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MEMBER DIARY

What ‘Free Market’ Health Reform looks like…

Come 2016, what 'Repeal and Replace' should do:

We’ve all heard it before, from some lefty somewhere… ‘You Republicans are just the party of ‘No’…

You hate Obamacare because you hate Obama, but you don’t have anything better…

So, how about we ask: What *WOULD* be better?

  1. End ‘Whole Office’ Group PlansThe fact is, in economic terms, having your employer purchase insurance for all employees as a ‘group’ is almost as bad as single-payer!

    One of the biggest falsehoods in health-care today, is that it is somehow cheaper to insure an office of 100 people, than it is to write 100 individual policies. People have learned what a ‘volume discount’ is with regard to manufactured goods (See ‘Groupon’), but they fail to realize that there is no comparable volume discount for personal-services such as health care… In reality, It’s NOT cheaper to buy as a pool – in fact it’s MORE expensive…

    When you allow someone to consume without also paying the price of what they are consuming, there is no economic incentive to consume wisely. ESPECIALLY if the ‘payer’ has deep pockets, like a government or an insurance conglomerate. It is NOT a coincidence that the 2 areas of the US economy with wildly above-inflation price growth, are the ONLY two areas of the economy where the consumer is not personally paying for the service (Health Care & Higher Education).
    To accomplish this, we (a) tax pooled-group health insurance as income, and (b) prevent employers from deducting it as a business expense, while (c) making the purchase of an individual policy tax-deductable and (d) making the payment of a stipend for the purpose of individual-policy purchase a deductable business expense.

    Employers would be allowed to pay employees a health-stipend, which would be tax-free & deductable against corporate taxes. But there would be no more ‘employer buys the policy, employee consumes the care’ model to distort the pricing of the health-care market

  2. Replace the ‘individual mandate’ with a limit on coverage for pre-existing conditions
    If you think about it, our ‘individual mandate’ prior to Obamacare, was the ‘standard rules’ of the insurance market: You are only covered for things that happen after you buy your policy.Now, in the interest of competition there has to be *some* mandate to cover pre-existing conditions that occur under a competitor’s policy – this ensures that people can actually change plans when they want, rather than be ‘trapped’ in an under-performing plan. And logically, there should also be a ‘grace period’ to allow you to change without risking ‘pre-existing’ denial.

    However, there should NOT be universal coverage of all pre-existing conditions. This acts as a ‘free market mandate’, which encourages people to buy at least some insurance rather than risk financial ruin if they need care.

  3. Require Medicaid/Medicare to pay the average private-insurance reimbursement rate for all care providedThe ‘Medi-programs’ currently drive prices up by demanding lower-than-cost pricing for services provided to their benficiaries.

    This needs to be outlawed. Medi-programs need to pay the same rate that private-sector insurers are paying, rather than undercut the market with the ‘power of government’ and force everyone else to pay more in the process!

  4. Ammend EMTLA to restrict mandatory unpaid ER-care to immediate life-limb-and-eyesight conditions, and make ER bills not dischargable in bankruptcy (with garnishment).Simply put, we *do* have to do something about people playing dine-and-ditch with the ER.

    The solution is similar to the one adopted for student loans: No more dumping your ER bill in bankruptcy. Since so many hospitals are publicly funded, this is essentially ‘ripping off all of us’, and it needs to be stopped…

    Further, hospitals need to be able to turn away non-paying patients who are not truly having an emergency, without fear of lawsuit.

  5. Eliminate all coverage mandates.Insurance should be ‘a-la-carte’ just like car insurance. Those who want full coverage can pay for it… Those who don’t, can pay less.

    There is no reason to require a childless couple to pay for a policy which features ‘children covered until 26’… No reason for an individual who can’t have children to pay for contraception & pregnancy coverage… There’s really no reason for a 24yo to pay for ‘full coverage’ of aging-related diseases… And a family who’s 25yo child is in the Army doesn’t need ’26yo child coverage’ because theirs gets full-coverage medical from Uncle Sam….

    In the same sense that you can choose what coverages you do and do not want on your car insurance, health insurance should be the same way… Want ’26yo child coverage’? Check the box & pay a little more… Just want ‘catestrophic event’ coverage, because you don’t consume any ‘preventative care’, perscriptions or other ‘health services’? Go ahead…

  6. Make it explicitly legal to impose ‘unhealthy lifestyle’ premium increases
    Right now, the 300lb dude who smokes 6 packs a day & swills an entire half-gallon of Monarch Vodka every night pays the same for his insurance (via ‘group plan’ coverage) as the 150lb nothing-but-water marathon runner in the next cube…

    This should change, and there should be immunity from lawsuits for doing it… Smoke? Pay us… Get a DWI? Pay… BMI over 24% (or 26 for women)? Pay (pay even more if you also have high LDL while being fat)…

    Since statistically, people who drink too much, smoke, use drugs, and/or are fat cost more to insure… It should be explicitly legal to charge them more without fear of a discrimination suit…

  7. Tort Reform.
    For many, many reasons – but that’s a whole ‘nother diary entry…

With these in place, most of the desirable concerns – such as inter-state marketing of care, will happen because the market demands it…

Individual-purchase policies and a ‘portability requirement’ will make health-insurance a competitive commodity like car-insurance, with the resulting downward pressure on prices…

With no coverage mandates AND no group plans, insurers will come up with all sorts of unique ‘coverage options’ in the same way that the internet-car-insurance revolution brought us such features as ‘accident forgiveness’, ‘vanishing deductible’, and ‘newer car replacement’…

It will just work… People will like it… If we can pass it…

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