"He who does not think himself worth saving from poverty and ignorance by his own efforts, will hardly be thought worth the efforts of anybody else." -- Frederick Douglass, Self-Made Men (1872)
First of all, at age 70, you've got medicare already, so lets not concern ourselves too greatly with the elderly, although Medicare could use reform as well. Obviously nobody "chooses" to get cancer. If, in your scenario, the government is requiring that insurers not only accept these patients and their pre-existing conditions, then I only see two options that are viable. Have insurers be allowed to charge the extra premium they need to remain in business, or have the insurers determine the premium difference, and the government susidizes that difference back to the insurer.I agree that insurance is about pooling risk, which is exactly why I think it should be illegal to discriminate based on these things. Your "fair market share of the risk" is very subjective...it's not as though people CHOOSE to be 70 years old and have diabetes and cancer.
It wouldn't bankrupt the private market so much as shift some of the cost from high-risk patients to low-risk patients. Which is absolutely necessary, as people cannot afford expensive medical procedures on their own.
This is part of the reason I included the mandatory-health-insurance provision. I recognize that if discrimination is illegal, insurance companies will be flooded with high-risk applicants with few low-risk applicants to balance it out. This problem would be eliminated if it were mandatory.
To your bolded, by making insurance mandatory, you are making high-risk applicants flood the insurers, whether they be the private market or the government, in your scenario.
As I said in a different thread, the underwriting is not that discriminatory for a health insurance plan in the first place. Age, sex, pre-existing conditions, line of work, and family memebers is all thats really used in a single, non-group, policy. The only thing that may get people turned away, is the pre-existing conditions and usually an insurer will offer to cover the person, as long as the pre-existing is excluded. All the other information, is simply underwriting information used to determine premium amounts. People aren't denied coverage, because they are female or black. I believe that all things being equal, a female pays slightly less than a male for insurance. I am unaware of any racial difference(assuming health is equal) since race isn't used as underwriting criteria(as far as I know).
Actually, they present the hospitals, and by proxy, the people who do have health insurance, with the burden of their cost, not the government.If they don't get health insurance, then they'll eventually show up at the ER and present the government with a much higher bill, than if it had just been nipped in the bud when the problem was small.
I see your point. Although I don't really agree with your plan in principle, if something to this effect were instituted I would rather see an annual contract, vs. a bi-annual contract.I included this provision more for cost-control than anything else. Forbidding people from cancelling their plan before the end of the session would prevent people from joining in June 2011, having some expensive one-time procedure in July 2011, and cancelling the plan in August 2011. Most private insurers have similar provisions.
Alot of states sign compacts with each other, recognizing the liscences from other states as valid or equivalent requiring no extra training or CE courses. But you still have to apply for a state liscence to the state you are practicing healthcare in. My wife, an RN, has had to get a new state liscence each time we have moved(SC,WI,NC). She could not work in WI, with a SC liscence. But she did not need to attend any extra training due to the compact between those particular states.That's fair enough. I'm not entirely sure how medical licensing works (like if an Ohio Medical License is valid in the other 49 states), but if the states have complete control over who can operate in their states, then I'd agree that this provision could be nixed.
Alright, thats not as bad as what I thought you were saying. Still, I would be against the creation of a national patient database, which I think you mentioned. However, so long as state legislatures are writing the insurance laws, this won't be feasible(the nationalized paperwork scenario) IMO. I think there is some validity in trimming the paperwork to be more efficient, but I am leery that the federal government could mandate efficient paperwork in the first place. That would be a hypocrisy of the highest standard. However, it would be beneficial if states adopted your idea regarding the paperwork, prehaps as with state liscensure, adopting a "compact" of standards. What works for Wisconsin and Minnesota, may not work for Claifornia and Arizona.I'm not referring to the DHHS publishing guidelines that say "If the patient has Disease X, give them Treatment Y." I agree that the doctors and nurses should do that. I was referring more to the clerical aspect of medicine. If Cigna requires Form A and C, and Anthem requires Form B and D, and Medicare requires forms A, C, and D, then the system is really not efficient. If the federal government simply mandated a common standard, then a lot of these inefficiencies in the system would be eliminated. One of the biggest problems in our system is that isn't really a system at all, but a patchwork of hospitals and insurers each with different policies. An obscene proportion of medical costs go toward paper-pushing. If we had some national standards, that could largely be eliminated or at least mitigated.
Breaking the tie between employment and insurance isn't going to bring costs down for individual plans. The price for an individual plan is not tied to the price of group health insurance. The price of the individual plan is the market price. The employer tie to health insurance does keep cost down for the employed individual, usually because the employer is paying part of the premium. If you added together the employer contribution and the individual contribution and compared it against an individual plan, the difference between a group plan and individual plan is not all that great. Especially for smaller businesses.This really isn't so much a penalty as the removal of a subsidy. There's not really any reason that employer-paid medical benefits SHOULDN'T be taxed as ordinary income. People are still getting something of monetary value in exchange for their employment. Eliminating this subsidy wouldn't really favor government plans over private plans...it would favor individual plans over employer plans.
The idea of this isn't necessarily to get everyone's on the government dime. It's to break the tie between employment and health insurance. Under the current system, people have very few options for affordable health insurance if they aren't employed, because individual plans are unbelievably expensive.
Health insurance costs paid by the employer, aren't tax deductible for the individual in the first place, because it is not a part of income. It seems that way on the surface, but the employer does not deduct from somebodys check, the employer participation in health insurance. So it shouldn't be taxed as income, because it is never received as such. When companies file their taxes, health insurance expense is seperate from payroll.
