This is Just a Health Care Suggestion
11:00 AM
by Chris Johnson of Drawnlines Politics.
My previous post on the healthcare debate got a few responses that led to the question of how to fix it. I got to thinking about it and decided to write another post on the topic with a few ideas.
Obviously, we can’t shut out insurance companies. Obviously choice in healthcare is necessary for most Americans. And obviously continuing down the path we are on is not sustainable (see my original post. If you need more reasons, I can provide them). So what do we do about it? That is a very fair question.
Here is my personal idea for reform. I have not scored this with the Whitehouse or the DNC, so don’t blame them for this one. A lot of my professional background comes from the insurance field. While the industry is a den of bloodsucking leeches, they do provide a necessary service and they have the ability to do so efficiently. Just like a car factory would go broke with a lot of waste, without a decent product, and without knowing their competition inside out- so goes the insurance business. One big change in the type of coverage they provide could fix it all.
Medicare is not a panacea for old folks. It does, however, provide an avenue for people to get all of the care that they need. It does a very good job of providing basic care for its participants. I will handle the complaints about the system in a bit.
Medicare in a nutshell has four parts: Part A is hospital care. This is your basic emergency care. It is free for all qualified citizens over the age of 65. It has some caveats to it in the form of deductibles and limits of service, but hey, you got a free hospital bed and a cup of jello out of the deal… let it be.
Part B is doctoral care. These are your general practitioners and your specialists. This coverage does not come automatically. For the privilege of this care, seniors pay about $100 per month. I know it sounds expensive, but remember- there are a lot of people who purchase their insurance for a lot more than that… not to mention the fact that these are seniors that we are talking about. They are the single most expensive group to insure. Like Part A, B has some holes in it too: co-pays, deductibles, and limits.
I’ll skip to Part D for a second. D is the prescription plan. This works pretty good too- it is also optional and fairly inexpensive on a monthly basis. The huge downfall of this part is the “doughnut hole”. The limits of coverage change with the amount of expense incurred in a calendar year. There is a range of expense in the middle where Medicare pays 0% of drug costs. Once you hit the upper end of that range, Medicare will begin paying again. The reason for this system comes from the thought that people that need excessive amounts of prescriptions will have part of their cost defrayed at the beginning of the year- then when they hit the doughnut hole, they no longer meet the design of the system and are cut off. The reason that Part D will start paying again is because if you need THAT MANY drugs, you are deemed to need catastrophic coverage.
Part C, AKA Medicare Advantage, AKA Medicare Supplemental Coverage, is where the answer lies.
The private insurance companies are handed a rule book to play by for Part C. All the companies then compete to offer different combinations to plug all the holes listed above. It is that simple. There are many different ways to do this, but they aren’t all that important to my point- Private carriers make a fortune offering supplemental insurance to seniors. AARP is not just a lobby for oldsters, they are one of the largest health insurance providers in the country. So large in fact, that they no longer need sales reps. They only have order takers. Just ask Rita Moreno.
Why does all this matter to today’s issue? If all Americans (not just the old ones) were enrolled in Medicare and automatically given free hospital coverage and a way to buy basic health and drug coverages at inexpensive prices- wouldn’t you call that a wonderful thing?
Now to the debate you are formulating:
Isn’t Medicare already going broke? Wouldn’t this be putting too much strain on a distressed system?
Yes. Medicare is going broke. They ONLY insure the old, the infirm, and the dying. Their primary source of premiums comes from us, the working tax payers. The ratio of working to retired is quickly headed in the wrong direction. In short, this solution not only provides coverage to all Americans, it also fixes Medicare by supplying the risk pool with tens of millions of healthy people AND by taking premiums from all tax paying Americans. The idea of Medicare works extremely well- I’d like it to work for me too.
Won’t this make my taxes go up?
Before I answer this one, allow me to voice my displeasure with people who are afraid of higher taxes. We (USA) have one of the lowest tax burdens in the world. On top of that, in this “trying time” that we are in, we have one of the lowest tax burdens in our own history! We won the greatest war ever fought and conquered The Great Depression on a 40% tax burden. Grow up people and pay your bills.
But to answer your question- yes. Your taxes will go up. Your health insurance premiums in a pool as large as the entire country will be incredibly low. Much, much lower than you pay now (I don’t care what coverage you have). On top of that, there is no profit margin incorporated in your premium, just your expected cost of coverage. While your taxes go up, the money to your pocket also goes up.
What about the insurance companies? Won’t they go out of business?
No. All carriers that desire to participate in health coverage can continue to operate by selling plugs for all the holes in the basic coverage. What’s more is that all of the insurance companies would be providing supplemental policies that are based on the same easy to understand rules. Competition would increase and prices would go down. Cadillac plans would be a lot more commonplace than they are today.
Ok, if you still aren’t sold, I will give you two personal stories that incorporate a few more points:
My mother is going to be 55 this year. She is a stage 3 breast cancer survivor. She is uninsurable. In order for her to have coverage, she has to limit her career to companies that offer good health insurance benefits for reasonable co-premiums. She will never own her own business. She will never work at a not-for-profit enterprise. She will always work full time until she is 65 years old. This is not fair.
My sister is in much the same condition. She had a non-cancerous growth removed at the age of 17. After the procedure, she developed MRSA. Even though she is an incredibly fit and healthy police officer, she is uninsurable- and has the same career-limiting restrictions put on her as my mother. The same burden at the age of 23. How is it that there are people in our society that are fine with this?
So tell me, what do you think? Like I said before- I am floating this to you as a trial balloon. The idea isn’t all that original. This is just some fleshing-out for public consumption. If you see a downside, tell me. If you have a better idea, I would love to hear you out. Just don’t be a “Tea Partier” and throw rocks without something constructive to offer.
