{"id":2323,"date":"2019-01-10T11:06:19","date_gmt":"2019-01-10T17:06:19","guid":{"rendered":"http:\/\/www.wilsonld.com\/weblog\/?p=2323"},"modified":"2019-01-10T11:18:25","modified_gmt":"2019-01-10T17:18:25","slug":"last-chance-idea-for-workable-market-based-health-care","status":"publish","type":"post","link":"https:\/\/wilsonld.com\/weblog\/?p=2323","title":{"rendered":"Last Chance Idea for Workable Market-Based Health Care"},"content":{"rendered":"\n

The Affordable Care Act (aka Obamacare) was supposed to be a market-based healthcare system where individuals could shop for the best (and least expensive) health care insurance option for themselves and their families.  The concept (first introduced as \u00e2\u20ac\u0153Romneycare\u00e2\u20ac\u009d in Massachusetts and then adopted by Republican lawmakers as the best solution for providing consumers with their health care solutions) quickly became anathema to conservatives as it was passed into law under a Democratic administration and Congress.<\/p>\n\n\n\n

Now the Democrats are proposing a single-payer \u00e2\u20ac\u0153Medicare for\nAll\u00e2\u20ac\u009d system to replace Obamacare which would essentially be expanding Medicare\nto include everybody.  While this would\nprobably be the most efficient and workable system, it likely won\u00e2\u20ac\u2122t pass given\nthe opposition to government paid health care by a large segment of the\npopulation and the cost associated with this expansion.<\/p>\n\n\n\n

The Affordable Care Act (ACA), however, created a\nhodge-podge of insurance offerings and ended up not being very efficient or\ncost-effective.<\/p>\n\n\n\n

What could be done to fix the ACA to make it much for\nefficient and cost effective, or, more directly, what can be done to make it\nactually work as a market-based system? \nI offer these thoughts, which admittedly might be radical, but also might\nmake a lot of sense:<\/p>\n\n\n\n

  1. Create a category of health care insurance options which can be construed as \u00e2\u20ac\u0153Qualified Plans.\u00e2\u20ac\u009d\u00c2\u00a0 These plans would have the following characteristics:
    1. Cover pre-existing conditions<\/li>
    2. No lifetime caps on the cost of care<\/li>
    3. Offered to everybody and everywhere (not just in cherry-picked counties as insurers are able to do under the ACA)<\/li>
    4. Offered by financially sound healthcare insurance companies who have the capacity to pay claims<\/li>
    5. Not subject to state regulation or cost controls<\/li><\/ol><\/li>
    6. Consolidate state market exchanges into one national exchange and eliminate all state regulations.\u00c2\u00a0 Currently there are over 30 state marketplace exchanges operated by the federal government but with varying rules and regulations imposed by the states as well as multiple state exchanges.\u00c2\u00a0 When you buy a car, however, all of them are required to have seatbelts, airbags, other safety features and standard emissions (other than California).\u00c2\u00a0 When you buy health care insurance, however, the plans must be approved and priced according to each state regulator.\u00c2\u00a0 This is nuts.\u00c2\u00a0 We are one country with 50 states, but we are not the Balkans.\u00c2\u00a0 Why must we have any state regulation if we were to have something like \u00e2\u20ac\u0153Qualified Plans\u00e2\u20ac\u009d at the Federal level?<\/li>
    7. Make all \u00e2\u20ac\u0153Qualified Plans\u00e2\u20ac\u009d available nation-wide on the national health-care exchange.\u00c2\u00a0 A Qualified Plan would be available to everyone everywhere.\u00c2\u00a0 Insurers would no longer be able to pick and choose which states and which counties where they would sell their plans.<\/li>
    8. Eliminate tax deductions and tax credits for all healthcare insurance other than \u00e2\u20ac\u0153Qualified Plans\u00e2\u20ac\u009d both for businesses and individuals.\u00c2\u00a0 Employers would be able to continue offering healthcare benefits to employees but only for a subsidy to purchase a Qualified Plan on a Health Care Exchange if they wish to deduct the cost from their taxes. The tax deduction for \u00e2\u20ac\u0153Qualified Plans\u00e2\u20ac\u009d only would discourage employer, affinity group and association healthcare plans.\u00c2\u00a0 These plans are special deals cut between employers (and other affinity groups and associations) that reduce the number of healthy individuals in the market place, thus substantially driving up the cost of healthcare insurance for those not fortunate enough to belong to one of these organizations.\u00c2\u00a0 A Qualified Plan would be one that is available to everyone on the healthcare marketplace.\u00c2\u00a0 This is counter to the current thrust to create more of these special healthcare affinity groups or associations which, I contend, only drives up the cost for the rest of the individuals attempting to purchase healthcare insurance as it reduces the number of healthy individuals in the larger pool. (Note that this change would also provide substantial cost savings to employers who would no longer need to have staff on board to negotiate and maintain their employer-based plans.\u00c2\u00a0 Employers could simply determine how much of a subsidy they would be willing to pay their employees for healthcare and the employees would choose which Qualified Plan they would sign up for.)<\/li>
    9. Rather than the \u00e2\u20ac\u0153Individual Mandate\u00e2\u20ac\u009d that was imposed as part of the ACA and subsequently repealed, impose a surcharge for those healthy Millennials who chose to wait to enroll until they actually need healthcare insurance.\u00c2\u00a0 This is what is done for individuals who delay enrolling the Medicare Part \u00e2\u20ac\u0153D\u00e2\u20ac\u009d drug coverage instead of signing up when they are first eligible.\u00c2\u00a0 This would help expand the pool of healthy insured individuals to reduce the cost of the \u00e2\u20ac\u0153Qualified Plans.\u00e2\u20ac\u009d <\/li><\/ol>\n\n\n\n

      Although some the above reforms\nmay be somewhat radical, I believe they could substantially increase\ncompetition between health care insurance companies, reduce the cost of\nregulation, lower costs for employers, while retaining a market-based system\nusing non-governmental payers.  This\nmodel would result in a single market place for purchasing health care and\nwould possibly resemble the model of our stock markets where you can buy stock\nregardless of which state you reside in or whether you are employed by a\nparticular company, affinity group or association. <\/p>\n","protected":false},"excerpt":{"rendered":"

      The Affordable Care Act (aka Obamacare) was supposed to be a market-based healthcare system where individuals could shop for the best (and least expensive) health care insurance option for themselves and their families.  The concept (first introduced as \u00e2\u20ac\u0153Romneycare\u00e2\u20ac\u009d in …<\/span> Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-2323","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=\/wp\/v2\/posts\/2323","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2323"}],"version-history":[{"count":2,"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=\/wp\/v2\/posts\/2323\/revisions"}],"predecessor-version":[{"id":2326,"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=\/wp\/v2\/posts\/2323\/revisions\/2326"}],"wp:attachment":[{"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2323"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2323"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wilsonld.com\/weblog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2323"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}