Last edited by WI Crippler; 03-13-09 at 08:02 PM.
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"Never fear. Him is here" - Captain Chaos (Dom DeLuise), Cannonball Run
Mace Windu: Then our worst fears have been realized. We must move quickly if the Jedi Order is to survive.
I'm not in favor of a Universal Health Care plan at all. Nor would I support a Galactic Health Care plan.
I'd keep it in our own solar system. Do you guys have a clue how much it costs for a Vloktrogian to have it's Gimblat removed?!?!? One case of Gimblaticitis and boom! There goes the global economy!
Sounds good.2. Federal Health Vouchers shall be made available for individuals with incomes below $20,000 who request them, to purchase a public or private health insurance plan, using the following formula to determine the per-month stipend: ($1,000 / Income) * $750. Vouchers shall not exceed $75 per month for individuals. The voucher shall be paid directly to the health insurer.
3. Federal Health Vouchers shall be made available for families with incomes below $32,000 who request them, to purchase a public or private health insurance plan, using the following formula to determine the per-month stipend: ($1,000 / Income) * $2,250. Vouchers shall not exceed $225 per month for families. The voucher shall be paid directly to the health insurer.
Well what if you don't work? Wages can not be garnished in such cases yet person still automatically gets the Green Plan. We're clearly not going to jail folks for not carrying medical insurance so what's to stop all non-working folks from just refusing to pay for any medical plan with the knowledge that they'll automatically be enrolled in one anyway???4. All persons residing within the United States or its territories shall be required to have health insurance for themselves and all of their dependents. Failure to comply with this provision shall result in the offender and/or his or her dependents being retroactively registered for the US Green Plan. The offender’s wages may be garnished to pay back premiums.
Absolutely not. I foresee huge issues with this and stipulating that it is illegal for foreigners to travel here to use the Green Plan will do nothing to resolve the issues this would cause.5. Foreigners in the United States on a temporary work visa or student visa, or foreigners who are in the United States for no more than three months, shall be automatically covered under the Green Plan unless they have health insurance of their own. It shall be illegal for foreigners to travel to the United States specifically to use the Green Plan.
and according to above any foreigners....FEDERAL PLANS
6. The federal government shall offer the following health insurance plans to all US citizens and permanent residents,This is incredibly close to my current plan that's combined with an HSA account. You don't mention HSA accounts anywhere. You should, they're a fantastic idea. Since the Green plan is the "automatic enrollment" plan and the one that is most likely going to be used to cover poor folks, foreigners, non-working peoples, etc the plan is virtually akin to having no insurance. With a $2000 ind and $4000 family deductible the plan will almost never be used. My family currently has a $3000 yearly deductible. We've never met it. Unless someone in the family is chronically ill or there is a catastrophe the people under the Green plan are going to be expected to just flat out cover most of their medical expenses out of pocket on top of paying their monthly premiums. Unless the government is going to reset dr. fees to make them incredibly low this ins. plan is akin to a poor person having NO insurance but being required by law to pay a monthly premium with forced enrollment.beginning on January 1, 2011:
a. Green Plan (Individual/Family) - $40/$120 Premium per Month. $2,000/$4,000 Annual Deductible. $6,000/$12,000 Annual Maximum. 60% of hospital services. 60% of newborn care. 80% of physician visits. 70% all other services. $100 co-pay for emergency care. $30 co-pay for urgent care. $20 co-pay for physician care.
I'm not sure if I'm comfortable with a national database with all my medical info on it. Personally, right now, I view it as a non-issue for myself because I have no diseases or issues that I'd like to keep private. But what if I did? There's no way such databases would remain private. Especially in the cases of celebs, public figures, etc. You can only punish the person who released such info if you can find them. Imagine trying to figure out who leaked that Angelina Jolie is HIV + when all doctors have access to such a system.11. The federal government hereby authorizes the Department of Health and Human Services to establish best methods and practices, including a National Health Database through which doctors may access patients’ medical records if the patient signs a release. No information from the National Health Database may ever be sold or made public, except with the consent of the patient. No information from the National Health Database shall ever be turned over to law enforcement, except with the consent of the patient or under court subpoena. Violators of this policy are subject to a $500,000 fine, up to six years in federal prison, and the permanent revocation of all medical licenses.
I think the employer/employee/health coverage link should be broken. I'm in favor of no employer being allowed to offer health care plans. I don't insure my car through work, nor my house, why should my health ins be tied to myPAYING FOR IT ALL
12. In Fiscal Year 2011, 20% of employer-paid health insurance premiums shall be taxed on the employee’s income and payroll taxes as ordinary income. In FY2012, 40%. In FY2013, 60%. In FY2014, 80%. In FY2015 and every year thereafter, 100% of employer-paid health insurance premiums shall be taxed on the employee’s income and payroll taxes as ordinary income.
13. In FY2012 and every year thereafter, all income over $3.5 million shall be taxed at a rate of 42%.
14. In FY2011 and every year thereafter, all out-of-pocket health expenses (excluding cosmetic surgery) and all health insurance premiums which are paid by the consumer and/or the consumer’s dependent shall be tax deductible.
workplace? The practice of large insurance companies offering cheap plans to huge corporations with 1000's of employees while completely refusing to offer anything even slightly decent and affordable to small businesses needs to stop, the sooner the better.