Real Health Care Reform- Part 8: Putting It All Together
For anyone who has read this series, it is obvious that it stands as the anti-Obamacare solution to health care reform in this country. It is based upon the premise that informed consumer choice and competition- two hallmarks of a free market- are the mechanisms that will drive health care costs down and make it easier for most to have insurance. Even if not, there would be a social safety net still in place. The alternative- socialized medicine- and its bastard sister, Obamacare, are a debacle as has been proven in other countries. There are some “good” elements of health care in other countries, but by and large, socialized medicine necessitates the rationing of services or exorbitantly high taxes to fund the entitlement. Both run counter (or they should) to basic Republican core values. It is also an unmistakable fact that the government is notoriously terrible in budgeting estimates and the administration of basically any social service. How many times has the CBO released revised estimates of Obamacare’s cost three years after the fact? And those costs are not being revised downward.
(1) Fundamental tort reform where there would be regional resolution boards to decrease the amount of frivolous malpractice lawsuits. Payments would be funded by the insurance industry and surcharges on policies. The boards would have the authority to make awards and allow only the most serious instances of malpractice to go to trial. Even still, jury awards would be capped. Additionally, all board decisions would be made public.
(2) Policies would be written that reflect premiums based on demonstrated lifestyle choices such as weight loss and smoking cessation.
(3) There should be no denial of insurance for pre-existing conditions and children should be permitted to stay on their parent’s policy until age 24. These are two aspects of Obamacare that, if I remember correctly, where there was minimal Republican objections.
(4) Cease the special tax treatment for employer-based insurance thus eliminating government-created distortions in the insurance market.
(5) The government’s role here has to be the provision of subsidies in the form of tax credits or refunds on a sliding scale basis up to $50,000 AGI indexed to inflation that are used towards the purchase of private insurance
(6) There must be a mechanism that encourages people to purchase health insurance that is not a mandate or command from Washington down the barrel of the gun of tax penalties. Also, there must be a mechanism to encourage employers to divert the cost of health care benefits into higher wages for workers to give them added impetus to purchase insurance.
(7) Americans must be offered health insurance policies tailored to the individual or family’s needs and wants, not one-size-fits-all policies dictated by the government or employers.
(8) Health Savings Accounts should be expanded and encouraged and should be allowed to roll-over year to year until a threshold is reached.
(9) The federal and state governments must adopt policies that allow the entry of insurers into new markets and that allow insurers to innovate and specialize. This can be achieved through the removal of regulations that deter competition in the insurance market.
(10) The sale of health insurance across state lines must be allowed with mandatory coverage for catastrophic instances and a certain minimum of “basic” coverage. Basic coverage would be those items currently mandated in at least 26 states. Within that basic coverage, consumers should be offered to partially opt out in exchange for lower premiums. All other items currently available could be offered, but would be optional with respect to the consumer. Additional “basic” coverage items can be added in the future as more states mandate certain coverages.
(11) Policies should be clearly written and explained to decrease disputes.
(12) Policies should be written to given maximum flexibility with respect to the needs of the consumer and allow, in exchange for lower yearly premiums, higher deductibles and co-pays by consumers.
(13) Repeal the antitrust exemption for health care insurers and vigorously enforced against market monopolies with respect to insurers in any state.
(14) Facilitate all efforts to detect insurance fraud, especially with respect to Medicare and Medicaid, with criminal penalties for convictions in addition to repayment of any ill-gotten funds.
(15) Conversion to digital medical records by all providers. The cost would be written off on their taxes 100% upfront. Failure to convert would result in lower Medicare and Medicaid provider reimbursements. Hence, the government holds both a carrot and a stick.
(16) States should be allowed to cap mark-ups on surgical, medical, and pharmaceutical supplies in hospitals that receive any government funds from any source, IF they so desire.
(17) Physicians need to be encouraged to use the least costly technology provided it is equally efficacious in patient outcome.
(18) The government should pay for the medical education of general practitioners, not specialists, provided they agree to serve in under-served geographical areas after residency, be paid a predetermined yearly salary (maybe $60,000) and that would be exempt from federal income and payroll taxes if they serve that area for a specific number of years (maybe 6?). If they fail to abide by their end of the bargain, the educational grant would convert to a student loan with interest.