My previous post on the healthcare debate got a few responses that led to the question of how to fix it. I got to thinking about it and decided to write another post on the topic with a few ideas.
Obviously, we can’t shut out insurance companies. Obviously choice in healthcare is necessary for most Americans. And obviously continuing down the path we are on is not sustainable (see my original post. If you need more reasons, I can provide them). So what do we do about it? That is a very fair question.
Here is my personal idea for reform. I have not scored this with the Whitehouse or the DNC, so don’t blame them for this one. A lot of my professional background comes from the insurance field. While the industry is a den of bloodsucking leeches, they do provide a necessary service and they have the ability to do so efficiently. Just like a car factory would go broke with a lot of waste, without a decent product, and without knowing their competition inside out- so goes the insurance business. One big change in the type of coverage they provide could fix it all.
Medicare is not a panacea for old folks. It does, however, provide an avenue for people to get all of the care that they need. It does a very good job of providing basic care for its participants. I will handle the complaints about the system in a bit.
Medicare in a nutshell has four parts: Part A is hospital care. This is your basic emergency care. It is free for all qualified citizens over the age of 65. It has some caveats to it in the form of deductibles and limits of service, but hey, you got a free hospital bed and a cup of jello out of the deal… let it be.
Part B is doctoral care. These are your general practitioners and your specialists. This coverage does not come automatically. For the privilege of this care, seniors pay about $100 per month. I know it sounds expensive, but remember- there are a lot of people who purchase their insurance for a lot more than that… not to mention the fact that these are seniors that we are talking about. They are the single most expensive group to insure. Like Part A, B has some holes in it too: co-pays, deductibles, and limits.
I’ll skip to Part D for a second. D is the prescription plan. This works pretty good too- it is also optional and fairly inexpensive on a monthly basis. The huge downfall of this part is the “doughnut hole”. The limits of coverage change with the amount of expense incurred in a calendar year. There is a range of expense in the middle where Medicare pays 0% of drug costs. Once you hit the upper end of that range, Medicare will begin paying again. The reason for this system comes from the thought that people that need excessive amounts of prescriptions will have part of their cost defrayed at the beginning of the year- then when they hit the doughnut hole, they no longer meet the design of the system and are cut off. The reason that Part D will start paying again is because if you need THAT MANY drugs, you are deemed to need catastrophic coverage.
Part C, AKA Medicare Advantage, AKA Medicare Supplemental Coverage, is where the answer lies.
The private insurance companies are handed a rule book to play by for Part C. All the companies then compete to offer different combinations to plug all the holes listed above. It is that simple. There are many different ways to do this, but they aren’t all that important to my point- Private carriers make a fortune offering supplemental insurance to seniors. AARP is not just a lobby for oldsters, they are one of the largest health insurance providers in the country. So large in fact, that they no longer need sales reps. They only have order takers. Just ask Rita Moreno.
Why does all this matter to today’s issue? If all Americans (not just the old ones) were enrolled in Medicare and automatically given free hospital coverage and a way to buy basic health and drug coverages at inexpensive prices- wouldn’t you call that a wonderful thing?
Now to the debate you are formulating:
Isn’t Medicare already going broke? Wouldn’t this be putting too much strain on a distressed system?
Yes. Medicare is going broke. They ONLY insure the old, the infirm, and the dying. Their primary source of premiums comes from us, the working tax payers. The ratio of working to retired is quickly headed in the wrong direction. In short, this solution not only provides coverage to all Americans, it also fixes Medicare by supplying the risk pool with tens of millions of healthy people AND by taking premiums from all tax paying Americans. The idea of Medicare works extremely well- I’d like it to work for me too.
Won’t this make my taxes go up?
Before I answer this one, allow me to voice my displeasure with people who are afraid of higher taxes. We (USA) have one of the lowest tax burdens in the world. On top of that, in this “trying time” that we are in, we have one of the lowest tax burdens in our own history! We won the greatest war ever fought and conquered The Great Depression on a 40% tax burden. Grow up people and pay your bills.
But to answer your question- yes. Your taxes will go up. Your health insurance premiums in a pool as large as the entire country will be incredibly low. Much, much lower than you pay now (I don’t care what coverage you have). On top of that, there is no profit margin incorporated in your premium, just your expected cost of coverage. While your taxes go up, the money to your pocket also goes up.
What about the insurance companies? Won’t they go out of business?
No. All carriers that desire to participate in health coverage can continue to operate by selling plugs for all the holes in the basic coverage. What’s more is that all of the insurance companies would be providing supplemental policies that are based on the same easy to understand rules. Competition would increase and prices would go down. Cadillac plans would be a lot more commonplace than they are today.
Ok, if you still aren’t sold, I will give you two personal stories that incorporate a few more points:
My mother is going to be 55 this year. She is a stage 3 breast cancer survivor. She is uninsurable. In order for her to have coverage, she has to limit her career to companies that offer good health insurance benefits for reasonable co-premiums. She will never own her own business. She will never work at a not-for-profit enterprise. She will always work full time until she is 65 years old. This is not fair.
My sister is in much the same condition. She had a non-cancerous growth removed at the age of 17. After the procedure, she developed MRSA. Even though she is an incredibly fit and healthy police officer, she is uninsurable- and has the same career-limiting restrictions put on her as my mother. The same burden at the age of 23. How is it that there are people in our society that are fine with this?
So tell me, what do you think? Like I said before- I am floating this to you as a trial balloon. The idea isn’t all that original. This is just some fleshing-out for public consumption. If you see a downside, tell me. If you have a better idea, I would love to hear you out. Just don’t be a “Tea Partier” and throw rocks without something constructive to offer.
Posted by Nick Stone
on 11:00 AM.
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