Here are some ideas I came up for health INSURANCE reform.  Would love to hear your thoughts, positive or negative. 

  • Open up state lines – If you want to buy insurance, you are limited to buying insurance in your home state.  If you want to buy car insurance, you can buy it online, you can buy it from a broker who will shop around for a policy.  In my world, you would be able to go to a Health Insurance place, or many places run by the private sector similar to LendingTree for mortgages. 
  • No more suing for medical malpractice – Some might call this tort reform.  I propose doctors no longer have this worry in the back of their mind.  Instead of paying $100k a year for malpractice insurance, their premiums would be cut by 75% to pay into an incidental fund.  The doctors would come under more scrutiny but it would be more of a review process (paid by the incidental fund)  and require more participation from patient and doctor.  Both would have to document much more of the patient and doctor interaction.  This would allow for reviews and allow for standards in doctor patient treatment and allow for review of best practices.  Every other business measures this.  Why not review this?  Insurance companies pend a large part of their revenues on litigation – not anymore.  If something went bad, the largest amount awareded to someone would be $100k.  And that is when they put your heart in backwards.  Their would be a fee schedule to be paid out if something went wrong once this review panel decided as much.  Too much government involvment?  What do you expect?  That is all tort reform is….
  • Make a mandate – Everyone has to have insurance.  Period.  This will give the insurance companies much more capital to work with in order to account for the variation in risk model from removing some of the more conservative money making schemes they use, i.e. pre-existing conditions and recissions.  Everyone who owns a car has to have insurance in most states.  And when someone doesn’t, they are costing the rest of us in premium increases and increased liablity suits.  Not anymore.  Penalties are added to your tax liability to the Federal government if you should decide you dont’ want health insurance.  
  • No more recission – Insurance companies have a larger pool of capital to work with since everyone has to have insurance now.  You never have to worry about the insurance company bailing on you when you have a sickness.  You also never have to worry about going bankrupt when when you have an illness.  Your premium is based on age, dimensions, smoking or non smoking.  No other criteria. 
  • No more group policies – This will inject major capital into businesses and corporations.  They can then subsidize (pay their employees more) the insurance premiums that every individual HAS to pay.  Only family plans and individual. 
  • No more pre-existing condition clauses – What is your age?  What is your weight?  What is your height?  Do you smoke or not?  Deductible?  Ok, here is your premium. 
  • Medicare fraud  will close the hospital down and you lose your license to ever practice medicine – No more bullshit.
  • All medical records will conform to some electronic universally accessable format - I am not about putting your health records in the public library.  I mean that licensed practicioners will have acces to your medical records at the touch of a button.  Sure its encrypted, and the penalty for unwarranted intrustion is just about death.  We have the technology.  This will allow for easy diagnosis, and prognosis about the interaction of medicines and vacccines, etc.  Again we have the technology.
  • One bill for each visit - No more inter-hospital bureacracy to mess with.  If I go to Lancaster General, my insurance company gets a bill from Lancaster General.  I get my part from Lancaster General.  Lancaster General, get your shit together.  I might not understand billing, but I do understand that hospital administrators get paid a lot of money – administer your hospital.
  • Every policy has a MAXIMUM yearly out of pocket cap based on your finances  - You can never have your healthcare bankrupt you if you get really sick. 
  • Drugs can be bought from ANYWHERE – Let us let those free market principals work.  My asthma medicine costs $398.40 for a years worth if I buy it in Canada.  Same stuff different name.   When I didn’t have insurance, it cost me $250 for a month.  That is $2601.60 more here in America where it is made.  Sure my insurance pays for it, but that is what wer are trying to reform?
  • Bye bye health insurance salesman – No more commissions going to salesmen for health insurance.   You buy your insurance at a licensed exchange direct from insurance companies.  Since the only variation in policies is your deductible or the way the insurance companies manage their risk.
  • Your insurance company will pay even if you go see an out of state specialist? – We have waiting lines right now – but now you can take your referral to any specialist anywhere. 
  • Medicare for the elderly, and those that can’t afford to buy insurance including in some cases, children(without qualifying parents) - Medicare will now expand to pay for the less fortunate and those that are over the age of 65.  Formula to calculate less fortunate will be made broad enough to make sure everyone that can’t afford coverage, can get
  • What purpose does a pharmaceutical rep serve? 


How do we pay for it?

  • Remove wage base cap on Social Security and use those funds to fund Medicare changes  - Social security and Medicare taxes, also known as FICA taxes must be withheld from your employees’ wages. As an employer, you must also pay a matching amount of FICA taxes for your employees. Currently the social security tax rate is 6.2%. You are required to withhold 6.2% of an employee’s wages for social security taxes and to pay a matching amount in social security taxes until the employee reaches the wage base for the year. The wage base for social security tax is $106,800 for the year 2009.  Once that amount is earned, neither the employee or the employer owes any social security tax.  Not under my plan
  • Incentivize being healthy – If you have a personal trainer, or can show prove you attend a gym regularly, you can get credits toward your health insurance premiums.  I am sure there are other ideas out there.
  • Repeal Bush tax cuts – The fact that businesses no longer have to pay for insurance will be a major incentive for them to hire and pay their employees more.  Strongly penalize tax fraud and illegal tax sheltering. 
  • Cut down on Medicare abuses and frauds – Make these penalties worse than selling crack to children – you are defrauding the country! 
  • Appropriate $20 billion and set a deadline for 2012 for all medical records to be digitized.  We have the technology.
  • Fund Medicare like we do Militairy.  Make it a non-partisan issue!!  Give Congress power to review medicare systems..  Set up standards, guidelines and make it happen.

