Wednesday, July 11, 2012

One man's health care plan

As mentioned in my last blog, I was fortunate enough to have two letters recently published in the Philadelphia Inquirer.  The second one was the first paragraph of my post today and is as follows:

Now that the Supreme Court has ruled the constitutionality of the individual mandate, it is time for our elected public servants on both sides of the aisle to take a serious look at the various laws related to this historic set of reforms, keep those aspects which benefit America, and adjust/remove those which do not. That is the essence of governing and that is what we, the American electorate must demand.

Of course, my post for today is a bit more wordy.  Its title, Reforming the Health Care Reform Law should not be taken as a slight towards the Affordable Care Act as I believe that it is a great start towards focusing America on the fact that we have a health care crisis.  Not withstanding the far rights criticism that it is socialism at work, it is clear to me that the reforms in this law were constructed with too much compromise.  Compromises with the right (no public option), compromises with the insurance providers as it is still market based.

That being said, I am fine with some compromises, as long as they can be fashioned so as to help the American consumer who needs relief from high insurance premiums, lack of access to medical insurance and the real fear that we are one serious illness from losing our homes.

So, here are my suggestions.

Reforming the Health Care Reform Law

Now that the Supreme Court has ruled the constitutionality of the individual mandate, it is time for our elected public servants on both sides of the aisle to take a serious look at the various laws related to this historic set of reforms, keep those aspects which benefit America, and adjust/remove those which do not. That is the essence of governing and that is what we, the American electorate must demand.

But before this process begins, perhaps we should enumerate the issues which created the need for the health care reform bill in the first place, and consider one man’s solutions to this important problem.

Issue 1. Access to health insurance for all who wish it

Issue 2. Rising cost of health care services and premiums

Issue 3. The sickest in America are the first to be denied access and affordable premiums yet need the services the most

It has been widely documented that there are millions of Americans who want to purchase health care insurance but cannot acquire it due to an insurance industry denial, or simply because the premium is unaffordable. If we are going to continue to claim “greatest country on Earth” status, we need to create a plan whereby everyone who wants health care coverage, regardless of health or financial resources, must be given the means to purchase this insurance.

It has also been well documented that there is a trend among employers to reduce their health benefit packages to their employees or drop this benefit all together, the latter being more prevalent among smaller (50 employees or less) businesses.

And, of course, during times of recession when unemployment is high, more people lose their health insurance as the result of a job loss, and then cannot purchase insurance on their own due to insurance industry denials and high cost as noted above. A double whammy, so to speak.

Considering these problems, many on the left cry out for a single payer health plan. All people in one big pool. This is just an extension of the current system that offers more attractive premiums to larger businesses and large affinity groups, like AARP. The fear among many conservatives is that having the federal government oversee this system will simply create a bureaucracy which will add costs without improving services, and most likely be inefficient in doing so.


1. All Americans are immediately entered into one huge pool of patients.

Having one large pool spreads the cost of illness across all age groups just as it currently does for large corporations or affinity groups. Our current system penalizes workers who choose employment with small companies or choose to self-employ. Just as paying for health coverage through an affinity group or a large business reduces premiums, this should reduce premiums for most Americans.

2. All states must create a plan to cover all of their citizens. This plan should include multiple options ranging from “Cadillac” plans that cover virtually anything, to catastrophic coverage, defined by me as plans with a range of deductibles and various levels of premiums but a cap on out of pocket expenses.

Separate plans for each state will allow each to address its specific needs whether they be related to a lower population, higher median age, etc. They can open their particular requirements to any insurance company interested in their business so there should be some competition at work. If there is resistance to one big pool as noted in solution #1, then at the minimum each state would be considered its own “pool”. For states with smaller populations, there would be no restriction on them pooling together, if it is advantageous to their needs.

3. The states will contract out these plan choices through private insurance companies but each state must have a range of choices among at least 3 health care providers.

Again, some competition in play as there may be some insurance companies which prefer to enter the catastrophic market in multiple states, some which prefer states in certain areas of the country, some which decide to offer the best rates in only one state based on historical data and past experience, some which offer a full range of plans for multiple states, or even all states. But again, the plans treat all citizens of that particular state (or states) as being in one pool.

4. Employer based health care is eliminated. What premium an employer was paying for an employee’s coverage now becomes additional compensation, a raise so to speak. For those individuals who were not blessed with company subsidized health coverage and therefore had no coverage, the individual states would need to establish a “minimum” benefits plan which they would receive for free but only until they made a choice to enter the market and purchase the correct insurance for them. Each state would have to establish its own particular time frame for this to occur.

