Health care is NOT a right. It is an option. In my plan there are "Tiers" of health insurance. NO ONE is required to purchase health care insurance, and there are no fines if you do not.
Does this equate to everyone in the US being covered in one way or another (particularly to a major injury/disease)?
Tier 1: Public Option: this option is offered by the government at prices competitive with private insurance, or at low cost for those who have problems with affordability based on eligibility. It would be paid for through an additional tax called the "HC" tax. Folks who do not want this option, can opt out, and will either get a tax rebate for the "HC" amount, or will simply not be required to pay it, which ever is more efficient.
I agree for the most part. However, what about those who still opt out and happen to develop a serious injury or disease? How does this reduce/eliminate medical bankruptcy?
Tier 2: Private Option: for those who opt out of the public option. Folks can pay for private insurance, or accept their company's insurance options.
Are they forced to comply with various regulations that add to inefficiency i.e. state boundaries, insuring those with pre-existing conditions, etc...? A "public option" that competes with a private firm(s) will create a market foothold for the public option given firm objectives (profit/stop loss). It would be incredibly hard to compete in this environment.
Exemptions: Under no circumstances can any illegal alien receive any kind of health insurance, public, private, or Medicare/Medicaid.
Agreed.
Cost offset: This is the radical, yet cornerstone of my plan. If you opt out of the public option, and do not purchase a private plan, if you get ill, you MUST pay out of pocket. Under NO circumstances will the government subsidize your treatment. NO EXCEPTIONS... catastrophic illness, accident, children... NO EXCEPTIONS. The options will be there and will be affordable. You chose not to take one of them, you lose. No physician or hospital will be under any obligation to treat anyone with no ability to pay. They MAY if they choose, but they can also "opt out".
What effect does this have on current ER mandates? Hospitals and physicians will be able to turn anyone away if they perceive that they will not be able to pay? What about someone who "says" they will pay but does not have the means in which to comply? This (IMHO) will lead to an increase in medical bankruptcy which accounts for the majority of all bankruptcies in the US. Not to mention, MB is still a reality for millions of middle class Americans who do have coverage due to various payment restrictions.
Although inflation in insurance premiums has moderated in recent years, the Kaiser survey found that employees were continuing to spend more in medical costs, including their share of yearly insurance premiums. Employees are paying an average of $3,354 in premiums for family coverage, more than double the amount they paid in 1999. The total cost for family coverage now averages $12,680 a year, up 5 percent from 2007.
And as people are paying more, they are finding the higher expense less affordable. In the study by the nonpartisan Center for Studying Health System Change, based on its national survey of households, nearly one of every five families had problems paying medical bills last year. More than half of these families said they borrowed money to pay these expenses, and nearly 20 percent of those having difficulty said they contemplated declaring personal bankruptcy as a result of their medical bills.
The study estimates that 57 million Americans live in families struggling with medical bills, and 43 million of those have insurance coverage. “It’s hitting both the insured and the uninsured, and it’s hitting middle-class families,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit research organization that financed the study.
Because they are already in debt over their medical care, some families start forgoing treatments, even for serious or chronic conditions, Ms. Davis said. By deciding not to fill a prescription for high blood pressure medication or failing to go to the doctor for diabetes, they are at risk of incurring more serious and costly problems that can land them in the emergency room.
http://www.nytimes.com/2008/09/25/business/25health.html
Other parts of my plan:
1) Major Tort Reform.
2) The ability to purchase health care across state lines to further stimulate competition.
3) Elimination of insurance company driven utilization review, putting all treatment decisions in the hands of the provider.
4) No pre-existing condition limitation.
5) Adult children can remain on parental health insurance until 26.
6) Centralized, independent organization reviewing/evaluating all health care insurers (including the public option) with the power to fine or even shut down.
While i agree with the bold, how do private firms compete with the public option given the remaining points?
These are broad strokes, of course, but you get the gist. The plan above should both please liberals with a public option and making health care affordable to everyone, and to conservatives with creating a system that requires personal responsibility and competition. I'd be happy to answer questions about this plan, and am open to some REASONABLE additions. If you just want to throw hysterical partisan hackery at me, don't bother responding to this post. Both HarryGurellia and LaMidRighter have seen parts or all of this and, if I recall correctly, liked what they saw.
I have been toying with an idea for about a year now. It is very simple and has similar points.
1.) Guaranteed public option for anyone regardless of income, health, and age. This will be funded by the tax payers and can be considered "open arms" from medicaid/medicare. Even if you have private insurance and it does not cover the costs, this option will pick up the tab (although the private sector will not be able to use this as a means to "free ride").
2.) A heavily deregulated private insurance industry. Stipulated contractual coverage at multiple levels. For example, if you are a non smoker who is in good health and does not participate in "risky" activities (hang gliding etc...), you can purchase a policy that is much cheaper if you agree (contractually) to the specific terms. If it is found out that you violate them, you can be dropped immediately. Firms can deny coverage for pre-existing conditions that are not initially declared, and do not have to offer affordable policies for high risk potential clients. They will also have the ability to create policies that outsource major medical care (special surgery, experimental treatment, organ transplant).
3.) An independent advisory board consisting of both sides of the spectrum (public/private) that conduct investigations regarding fraud, abuse, malpractice, contract reneging, competition, price fixing, pricing abuse etc.... This independent board will also outline and design tort reform that can be handed over to vote a simple "yes/no" without legislatures redesigning it for political influence and/or will. This board would also conduct research in medical efficiency, cost effective measures that do not reduce quality as well as the differential effectiveness of pro bono (private) vs public financing for extreme cases.
It allows for true competition. Private firms cannot compete with the bottom line of a public option but have something a government run program does not: discretion. This would open the door to hospitals and physicians to refuse public insurance (Mayo, John Hopkins, Cleveland, etc... at the high end), and allow customers who feel "mistreated" to move to the public option without barriers. Essentially, it moves the most risky citizens off of the aggregate private risk pool into one that has the means in which to properly fund their medical care without "spreading" the costs. I have very little doubt this alone would dramatically lower costs or allow for more quality treatment.
A little more extreme than your plan CC, but i think it allows for greater competition between the public and private sector, while eliminating medical bankruptcy. Medicare was essentially created to shift the most risky citizens to the public sector. Why? Because the majority of your health care costs will be incurred when you are older, and the affordability for such coverage would extremely limited given that elderly people tend to live on fixed incomes.