Monday, March 22, 2010

How I Would Provide Health Insurance to the Uninsured

In light of the monumental monstrosity that, rather than solving the health insurance problem for millions of Americans, will much more likely bankrupt our country, I have been asked to provide a description of how I would provide health insurance to the uninsured.  Here is a stream-of-consciousness list that I put together off the top of my head. How did I do?


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1. Ask them if they want to be insured.  If they don't want to be insured, remind them that certain pre-existing conditions may not be covered in the future if they choose not to be insured. Create a separate statistic entitled: "Uninsured by Choice", and stop using this segment of the population as a battering ram for federal takeover of health care.

2.  Allow health insurance companies to provide cafeteria-style health care plans.  Do not require health insurance companies to provide one-size-fits-all plans that cover, in some cases, everything from Botox to hangnails.

3.  Do not allow insurance companies to declare conditions acquired during a period of insurance coverage as pre-existing conditions.  They are not pre-existing.

4. Require health insurance companies to be non-profit organizations.

5. Remove ALL federal legislation that allows health insurance, pharmaceutical, and other health care companies to operate in quasi-monopoly status. (See the book "Who Killed Healthcare?"

6. Prohibit the American Medical Association from limiting the number of students who want to become doctors.

7. Encourage civic, governmental, and religious leaders to mount their bully pulpits and remind the people the importance of being a Good Samaritan.

8. Admit that federal administration of Medicare has been a colossal failure, and transition the program over a period of years to the States.

9. Require states to show "full faith and credit" to other states by requiring them to provide the same or similar health insurance coverage to anyone who moves into their state with a health insurance policy.

10.  Allow anyone to purchase any health insurance policy in any state.

11. Require that all Insurance Companies offer a Health Savings Account as an insurance policy option.

12. Require that companies increase employees' salary in lieu of the hidden employer costs that are currently paid to "pool" health care plans, thus giving the employee more ability to find and afford the health care plan that he or she prefers.


19 comments:

  1. These ideas are way too effective to ever be actually enacted.

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  2. Wow Frank, No #1 is HARSH!

    "1. Ask them if they want to be insured. If they don't want to be insured, remind them that certain pre-existing conditions may not be covered in the future if they choose not to be insured. Create a separate statistic entitled: "Uninsured by Choice", and stop using this segment of the population as a battering ram for federal takeover of health care."

    ...and if they choose to not be insured, and they get sick, we let them die?

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  3. Many good points. I take issue with number one, as I pointed out in the conversation on FB. If all the low-risk people leave the insurance pool, so that the remaining people are high-risk (cost), that will improve the health care system?

    (I don't know of anyone who is voluntarily uninsured. Every single one, including myself in the past, was uninsured because they couldn't afford it.)

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  4. Who asked you in the first place Frank? That stream of nonsense doesn't sound like it came from the top of your head. It sounds like it was pulled from another lower part of your anatomy.

    It amazes me that you keep embarrassing yourself with this sort of drivel. All you end up doing is proving to the rest of the world that you are just not that bright. You are indeed a simple mormon. At least you picked an appropriate title for your blog.

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  5. HEY ALIBERALMORMON I'm one of those people. Just for your info. My mom was until she passed with cancer. She choose to forgo life prolonging treatment in order to have a more quality of life. And yes, Cliff they die. Everybody dies Obama hasnt figured out how to write a bill stopping all death yet. And, Frank yoiu did good just a few of these would dramatically imporve the health care but as Cameron said there will never make it.

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  6. Frank, this is a really interesting list. Coming from someone who I think one might justifiably label as conservative, a number of your points would be heartily supported by progressives as well. Of course, they would not be supported by lobbyists for any of the concerned industries so have no chance of being enacted, but it does show that the partisan divide we hear so much about is not as wide a gulf as we are led to believe.

    I agree with #4, #5, #6, and #9 exactly as you state them. If we are to retain a system where insurance is to be provided by private institutions rather than government, then it is imperative those private institutions be required to actually perform the service for which they are being paid. That said, I cannot imagine that anyone (save those who need mental health treatment) would reject insurance if they could be afford it. I also see nothing to be gained by permitting insurance companies to design complex plans so that consumers will be unclear about what is and isn't covered.

    The key to eliminating the employer-based system of health insurance is controlling costs. Eliminating monopoly and profit will certainly help, but once those factors are gone, we are left with cutting benefits and in the case of lifesaving or life-preserving health care, that is not an option. I fail to see how we make a large enough dent in costs without getting drug costs under control. This article has some good ideas that could work. Another factor is preventive care. Americans tend to wait too long to get medical attention because of cost and when they finally get to the doctor or hospital they become expensive patients. It's hard to figure how even a non-profit could offer affordable comprehensive care.

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  7. vCharles D. Interesting you should mention mental health. One big problem rarely discussed is that poverty and homelessness frequently have a mental health component. I fail to see how any of the conservative reforms do anything to expand the long-term services which the mentally ill require to be functioning members of society, which would then help reduce homelessness, hunger, and other poverty-related issues.

    Anonymous, I'm sure there's a few of you out there. I doubt many. Lets assume there are many of you: what then of the consequences for the concept of insurance if all the low-risk individuals leave the pool?

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  8. I agree with you aliberalmormon. Mental health is the red-headed stepchild of the health insurance system as it is. Even if you have coverage (and usually those with the most severe illnesses don't), the coverage is not adequate. One of the most onerous features of the new private health insurance preservation act is the individual mandate, but without everyone in the pool, no insurer could afford to cover the sickest Americans. Of course, it remains to be seen whether they will choose to use their new-found income to pay claims or pay executives.

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  9. I think that mental health should be covered, but I think it only works if cafeteria-style plans are offered, so that those people who don't want mental health coverage don't have to pay for it.

