Health Care

More than 15% of Americans do not have health insurance and those that do are often poorly served and overcharged.  This is unacceptable for a country with America's wealth and resources.
I am not really wild about the Health Plan passed by Congress.  My statement in 2008 was "I will support any plan as long as the money is there to pay for it and it doesn't involve imposing fines on poor people who can't afford insurance."  To be honest, I'm not sure whether I would have voted for the current plan -- there was a lot of pressure to vote for it in memory of Ted Kennedy and that would have been hard to ignore.  It certainly didn't meet my goals and missed two of President Obama's goals:  Cost reduction and universal coverage.  At this point, I think this ship has sailed and we should be focused on fixing the energy crisis; however, if it comes around again, here is what I would like to see in a health plan:

  • Universal Coverage.
  • Required support of portable health plans.  If one desires a portable health plan, one should be able to buy one.  Employers with their own plan would be required to contribute the same amount of money to the portable plan that they would contribute to their own plan.
  • Companies that provide a health plan for any employees must provide the same plan for all employees -- including part-time employees.  The employer paid portion of the coverage would be pro-rated for part-time employees.  Current federal law requires identical coverage for full-time employees, but not part-time employees.  Current federal law does not allow for pro-rating the employer contribution for part-time employees:  This has the unintended effect of keeping most employers from offering health plans to part-time employees.
  • All health care expenses should be pre-tax.  This includes employer and employee contributions to health insurance and flexible spending accounts. 
  • Flexible spending account deductions amounts should be changeable at any time:  It is unreasonable to expect people to predict their medical expenses in advance!
  • Drug co-pays for all life-saving drugs should be the same and in the least expensive tier unless there are generic equivalents of the same drug.
  • Health plans should cover pre-existing conditions with possible exception of people who had the opportunity to purchase health insurance through their employer and declined.

I think it's really important to include portable health plans in the mix.  At one point in time, I was self-employed and buying my own health insurance.  Then the Mass government "reformed" health insurance the first time (not the Mitt Romney plan).  I was originally covered directly by a community health plan (HCHP) that took care of me at a flat rate (the community health plan purchased insurance for catastrophic coverage).  When the government got involved, I had to buy from an insurance company that turned around and purchased the same coverage from the same provider -- at a 40% cost increase to me.  Ten percent of that 40% was supposed to cover people who didn't have health insurance, but the other 30% was insurance company profit.  The reality is that insurance companies that sell health insurance plans take a profit off the top -- that's what companies do.  They also force doctors to hire additional staff to deal with the insurance companies and drive up costs that way.  Portable health plans allow for community health plans and clinics to offer health plans that compete with the insurance company health plans and competition is always good for keeping the costs down.  The other nice thing about portable health plans is that you keep the same plan when you switch jobs.

One way to have portable health plans is to have the IRS collect health coverage funds from the employer and pay the health provider of the employee's choosing.  I have to admit I cringe a little about having the IRS do this, but they are already collecting payroll deductions; so, it should be a very efficient mechanism.  This is NOT intended to be socialized medicine.  The IRS would simply collect and disburse the money -- they would not administer any sort of plan.  The IRS would also be in a position to redistribute income from the highest earners (making over $200K per year) to subsidize those who can't afford to pay for insurance.  The idea here is that everyone would be able to purchase a health plan from any provider and the increased competition would keep costs under control.  The provider could be an insurance company or a community based health organization.  The transition to this system would simply be to have the IRS start collecting and disbursing the money:  There would be no change to the health plan.  Some time after the transition, everyone would have the option of sticking with their company provided plan or switching to another one.

Another big health problem is that drug companies are charging twice as much for drugs in the US as they charge in other developed countries.  Somebody does need to pay for the R&D, but this burden should be shared by all developed countries, not born entirely by the US.  We need to stop that.  We could create a federal bureaucracy to regulate drug prices, or we could allow parallel imports.  I prefer the latter.