No matter how you slice it, there needs to be regulation and the government has to get involved.  If you think the status quo is ok, then you don’t know anyone who has had cancer, or has been sick, or has been denied insurance for a pre-existing condition.  The more I look at these ideas, which I have aggregated from both sides of the argument, the more I tend to believe that perhaps the best solution is to just expand Medicare for all.  Fix it, and expand it to cover everyone.  Businesses would be flush with capital.  The increase in taxes would be easily balanced with increase in wages across the board.  A progressive tax policy is important for sustaining our Medicare and Social Security and road building, firemen, policeman, etc, etc..  Everyone that has a small understanding of numbers can quickly figure out that the richer you are, the less taxes you pay. 


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7 Responses to “Health Care Reform Ideas”

  1. Judah Hoover Says:

    Nate you start off strong but you start to go shake in the middle and by the end you completely lose me.

    If we keep this a private/ free market matter there is no need to ask the question “how do we pay for this” there is nothing “we” need to pay for. So none of the things listed under this section need to be done to make insurance/medical care better. (other than the one about fighting fraud, I am all for that)

    I don’t think we should eliminate insurance sales men. They bring in customers for the insurance companies and get paid a fee for doing it. then the insurance company doesn’t have to have the cost overhead/liability of the larger sales force. And customers get someone that represents them and can impartially shop. Kind of like us mortgage brokers…

    The Car insurance vs. health insurance comparison is a bad one. The only car insurance that is required is “liability coverage”. If states required “collision/comprehensive” you might be drawling a logical parallel, but they don’t so you’re not. health insurance run the way you are talking about would be like requiring car insurance to pay for new tires, state inspections, and every time I fill up on gas. Oh but preventing accidences is helpful so if you change your headlights and wiper blades we will give you a tax credit.

    Every policy has a MAXIMUM yearly out of pocket cap based on your finances
    -you can’t set up this type of safety net in a free market. This will not work. who pays the difference on those years? Answer: Everyone else in the plan, that is back to me/us paying for your health insurance.

    I like a lot of your ideas, and some I don’t like but can go half way on… but some of this would lead us right back to were we are.

  2. Nate Says:

    You say I start off strong and lose you. I would expect you to clarify how any completely free market solution wouldn’t put us where we are now. Thank you for your comments. Thank you for reading!

  3. Twitted by natebomberger Says:

    [...] This post was Twitted by natebomberger [...]

  4. Judah Hoover Says:

    My ideas are the same as yours. I really like a lot of what you wrote, I only took time to point out our areas of difference. You are right on with tort reform and open up state borders to competition. As to your car insurance analogy, I shouldn’t have said “illogical” I should have said it is a Non sequitur, but then I get accused of using big words. Car insurance that is required is vastly different then medical insurance. Maintenance and ware & tare items are not covered by car insurance. and they shouldn’t be completely covered by health insurance, otherwise the system gets over used by some and breaks down over time.

    The idea that will save us the most in our health premiums is allow people to buy what they want. Policies that are mandated to cover rare and unusual conditions jack up the price for everyone. If you are in your 20s basically healthy and you want a streamline policy you can’t get one, it is illegal to sell. You have to be covered against every possible illness out there, so young people decide not to participate.

    Eliminate tort, eliminate state boarders and the problem is 90% fixed right there. I am scared about “over fixing” health care. Let’s just do those 2 things, things you say you are for, let’s do nothing else and let’s see what happens.

    To answer your request directly:
    “where we are” is too much government regulation. Free markets have not led us “here”. A little intervention caused this problem, the way to solve it is not with more.

  5. Eric H Says:

    That’s unfortunate that you can only understand the first part Judah. I would be ashamed if I did not understand things like one bill, mandating insurance, no pre-existing conditions, policy caps, affordable drugs and no more group policies etc. It would behoove you to try and grasp the concepts because this type of legislation will be passed soon.
    Free market is great, I am all for it, but we also have a “government of the people, by the people, for the people.” FOR PEOPLE adding a public OPTION to the market would benefit people. So “we” DO need to figure out a way to pay for this. We are talking people, human beings not machinery or automobiles. So I must refute your argument on wiper blades, gas etc. If I need blood or an injection in my eye I should get it. If we would have a universal health care system then everyone would pretty much be offered the same great coverage, so really would we need salesman if we knew the coverage was standardized? Nate made a simple comparison to car insurance being mandated by states. He was not saying both should be run exactly the same. Maximum out of pocket caps are already a safety net that currently exist in this market. Go look at your policy. I love how “jacks the price for everyone” comes before saving a persons life, real nice and humanitarian statement. Young people don’t buy insurance because it’s to expensive for them, a government option would be a streamline for EVERYONE! I am still trying to figure out how a little intervention resulted in skyrocketing premiums, absurd deductibles and less coverage.

  6. Eric H Says:

    With billion dollar profits!

  7. JHC Says:

    Nate, I truly love all of your ideas. Really. I’m especially with you on tort reform, because I think a lot of really wonderful doctors are forced out of practice by the ludicrous cost of malpractice insurance. Oddly enough, the only place I’d disagree is putting a cap on malpractice rewards. If a patient is truly deserving of compensation for a medical wrong, $100K will hardly cover it in many cases. (Just as an example, I’m thinking of cases like babies with brain injuries caused during birth where the doc was clearly liable and now the parents have decades of expensive medical care to deal with, etc. etc.)

    But really, that’s a very small “i disagree” amidst my resounding “YES!”

    You really seem to get it, man. Nice work.

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