Enough Criticism – What’s your plan

It’s easy to be critical, it’s tougher to present an alternative.    Today’s entry will focus on an outline of the components that should be debated point by point and my suggestion of a bill that would probably be palatable to the majority of American’s.   Even though this debate is less than two weeks old, most are already tiring of the hyperbole being thrown from all the special interests.  

To design any plan, the problems we want to address must be clearly defined.  I also want to be out front with my perceptions and biases so that you can judge them accordingly and take issue with them, if you disagree.  (although most criticism is coming via personal email)

Here are the key components of designing a more cost effective health care system, as authored by me. 

  • Providers are mandated to charge all customers the same amount and declare their fee for service.   
  • The Government creates an agency to take all the pricing data nationally and break all providers into a group of 6 pricing models with regional adjustments based on service area of providers.   All providers fees would then be compiled into the national price levels and each provider would charge the average level based on the price group of 1,2,3,4,5 or 6. 
  • The Federal Health Agency is the only legal wholesaler of FDA approved drugs.    
  • The Federal Health Agency provides direct-to-insurers credits to insurers for those with income less than 300% of  Federal Poverty level.  

No matter if you are 65, worth $100mm, or on Medicaid, the doctor charges you the same amount, and your insurance, if you have it, the same amount.   A very simple premise.   Let the market compete for health care.   Insurance would provide insurance to provide coverage at the level of provider you choose.  

To address the insurance issue of a jolt to correct the system as it stands. 

  • A once in a lifetime waiver of the pre-existing condition clause. The waiver is offered on a national level based on the month of your birth, rolled out over 12 months.  
  • Those not electing coverage at the initial creation of the plan would be entitled to get insurance via underwriting at any time, or during the annual open enrollment period. 
  • If you do not elect insurance at the initial enrollment, you are subject to a 24-month pre-existing condition clause.  If you elect your once-in-a-lifetime waiver of the pre-ex clause, you pay a higher rate of 1%, per month for each month past the initial election period, up to 100%.  If you decide to change carriers, your rate premium would remain for a period of 5 years.   ( if you decided to roll the dice and go uninsured for 2 years, you would pay 24% more than the maximum allowed for each the next 5 years, with the original insurer receiving the 24% premium addition even if you changed carriers)  
  • Insurance carriers would offer open enrollment one time per year, if an individual wanted to change coverage or carriers in between that open enrollment period, they would be fully underwritten and could be declined.   ‘
  • Individual insurance would be offered nationally in a Plus or Minus 20% underwriting risk.    If the Standard Premium is $200, the healthiest person would pay $160, the sickest group $240.    
  • Group/Employer based Health Insurance would be offered at Plus or Minus 10% underwriting risk.
  • Unmarried children eligible to age 26 regardless of student status.
  • Cobra benefits offered for 12 months maximum.   

If the initial premise that a provider must charge are insurers, public or private , the same amount for the same procedure, then you can have a government health plan without unfair competition. 

A Mandate that all people must be covered by a minimum coverage health plan.  A government body would determine the minimum coverage parameters that all private plans must cover.   No plan could have out pocket expenses, including copayments, that exceed $2,500 per person.   

How it would work for individuals and businesses in greater detail later this week.   (Unless the Senate bill comes out, and then I will read and critique that bill)

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