This might be a bit dense for some readers. If I had anything to say about my concerns about President Trump on the world stage, I would. But literally what can you possibly say about this incompetent individual. He is incapable of developing policies or of having a vision for an end goal and how to get there in a political process. Yes, he won the election, but he didn't have a real set of policies or buy-in from his governing support to implement them. The import tax was the only real thing that would have helped him help his supporters eventually, but Walmart has killed it before it even got to the point of being debated.
Anyway, after reading this morning's paper, I have a vision of what a real health insurance debate between the Democrats and Republicans would look like if the GOP would leave tax cuts out of the equation and simply focus on trying to build a consensus that the people could vote on through the 2018 and 2020 election.
What the Democrats are moving towards is Universal coverage through a Single Payer Plan. It might require some increase in taxes, but most of that would be netted against what is currently being paid by employers and individuals in their group insurance plans so the net increase would potentially not be very much. The Democrats need to do some work with the people who really know this type of data and figure out just what this math would really look like.
One key to the Democrat's argument is the need to separate in the voter's minds what the cost of Medicaid is to cover people under 65 from the cost of Medicaid for people over 65, who for the most part are people with dementia in long term care. I think most voters want Medicaid to pay for that long term care since most voters do not want death panels and know they cannot take care of demented granny in their home.
I paid $130,000 to cover long term care for my wife and myself. The issuing company is so unsure that that was sufficient that they stopped issuing further policies even with that steep upfront cost. I don't believe that 98% of Americans can afford long term care policies, so something needs to be done about insuring this catastrophic cost and yes, it needs to be means tested somehow; perhaps as it is currently through the spend down process to meet Medicaid requirements.
Now what would a real GOP plan look like. Well, we know ObamaCare was originally designed by the Heritage Foundation to be the GOP alternative to a Single Payer Plan and keep the private insurance industry involved in controlling costs. But the private insurance industry was not successful at controlling costs before ObamaCare nor is it within ObamaCare. Now interestingly, somehow Medicare Advantage Plans which are basically privately insurance HMO's within Medicare have seemingly been able to perhaps control costs somehow for the elderly. But these HMO's are subsidized by Medicare directly so we don't have a clear picture of the real effectiveness in controlling costs. But Medicare Advantage Plans are supported by the GOP as the fix for Medicare and are basically ObamaCare for the elderly. So Paul Ryan supports ObamaCare's design for people over 65, but not for people under 65. No wonder the GOP is having an internal fight to repeal Obamacare, their only preferred replacement is the ObamaCare construct.
What prompted this blog was an op-ed by the Features Editor at Reason Magazine. This is a libertarian magazine. I have never heard of it, but the Chicago Tribune named it as one of the 50 best magazines about 10 years ago.
The writer offers a set of principles that the GOP needs to use as guidance for their solution to the fact that the Heritage Foundation design for ObamaCare has certain aspects that are unworkable in the minds of the GOP.
For starters, he says no universal coverage. Otherwise, the GOP would end up negotiating on the Democrat's terms. That is a non-starter for him. It also offers up a very stark political campaign between the GOP and the Democrat's if they go down this path. I would like to see an election campaign on that issue, as a supporter of Universal Coverage.
The 2nd principle is unification, not fragmentation. But what is unification, if not a single payer plan. He didn't touch upon that point. Our current system is fragmented between Medicare, Medicaid, the private employer paid market, and the private individual paid market. The result is that people view health insurance as a means of prepaying for health care, not as insurance from catastrophic risk. And the primary cause of this view by people is the reliance upon employer paid health insurance which is promoted by the tax deductibility for employers and zero taxable income for employees for the value of health insurance. No politician, be they Ted Cruz or Elizabeth Warren, wants to change that tax subsidy because it is an entitlement enjoyed by a huge percent of the working age electorate. That can be changed only as part of a huge overhaul of the entire health insurance scheme.
The 3rd principle is separate heath insurance from health care. Insurance is a financial product to protect against catastrophic risk. People need insurance because they do not want to worry about financial ruin from a catastrophic medical condition. What the GOP needs to focus on is making routine health care affordable through supply side innovations as well as demand side reforms. He is a little vague exactly what needs to be done here and whether it would be effective, but this is after all exactly where Obama/Romney/HeritageFoundation Care has failed.
His 4th and final principle is that government assistance always be focused on the poorest and the sickest. Now it is focused on "subsidizing workers with six-figure salaries and wealthy retirees, while sidelining the poor and sick in Medicaid, a system in which many doctors will not participate in because of low reimbursement rates.
So, what would his system look like: Expanded Health Savings Accounts, a broad comprehensive system for catastrophic health insurance, cessation of the tax subsidy for employer paid health insurance (making it income to the employees), means testing Medicare, and other things that no one has thought of yet.
It is the last point that convinces me that a Universal Single Payer Plan is the answer. Hospitals and Doctors will not be government employees. Leaving capitalism at work. No doubt, the wealthy will get concierge service, but everybody else will be fine too. After all, if people need to think of things that no one has thought of yet, when health care is a basic human need and there are literally millions of people thinking about this issue, what great insight can be found? That is not to say someone could not think of something new, but since many countries have moved in the direction of a Single Payer Plan, a case can be made that somewhere within that construct, there is the best design to minimize the % of GDP that is spent on health care.
And I would separate long term care from that cost calculation. That is not health care, it is resident care for people who cannot take care of themselves. I would call it specialized subsidized housing for the elderly.
No comments:
Post a Comment