is needed to keep providers from engaging in unaffordable defensive medicine.

The Purple Health Plan

1. All Americans receive a voucher each year to purchase a standard plan from the private-plan provider of their choice.
2. Vouchers are individually risk-adjusted; those with higher expected healthcare costs, based on documented medical conditions, receive larger vouchers.
3. Participating insurance companies providing standard plans cannot deny coverage.
4. Each year a panel of doctors sets the coverages of the standard plan subject to a strict budget, namely that the total cost to the government of the vouchers cannot exceed 10 percent of GDP.
5. Insurance companies providing standard plans contract with private providers to cover their plan participants.
6. Americans choose doctors and hospitals included in the standard plan they choose.
7. Plan providers compete and provide incentives to improve participants' health and limit bad health practices.
8. Plan providers offer supplemental plans to their participants and cannot deny supplemental insurance coverage to their participants.
9. The government (federal and state) ends the tax exclusion of employer-provided health insurance premiums.
10. Like all other Americans, Medicare, Medicaid, and health exchange participants are covered by the Purple Health Plan subject to appropriate transition provisions.
11. The roughly 10 percent of GDP now spent or allocated by federal and state government on these and related programs, as well as on the tax exclusion of employer-provided health insurance premiums, is reallocated to help finance the vouchers.

And here is a good analysis from Forbes:

The Republicans' Healthcare Answer -- The Purple Health Plan

As far as I can tell it would look a little bit like Medicare Advantage for all.

But the best excerpt:

Tom Price is a doctor. He’s not an economist, let alone a health economist. It shows. Economists know enough not to do brain surgery. Doctors should learn health economics and the economics of information before they try to fix health insurance.

 

[RayNY]

In response to the purple health plan.

1) "All Americans"? Even the rich? Even those covered on VA or federal coverage? No consideration for income level whatsoever? (I won't get into the abuse a voucher may create).

2) Risk-adjustment is nice, but unless directly tied to the rating of private carriers, there will always be people getting bonuses or falling through the cracks.

3) GI is a great concept, but without enrollment limitations, it's just begging for adverse selection and abuse.

4) Doctors aren't equipped with the knowledge to forecast costs. To ask them to define benefits that would result in an expected expenditure is to ask them to do the job of an actuary. Do remember, experience must be analyzed, usage must be forecast, regional provider cost differences and population density must be considered, and of course, GDP must be accurately forecast. A team of professionals in various disciplines is required (none of which are medical doctors).

5) Insurance companies negotiating individual contracts with private providers is a root cause of the network shrink that we've seen nation wide. To encourage this further, with the implication of a separate network just for the "standard plan", is likely to create very restrictive networks. OF course, no provision here replaces the "emergency room always in network" provision of ACA, so if you're on vacation and have a heart attack, prepare to go bankrupt.

6) HMO system. How revolutionary. Such amazing creativity.

7) Gov't regulating the marketing of carriers, and requiring bonus incentives? Can't see how that ends badly.../s

8) Planning ahead for coverage so poor, guaranteed issue supplemental coverage is required to be offered. That's pretty reassuring, especially for those that will struggle to cover the cost of the basic plan.

9) Employer sponsored health insurance is no longer tax deductible? It would likely collapse the group market, since it would be cheaper to supplement individual coverage than provide group coverage. Many carriers struggle to profit on the individual side and only survive thanks to group/federal product, which means collapse of the market as a whole is not far fetched. Job mobility is a bonus, but the cons far outweigh the pros on this one.

10) This proposal is for private insurance, Medicare, and Medicaid? As in, they want to fully eliminate Medicare and Medicaid? That's political suicide, and against the promises of many of our politicians.

11) They plan to fund 300M+ Americans using the same amount of money that partially covers 145M right now? I'm sure that will result in better and less expensive care for all. (I know they mention the added taxes collected due to the elimination of the group coverage deduction, but realistically, employers will just roll that into gross pay and deduct it as salary anyway, so there won't be any net gain in taxes collected from businesses)