Rational National Health Care
Revision 4, by William Bailer, written in 2010 before the
currently passed health care bill was voted on.
Please send comments to wbailer@frontiernet.net
Two of the regulations are dropped in this revision: the ones addressing
co pays and abortion, which are incidental to any plan, but which people
have irrelevant strong feelings about.
Dear Senators and Representatives [to be individually addressed],
If you want to be re-elected and not be known as one who voted for a
catastrophic health care plan that will take ten years to recover from,
please read this most sensible, illuminating few pages that will shock
you with how very wrong many assumptions are on which your current bills
are based.
I propose a plan, a very simple, practical, fair, inexpensive plan that
satisfies the demands of all who demand anything in a health care bill.
Incidentally, high income people now do pay the same rates as
those low income people who are not poor enough for Medicaid, and that is
continued in the current House and Senate bills (except for a hopelessly
complex and ineffective forest of tax credits, deductions, grants, etc.).
That must change in any national health care plan, as is the case
with every national plan in the world, except our
currently-being-considered House and Senate bills. You probably
have not studied the health care plans of other countries to see what
works and what does not. I have studied them.
This is not a 2,000 page mish-mash of hundreds of misdirected
useless unrelated excessively expensive and ineffective ideas like all of
the current bills before our legislatures:
bsp
The most serious fault of private insurance that must be corrected by the
plan:&n; Companies by their nature, are interested only in relatively
short term profits (within the life times of their employees who stand to
benefit from the success of the company), maybe something like a
projection of 40 years; they do not project their interests 75 years into
the future, which is closer to the life expectancy of an insured
person. Resultantly, they don't care to promote preventative
measures. This is compounded by the common psychological phenomenon
of people not planning for the future, irresponsibility, and
mismanagement of their funds, not buying insurance. There is little
incentive to be healthy, and there is actually an incentive for insurance
companies to ignore long term health. It is easier to sell cheaper
policies without preventative care to young people who think they cannot
get sick. Younger people should pay more now, for the
care they will get when they are old, the same way Social Security and
retirement plans work. Presently, the average age of the adult
uninsureds, is far below the national average. We cannot let the
folly of youth result in hardship when older. It is very easy
to change all of that by paying exactly in proportion to income tax,
actually collected at the same time as income tax, as Social Security now
is. It can be included in income tax, or accounted for separately,
like Social Security, if we want it to be paid for on a different scale
than income tax. Paying on the same scale as income tax is far
superior to and more fair than any other way in current bills, as well as
insuring everyone, which none of the current bills
accomplish.
This problem can only be addressed by health insurance regulation.
Insurance companies can have no objection to such regulation because it
applies to all companies equally, preserving features of each company
that distinguishes it in competition. All that insurance companies
are interested in is maintaining a level playing field, and of course
getting more business, which a universal health plan will provide plenty
of. For insurance companies, such a health plan (set of
regulations) is a very big win.
This plan is only a set of very inexpensively implemented federal
regulations. It is comprehensive, and the regulations mesh together
perfectly as follows:
1. Prices are the same for all individuals, independent of health
history or age. (Note that this also means that nobody can be
refused or dropped). Price varies only with optional features
offered by an insurance policy. (note that the House plan allows
charging old people as much as three times as much as younger people,
according to risk; how can anyone justify that? That is not
insurance; that is not sharing risk; it is more like "pay as you
go" with no insurance at all, hitting retired people
hardest.
2. No insurance will be sold through group plans or
workplace. That will eliminate inequities that exist because of
group plans for lower risk people that force non-group higher risk
insureds to pay more than they otherwise would. It is not possible
to have cost independent of risk otherwise.
It is a myth that employer insurance saves money. It appears to
cost less because non-employer insured people pay a subsidy in higher
costs. Employed people are younger, physically able, and healthier
than the general population. Overall, including those who do not
have employer insurance, the net cost is HIGHER because of
increased costs to employers to administer it. It is ridiculous to
burden employers as being insurance agents and collection agencies.
Why is it any more logical than getting insurance through your favorite
restaurant, grocery store, or school? --- the only
advantage is that the employer can take your money before you get it,
thereby forcing you to pay. Well, income tax does exactly that too,
in a way that is more fair to all and less expensive to
implement.
3. Cost to the individual must be independent of risk, based
only on income and the features of the offering, as is the case for
everything else paid for by income tax.
4. On a sliding scale, parents will pay more tax for each
child (to force financial responsibility for having more children),
although not to exceed actual cost. In other words, more than
three children per family will not be subsidized; low income families
will pay the national average cost for each additional child.
5. A base line insurance cost is determined for insurance that
offers at least all features of current medicaid, and all health
insurance companies are required to offer such a policy. Companies
compete by offering policies with more than medicaid offers.
6. Medicaid and Medicare, and all other government health plans are
eliminated. Those who have paid into Medicaid will be compensated
monetarily, OR, they can continue to get Medicare until they die off,
with no new people paying into or getting Medicare.
7. All current requirements of providers to offer free care, such
as Hill-Burton, are eliminated.
8. Every person is issued a voucher for exactly the value of that
baseline policy. That means everyone minimally gets insurance at
least as good as Medicaid, and anyone can use a voucher toward any more
expensive policies with more features, buying insurance in the same
manner as they presently do.
9. No state regulation may be less restrictive than federal
regulation. (federal takes precedence over state
regulations).
10. Insurance companies may conduct business across state lines,
anywhere they please, just as all other companies are free to
do.