(19) Decrease the number of medical errors through comprehensive primary care physician (general practitioner) coordination of treatments and diagnoses, with second opinions to enhance consumer choices in consultation with their doctors. The doctor-patient relationship should never be dictated by any government based on “best predicted outcome” models.
(20) Facilitate and encourage retail clinics to handle non-emergency medical needs, innoculations, and the like.
(21) Remove costly regulations that increase the cost of new drugs entering the market.
(22) Cease the costly multiple approval process for drugs (such as separate approvals for tablet versus capsule forms).
(23) Allow the importation of drugs from foreign countries provided they meet safety standards in those countries based on minimal FDA standards.
(24) Remove regulations that prohibit the timely introduction of drugs that would create competition within pharmaceutical classifications provided there is no patent infringement.
(25) After effectiveness has been established by the FDA in streamlined testing, further monitoring of effectiveness should be tasked to the FTC with the FDA monitoring future safety.
(26) Cease automatic enrollment in Medicare if the person is still in the workforce.
(27) Medicare would be restricted to current beneficiaries and only to people 67 and older in the future with age being the only requirement for benefits.
(28) Permanently repair the so-called “doc fix” by unlinking the Sustainable Growth Rate to GDP.
(29) Essentially transform Medicare along the lines of the Ryan plan which is based on consumer choice with government subsidization that is means-tested.
(30) Revise federal Medicaid funding guidelines and direct money to states where it is most needed based on an equitable formula with the funds disbursed from a strictly budgeted predetermined amount that decreases gradually over time.
(31) Allow the states wide latitude to institute Medicaid reforms that address the needs of their citizens without attaching strings to the federal funds.
(32) Cap the per person amount of dedicated Medicaid funds from the federal government.
(33) The federal government would not dictate coverage for Medicaid for anyone over 225% FPL, or $50,000 annual household income for a family of four.
(34) Experiment, at the state level, with Medicaid vouchers that would be used for the purchase of health care insurance for current and future beneficiaries. Again, no federal government strings should be attached.
(35) Establishment of state Angie List type programs regarding doctors and hospitals that inform consumers about insurances accepted, charges for services, patient outcomes, and other information. This would further empower consumers in health care choices.
A final thought before I finish up this series. Republicans are often portrayed as the “great deregulators.” Democrats try to portray the GOP as a party that wants to run roughshod over consumer protections in the name of deregulation. That is patently not true and patently not fair. Republicans are for regulations that empower consumers to make informed choices so that they may succeed or fail on their own terms. Information is a powerful tool in a free market and any regulation that furthers that goal only makes the market stronger.
Obamacare codifies the status quo at best and socializes medicine at worst. There may be success stories of socialized medicine in foreign countries, but those regimens are certainly not free market and in the overall sense, are hardly success stories. To believe otherwise is to accept a Michael Moore view of health care reform. If Cuban health care is so great, then let Michael Moore go to Havana to see his doctor. In neighboring Canada, several women every year opt to deliver their baby in an American hospital across the border. I do not see many Americans going to England or Sweden for knee replacement or cataract surgery, but I do hear of Brits and Swedes coming to America for procedures we consider routine. Of course, rationing and price controls would hold down costs, but at what cost? In effect, we would be surrendering our freedoms in exchange for slightly lower prices and longer lines and waits with lower quality. The free market, not government directives, dictates, mandates and bureaucracy, will drive health care costs down for all while making health insurance more accessible to all. As Medicare has proven, heavy government involvement is the last thing Americans should want as a replacement for Obamacare. Because government programs have so distorted the insurance market, the government’s role now must be extricating itself from the market as much as possible and as quickly as possible while empowering consumers- both in choice and in the pocket book- to make health care insurance decisions for themselves and their families without the heavy hand of government.
It is ironic that Liberals and Democrats often state that conservatives and Republicans have no new ideas, or no ideas at all. Listed above are 35 commonsense ideas none of which you will find in over 2,000 pages of Obamacare. It can be comprehensively or it can be done category-by-category or piecemeal if need be. It does not rely on mandates as a framework and it forces no one into commerce so that they can then be regulated.