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  10. The problem with cafeteria plans is that the insurer sets the pricing so it isn't really a matter of whether you want a particular type of coverage, but whether you can afford it. In such a plan, a prudent individual would want to select coverage for conditions he either had or felt he was likely to have - in other words, each coverage type would get populated by those most likely to use it, driving up costs even further.

    The most cost-effective approach is to create a minimum mandated level of coverage that is comprehensive and then requiring everyone to purchase (or purchase for them) at least that level of coverage. That spreads the risk and makes it rational for an insurer to provide the coverage. That won't really address the main cost issues, but it at least doesn't make them worse which a cafeteria plan would do.

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  11. Frank, most people with schizophrenia, for example, are in no position whatsoever to even consider buying health insurance. They're homeless. Having insurance companies offer coverage, allowing people purchase across state lines, etc, won't accomplish anything for them.

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  12. Excellent point. We need to take care of them. If families can't do all it takes, then communities, and if not them, then states have the resources to provide health insurance and other forms of welfare for them as needed.

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  13. We've heard this before. Families are no longer able, if they ever were, to care for severely mentally ill relatives, and communities in the sense you mean (churches, civic volunteers, etc.) when present usually don't have the funding, the resources and/or the will to take on these tasks. States could absorb the responsibility and cost of proper treatment for mental and physical health of those less fortunate within their borders, but with what revenue? The same folks who are always telling us that the states should take over this or that federal responsibility are the same folks who oppose every tax increase.

    We have to recognize that we don't live in the world of the 18th or 19th century any more. We live in a world where families are under constant economic stress because of wage stagnation and increased living costs. Community organizations are finding fewer and fewer members with the time, money and energy to volunteer. States are reeling from the economic crisis and the reduction in revenue due to tax cuts and lower federal revenue sharing. Let's don't kid ourselves that any of these institutions is able or willing to absorb additional responsibilities.

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  14. Frank, very few families in the nation can afford the costs of chronic and debilitating mental health problems. I doubt communities can or would do it (the Church has either not been able or willing to take care of the long term costs of a family member's serious bipolar disorder, for example).

    If you believe states can and should be involved in the funding of mental health care, then you agree that government can redistribute wealth for health care purposes?

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  15. Yes. States can redistribute wealth for health care purposes. The Federal government cannot. The General Welfare Clause of the Constitution and the 10th Amendment indicate that if anything, health care would be a state function.

    Nor should the federal govt be involved in health care. It's too far removed from the problems. It's not very good at doing it.

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  16. Frank, Article I Section 8 says "The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States". That would obviously mean that the general welfare was intended to be a federal responsibility and renders the 10th amendment argument superfluous.

    But even if one were to concede that point, how many states would actually enact legislation that would have the effect of significantly redistributing income? How many states would enact comprehensive affordable health care plans? I would wager that the number could be counted on the fingers of one hand. While some might believe Americans to be the sort of virtuous people who would never let a brother or sister die for lack of care, but that is not the case. For far too many, the political ideology that refuses to consider government as a possible solution outweighs the moral imperative to care for a fellow citizen in need.

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  17. OK, then: Should the feds regulate fire departments and police departments? That, according to your definition is the general welfare. Should they create zoning and other land use laws? That, according to your definition is the general welfare. Should they regulate what a farmer grows on his own land and feeds to his own cows? The precedent was firmly established that that was an absolutely silly proposition until FDR came along and Wickard v Filburn overturned decades of precedent. I'm not sure why precedent is important unless it doesn't comport with what you think the precedent should have been.

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  18. Frank, in our recent exchange on FB, you said "I'm not sure if this is what Liz was getting at, but from a fundamentalist Constitutional perspective, redistribution of wealth for health care ISN'T something that the force of government can be used for." city councils and state legislature is "government" just as much as Congress is. That is the sort of thing I mean when I talk about the overly broad conservative cliches. Once we agree, as we now do, that government rightfully can be involved in "wealth redistribution," then we can have constructive dialogue about the level at which the problem is best handled.

    Along the same lines, I would point out that your above statement that "nor should the federal govt be involved in health care" is belied by your assertion that federal regulations should stipulate that all states honor each others' insurance provisions. That is an involvement in health care.

    I would suggest that the there may be a need for further involvement by the federal government than you're suggesting. If we leave all health care, such as mental health care, to local municipalities and states, there may be a race to the bottom. Some cities will refuse to allocate funds for services for mental health care (there are few homeless and mental health resources in Davis County, for example). The homeless/mentally ill population then moves to places which do honor their responsibility to help those populations, with the result being that the resources there are swamped, and that city becomes unable to handle the workload. In other words, one community foists the costs of the mentally ill and homeless on other communities. That is an unsustainable model. How do we prevent this without some sort of federal involvement?

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  19. Obviously decisions about which level of government should undertake to provide which services for the general welfare should be made based on utilitarian concerns, not ideology. We have reason to believe that local government provision of local fire and police services is more effective than the state or federal government would be.

    There are situations and conditions that make federal intervention necessary, even in areas where government has not taken a role. In the 1960's, the federal government had to intervene to protect the rights of African-Americans to vote and be treated equally in public accommodations because states and localities were denying them those rights. In times of dire economic distress or in wartime, it is necessary to enforce rules (like how much wheat to grow) in order to provide for the "general" welfare. The general welfare of the people of the United States is what the Constitution talks about, not the specific welfare of Roscoe Filburn or anyone else.

    So when should the federal government "provide for the general welfare"? That's a decision the Constitution appears to leave to Congress. I would hope they make those decisions based on what is good for the vast majority of Americans and on what is the most effective way of providing the service.

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