11. Just as is now the case, health care providers may accept or
refuse any form of insurance as they please.
12. If a voucher is not used within an allowed time frame, the
voucher is voided, and baseline insurance is automatically
provided. Every resident, even if he does nothing, is automatically
insured with baseline insurance.
13. Just to be clear, the government will not directly offer any
medical services; not even Medicaid, which has been proven to be more
expensive than private sector insurance.
14. The government will not restrict or regulate prices of services
or drugs except as follows: The government will pass laws to
stimulate an increase in the supply related to demand. In other
words, more doctors, more less-than-doctors practitioners, greater use of
existing technology (run MRI's for 16 hours every day). Emergency
centers open 16 hours every day for non-critical cases, (instead of
hospital emergency rooms) are required to accept all forms of insurance,
including all people who have no selected insurance but will
automatically be covered by baseline insurance. If no ID, and any
indication of being an illegal alien, he will be reported and fully
investigated. By seeking medical services, he will not have to pay
anything, but he may be deported.
Resultantly, the many millions of people who have adequate or high
taxable income who now get medicare for free, will pay for insurance
through their income tax, thereby greatly reducing the cost for lower
income people. It is simply an extension of the usual sliding
scale income tax by which we pay for almost all other government
services. As things are now, low income people pay a much larger
proportion of their taxable income for insurance than for their
proportion of other government services paid for by income tax. In this
respect, the House's plan favors the rich and overtaxes the poor to a
much greater degree than income tax does. This does not make sense,
making poor people proportionately poorer than the rich. Universal
health insurance, especially health insurance, should be held to a
fairness standard at least as good for the poor as is income tax. The
only rational way to assure that people will be insured is to take their
money (as we do in income tax) and then allow them to "spend"
it only on health insurance of their choice, which is assured by
their money being in the form of a voucher. Everybody
is insured. Isn't that the primary goal? Isn't anything
short of that unworthy of even being called a national health care plan,
or coming to a vote?
The government can pass laws to control or regulate
anything! There is no reason for our government to go into
the health care business. They have already proven that when they
do it, it costs more than private insurance. In the hands of the
government, the system does not evolve --- it appears to work at
first because they are emulating private companies, but later when there
are no private companies, or existing companies have non-optimally
evolved to accommodate government insurance, there is nothing to
emulate. The system stagnates and does not evolve, as is presently
the case in some European countries and Canada. Their systems are
slowly disintegrating, not keeping up with changes in technology and
society.
It is a myth that most European universal health care plans are run by
governments. Actually, most insurance in Europe is private
insurance, most of the government run plans being only for the poor,
exactly like our present Medicaid, except more often by private
insurance. Many states here, including NY, already do that, and
save money by opting to buy insurance instead of paying for medicaid.
They even let the insured choose between two or more local
companies. Got that? Medicaid is more expensive than private
insurance, and the private insurance covers more, is more
flexible, and is accepted by 10 times as many doctors. Pay less,
get more. If you don't believe it, check it out (it is easy to find
a list of the states that do it). This is the way it is done in
most national health care plans that work. Some that have been
state run, such as ex USSR countries, are gradually switching to private
insurance, but retain previously established medical standards of
coverage and care.
Note that in this proposed plan, all medical services are paid for by
consumer-bought private insurance. The only role of the government
is in regulation, and using its already in-place income tax collection
service to collect insurance payments that otherwise are not voluntarily
paid for at present. Note that the majority of uninsured people are
uninsured by choice and can afford insurance. If they are to
be insured, they must be forced to pay. The way to do that is
already in place: income tax.
This numbered list of regulations makes sense; in fact, it is what the
best plans around the world are evolving toward being. If you vote
for a present bill, you will very deeply regret it, as the truth of the
incredibly misguided and misinformed assumptions rise as it is
implemented. The involvement of employers in the insurance business
will be injurious to the economy, and will take decades to repair.
The disaster will be beyond embarrassment. The confusion, higher
costs, unfair inequities, the burden to employers who know nothing about
insurance, restricted wages, and obstruction to enterprise, will make
most Americans feel cheated, and angry, and try to vote you all out of
office. The system I propose will eventually be implemented,
because it is the one that makes the most possible sense. It stands
as proof of the disastrous faults of the current legislation.
Almost none of the legislation has anything at all to do with what could
be called a national health care plan. It contains no plan.
If you do think there is a plan within it somewhere, what is it?
Can you state what the plan is? And most important of all, does it
insure everyone? Does the highest estimate of 96% (which assumes
voluntary participation that we all know will not happen) sound to you
the same as 100%? Is it not clear that people who now choose to
not buy insurance will only face higher insurance rates after the forced
employer scheme is in place? And of course because of that are even
less likely to participate? National health care, by definition,
cannot be voluntary. Penalties or fines for not having insurance
are blatantly ridiculous, counterproductive, and unenforceable.
How can anyone in his right mind not dismiss such a suggestion as just
plain silly.
Please do not be responsible for some of the most disastrous domestic
legislation in the history of our country.
Be one of the heroes who switch their votes to "no."
And be an even greater hero for starting new, sane legislation that
will lead us out of this morass, instead of burying us deeper in
it. The best solution, the only workable solution, is actually the
simplist, easiest, and most efficient of all that have been proposed in
the last 50 years
William D. Bailer
December 26, 2006 rev 4 (the actual plan has not been
revised, only the presentation and writing have been improved)
Please send comments to wbailer@frontiernet.net