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I have a great new idea for the health care system

It's pretty clear that 2017 is going to be a rough one for ObamaRomneyHeritageCare.  The insurers are basically giving up on the idea that they can get a proper risk pool, and healthy folks that are not getting a big premium tax credit are mad at the high costs and deductibles.  There seem to be 2 reasons for this mess: [1] unscrupulous providers that have super-expensive Medicaid patients are "charity gifting" these patients the full cost of an ORHC Exchange plan, so that they can get a higher reimbursement, and which ends up tremendously skewing the risk pools; and [2] the individual mandate is so flimsy that a lot of healthy folks that aren't getting a big premium tax credit and should be buying coverage are just not doing so.  The premiums are going to hit the roof, and since they will be divulged on Nov 1, the voters will get wind of it; it only because Trump is so unthinkable by so many folks that Clinton will still win.

Therefore, it's time to do major surgery to the health care system.  Sure, Medicare-For-All would be great, but the country is not quite ready for it, as large employers are still happy to provide health coverage through their somewhat cherry-picked risk pools (i.e., typically only health folks are hired!)  The public option could be a back door to Medicare-For-All, but if the public option is to be actuarially neutral (i.e., priced to fund its outlays), there would be the same problems as there are now, although probably not quite so bad.

My idea is to give the Republicans most everything they want - Health Savings Accounts, interstate market (even though this is a BS issue), "consumer based coverage" - and as well get rid of the guaranteed issue requirement (i.e., allow the insurers the ability to decline any applicant); IOW, pretty much go back to the pre-ORHC days, BUT with just a few very important tweaks:

[1] Continue to have the premium tax credit that is progressive.

[2] Continue to have some regulation that stops the ripoff artists from selling junk insurance or doing rescission (i.e., happily take premiums until the covered gets sick, and then retroactively drop them because they didn't disclose a pimple on the buttock, etc.)  The exchanges would still be there to stop the frauds and to bring some semblance of a clear market.

[4] Have the public option that would be available for anyone that wants it, and a place for anyone who gets rejected by the insurers.  But instead of being actuarially neutral, its premiums would be actuarially set to the risk pool that the lowest cost private insurers have, with the balance in funding to be provided for by a subsidy from the government.

[5] Instead of having the mandate, have an ironclad tax (i.e., a tax that is legally collectible as regular tax) on anyone that does not have coverage but uses a hospital to get medical care, with this tax more or less being the amount that the patient would have paid for the public option all the time he didn't have coverage - and make it as hard to get discharged as student debt.

NOTE: The Medicaid expansion is to be kept, and the problem with the "coverage gap" (i.e., folks in states with a jerk governor and thus no expansion of Medicaid, and who have an income of less than poverty are not allowed to get the premium tax credit).fixed by allowing the tax credit to be available to all.

This will accomplish a whole lot of objectives - it will immediately be very popular to 2 main groups: the folks who have been wanting Medicare-For-All, and the folks that want to go back to the pre-ORHC days of not having a mandate and being able to take advantage of the healthy-customer pricing.  I doubt that there is any real constituency along the middle of this spectrum.  And as folks get that buttock pimple and have to go to the public option, they will be instant supporters of government-guaranteed health care, thus insuring this program's political viability, and eventually lead to the most logical system of Medicare-For-All.

What do you all think?


  • Posts: 58
    Oops, somehow I skipped [3]!
  • Posts: 58
    Oh, and no individual mandate on the front end (the mandate in essence is back-loaded as per [5]).
  • eh, this could be do-able. Though, I think this idea needs polished up a bit to perfect it. However, with that being said, I think its a great idea to start with. I wonder how you could get this brought up, if at all. 
  • SkySky
    Posts: 6
    While doable, it's doubtful that one can get the two parties to agree to provide separate plans based on Federal and State cost of implementation. I firmly believe that if we were to tax the 1% at a higher rate to cover a Universal Health Care Plan For All, the country would be in far better shape. At the same time, it is essential that there are Federal and State programs that also participate and contribute in the establishment and ongoing process of such a plan. After all, if states like Vermont and others can come up with Universal Health Care for children, then I believe the process could be expanded to cover adults in each and every state. Of course, when it comes to states like Texas who don't even accept the ideology of expanded medicare to its citizens as an effort to keep all people healthy, then it is obvious that there will still be problems when it comes to selling and/or instituting such a plan. And, while I am a firm believer in State's Rights, I also believe there are some areas in which the States are being too restrictive and therefore, need to be disciplined like taxpayers in relation to issues in this regard.  Cheers!!!
  • I am struggling to see the difference between the mandate and the iron-clad tax that you mention.  Isn't all the mandate is is a tax?  That is my understanding at least, but I very well could be wrong.  It is an interesting proposal, and there are certainly some points to take away from it.  I am glad someone is out there thinking of solutions though, because we need them.  Thanks for sharing.
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