So we all know that Healthcare reform has been hijacked by turncoat Joe Lieberman. We all despise this traitor, but the fact remains that unless we use the nuclear option or pass a bill through the process of reconciliation (both of those options have major possible drawbacks) we need his vote to pass a bill. He has staked his opposition to ideas favored by most such as the public option or the expansion of Medicare on the claim that we (i.e. taxpayers) can't afford such new government run plans. Well I have a proposal that would probably be revenue neutral, and it would actually eliminate a government program (Medicaid) rather than create a new one; so the people who are so afraid of socialized medicine wouldn't have to worry either.
Follow me below the fold.
So here are the general provisions of this plan:
- Insurance Companies must issue policies to ANY applicant regardless of their age or health condition. Clauses excluding coverage of any kind (including riders, ect.) due to pre-existing conditions are prohibited. Lifetime policy limits would also be prohibited.
- Although Insurance companies may still have deductibles within certain prescribed limits based upon the insured's income, insurance companies must cover routine physical exams (i.e. well checks), a minimal amount of dental coverage, and also a minimal amount of vision coverage. As an additional catchall regulation, anything covered by Medicare must also be covered by private insurance companies once the deductible is exahuasted. Variances in premiums based upon anything other than tobacco use or the amount of the deductible (which would also be regulated) would be prohibited.
- Hospitals must charge uniform rates regardless of whom is purchasing or paying for the medical care. Hospitals must be prohibited from charging BCBS .30 on the dollar while they charge the uninsured or underinsured (i.e. those with really high deductibles) the full list price. Hospitals who continue to engage in such practices are subject to penalties for price gouging.
- Medicaid is abolished and in its place are sliding scale premium vouchers (discussed more fully below).
- The Act would do away with the tax exemption for employer based health insurance plans. Thus employers would no longer have an incentive to provide employees with health insurance as part of their benefits package. Employers currently offering their employees such benefits would be required to increase their employees salaries by the amount of money in health insurance premiums that they are currently paying on their employee's behalf, thus resulting in no net loss of income to the employees. (I know that this is a controversial proposal, but I personally believe that the lack of portability in health insurance as well as the restrictiveness that is created in the labor market as a result of current employer based health care system justify this proposal. Obviously single payer would accomplish the same goal of freeing up the labor markets, and I would love to see single payer; but we just don't have the votes to make that happen right now).
- The U.S. Treasury shall create a national health insurance trust account. Each taxpayer is required to deposit 10% of his or her income above the federal poverty line up to $250,000.00 into the trust account. Fifteen percent of income above $250,000.00 but below $1,000,000.00 must be deposited into the national health insurance trust account; and 20% of all income above $1,000,000.00 must be deposited into the trust account. Insurance premiums will be collected from this pool of money, and any unused money will be returned to the taxpayer as part of their tax refund. However, in the event that a taxpayer fails to purchase insurance; he or she forfeits this money.
- Insurance companies must charge premiums that are linked to a person's income, and they must be progressive in nature. The formula that must be used to make it progressive would be the same as the one for setting up the national health insurance trust account. The maximum premiums that can be charged by insurance companies are 10% of a person or family's income up to $250,000.00; 15 percent of income above $250,000.00 but below $1,000,000.00; and 20% of income above $1,000,000.00. The insurance companies would be forced to participate in a national health exchange that allows consumers to find insurance plans that charge less (hopefully significantly less) than the maximum prescribed by law.
- The law would create a single set of stringent national regulations and an enforcement agency that would pre-empt state laws regulating health insurance. This would break down the state law boundaries that conservatives always fuss about. (As an aside, I remember when conservatives actually favored state's rights.) A key part of these regulations would include the enforcement of anti-trust laws. The anti-trust exemption currently applicable to health insurance companies would of course be removed!
- Persons or families making income up to 400% of the federal poverty line would be eligible for vouchers with those at or below the federal poverty line paying no money for health insurance premiums.
Benefits to the Plan (in my humble opinion)
- It regulates some of the worst abuses currently perpetrated by insurance companies.
- It forces the wealthy to feel the increased costs of health care, which means that at long last they will have a stake in containing the costs of health care. This fact is important because the wealthy have a disproportionate impact on public policy, and if they are feeling the pinch along with the rest of us, then they are more apt to make sure the system is working properly.
- It would expand coverage to almost everyone.
Problems with the Plan (also in my humble opinion)
- It's still not as an efficient method of delivering health care as a single payer system would be.
- While on the whole I strongly agree that pre-existing conditions and increased premiums for persons with health problems are inherently unfair and should be made illegal, there is arguably a certain moral hazard associated with the elimination of such practices in that some people may be less likely to engage in healthy lifestyles. In order to ameliorate such a moral hazard, the government may want to incentivize certain healthy lifestyles like going to the gym by providing subsidies or tax breaks for such activities. The government may also want to consider sin taxes on things such as soft drinks, fast food, ect. ect.
So there's my proposal. Any thoughts?