Employer based health care was good in its time but its time has passed.  By eliminating the expensive and time-consuming responsibility of researching and choosing a health care plan every year for employers, we allow our corporations and small business entrepreneurs to focus on their business. It may also spur some hiring as many employers have been in need of new employees but remain hesitant because of the uncertainty in the health care debate as well as the added burden of paying for a new employee’s health benefits, a figure that has risen steadily in the last 20 years outpacing many other business expenses.

5. All individuals (families) must choose a plan as provided by their state, based on their personal needs. Ah yes, the individual mandate.  Amazingly, it has been upheld by the Supreme Court.  I say amazingly, not because I don't beleive it is necessary but because the deciding vote was cast by Justice Roberts, a Bush 43 appointee.  Of course, in this state based scenario, Romney-care hybrid so to speak, I feel confident that the Republicans desire for the removal of the federal government's role, other than mandating that they provide a plan, will be welcome.  As for those who protest that they cannot be forced to buy health insurance, I will use a phrase I heard at a July 4th party last week.  "It is time to put on your big boy pants".  Eventually we all need health care services, be a man and participate in the cost.  And, if by some genetic miracle, you are healthy your entire life, rather than feeling you have wasted your premiums, thank your god or fate that you were blessed with good health.  Would you rather be sick?

Placing the purchasing responsibility on the patients should lead to more efficient spending of the medical dollar. Too often we engage in medical services without knowing the costs or necessity of those services. This should re-energize the doctor-patient relationship while demanding our medical professionals to treat people rather than symptoms. 

6. All medical premiums and out of pocket medical expenses are tax deductible rather than the current 7.5% minimum break point.

Currently, if your out of pocket medical expenses fall below 7.5% of your adjusted gross income, they are not deductible. Including all medical expenses, premiums as well as deductibles, will help reduce income taxes for those who experience a one-time surge of medical bills or have chronic conditions that create higher than average out of pocket costs. While this may not seems as good as the current pre-tax plan that allows medical premiums to be removed from payroll checks before taxes, it evens the playing field for premiums as overall costs have been spread across all citizens of a particular state, and it places more responsibility on the individual to purchase plans that they can afford based on their own or their family’s health.

Finally, the really good parts of the Affordable Health Care Act, those parts which a majority of Americans support should stay. Things like

Zero co-pays for routine and preventative visits.

No more denials based on pre-existing conditions, especially for children.

Allowing young adults to stay on their parents’ plans until age 26.

No caps on benefits paid by the insurance company due to a chronic illness or catastrophic health care issues.

I recently had a conversation with a pre-med student who fervently believed that the health care insurance industry was the devil. His plan to fix our system was to limit health care providers profits, thereby forcing them to focus on patient care and reducing costs rather than squeezing all medical providers to improve profits. He was also not a big fan of the pharmaceutical companies.

My distaste for health care insurers falls a bit below that assessment, because, in the end, I think we need their expertise in knowing the demographics of Americans, in hiring and listening to their actuaries, and in offering a range of health care plans that provide reasonable premiums/exposure to out-of-pocket expenses to us, their customers, while returning a reasonable profit so as to provide jobs for their employees, and returns for their investors.

I certainly believe that the insurance industry profits need to fall, and will fall as a result of our aging population and their requirement to cover people for whom they denied coverage in the past.  It is my hope that the CEO's and corporate executives of these companies will recognize this need also because they are Americans first, capitalists second.

Let the comments begin!!!



  1. Health care insurance plans always confuse me. There are loops that are hidden that they don't tell you so that you would agree with them. It's time to be honest.

  2. Every person should really have to have his/her own insurance healthcare plan for him/her to benefit from it a lot. health insurance continued education

  3. Weew, your letter being published to the Philadelphia Inquirer is such great stuff to be proud of! Congrats for that feat! :)

    Hmm, about your post, I still feel that there are still a lot of things that needs to be fixed with our healthcare system even though the Obamacare is already passed. I agree with your solution number two of having a plan for every state to cover all of their citizens because every state has its own problem that needs to be addressed. So with less number of citizens to be served, chances are, the better medical service in general.

  4. Employer provided health care plans are still available but the beneficiary .... One man's "free society" is another man's segregation or another woman's
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