Health Care's Needed Changes

 
Health Care's Needed Changes from Allen Buckley on Vimeo.
(To watch video in FULL SCREEN, click this button in the above viewer)

To pay for a full coverage national health care system (i.e. a monopoly), taxes would need to increase by approximately 50 percent. Consider the many problems of national health care systems abroad caused in a large part due to lack of choice and lack of competition. Some people don’t need health care. Everyone needs food and shelter. It is not logical to make health care an entitlement if food and shelter are not entitlements. (I do not believe in making food and shelter entitlements.) The major parties have come up with absolutely no solutions whatsoever to these problems. There are two primary problems with our system: (1) there is not enough competition (and laws exist to prevent competition); and (2) private health plans with (a) co-pays and (b) deductibles, co-insurance and the full (100%) coverage do not create enough incentive to reduce spending. According to testimony of Peter R. Orszag of the Congressional Budget Office on June 17, 2008 in a document titled The Long-Term Budget Outlook and Options for Slowing the Growth of Health Care Costs, Mr. Orszag said: "On the consumer side, a landmark health insurance experiment by RAND showed that higher cost sharing reduces spending-particularly when compared with a plan offering free care-with few or no adverse effects on health." I believe that we do not need a single payer system. I believe that we need more competition and more incentive for individuals to maintain coverage and control costs. See: Health Care Analysis PDF.  Provided below are some changes that I would like to see made:

1. As a condition of receiving Medicare and Medicaid funds, require hospitals to make their charges readily available in an understandable manner and to make three (3) or more provider options available in advance of medical procedures, operations and child birth (instead of the current scenario where the patient receives the services of the provider with which the hospital has contracted) so that people can choose, for example, the anesthesiology group to supply their anesthesiology services.

2. For individuals who do not receive health coverage from their employer, allow an above-the-line income tax deduction or a refundable 28 percent tax credit (at the election of the taxpayer) for health coverage premiums up to the average high deductible health plan (HDHP) premium amount for the person’s coverage status (single or non-single), while continuing to allow tax-deductible contributions to HSAs and flexible spending accounts (FSAs). The exclusion for employer-provided health coverage should be limited to the average HDHP premium amount for the coverage type (single or family). With respect to contributions to HSAs, individuals should be able to elect either an income tax deduction or a refundable 28 percent tax credit.

3. Require any co-insurance percent (paid by the patient or insured) to equal or exceed 25 percent in order for insurance to be tax-deductible.

4. Wellness program concepts need to be incorporated into Medicare and Medicaid (i.e. less costs for individuals who do the things necessary to be healthy).  The current 20 percent maximum wellness disparity for employee costs under employer plans should be increased to 30 percent (so that a wellness program may cause premiums for someone who passes all wellness components to be 30 percent less than the premiums paid by employee who either does not participate in a wellness program or participates and does not pass any components).

5. As a condition of receiving Medicare and Medicaid funds, after installing an easy system for collection (similar to the IRS’s powers to collect), require hospitals and all other health care providers to pursue all people for payment for any services rendered (including emergency medical services).

6. As a condition of receiving Medicaid money, states should be required to: (a) make at least one cheaper basic health insurance option available and to allow coverage waivers (i.e. exclusions) for non-genetic uninsurable conditions; and (b) eliminate or substantially eliminate Certificate of Need (CON) laws.

7. Small business should be allowed to associate (i.e. group) to receive group health discounts.

8. As a condition of using a simplified collections system, require providers to participate in a secure national health care database. Such a database should result in better care and cost reductions.

9. Change Health Savings Accounts (HSA) rules so that the "comparable contribution" requirement (whereby an equal amount must be deposited  by the employer in HSA accounts of all similarly situated participants) to a "similar circumstances" requirement (whereby employer contributions are required when similar medical needs exist in terms of costs) or a "similar percentage" requirement, whereby an identical percentage of employee costs are contributed to HSA accounts potentially subject to a cap.

10. Provide VISAs to foreigners with medical expertise to fill shortages.

11. With respect to people who maintain health coverage for many years, a system needs to be implemented with state involvement to cover part of the cost of uninsurable conditions.

Note: On July 9, 2007, the Congressional Budget Office (CBO) reported that if health care costs continue to grow at the rate that they have over the past four decades (i.e. at a rate of 2.5 percentage points greater than the per capita GDP growth), and raising tax rates will be the only solution to the problem, then by 2050 the income tax rates will need to increase from 10 percent for the lowest bracket, 25 percent for the middle income bracket and 35 percent for the high income bracket, to 26 percent, 66 percent and 92 percent, respectively. (During World War II, the highest income tax rate was 94 percent.) Also in 2007, the U.S. Government Accountability Office (GAO) reported that, in large part due to health care costs, state and local governments will experience significant fiscal challenges in the future, with the problems beginning within ten years.