I've spent my last year looking at healthcare from my perspective as a consumer.
1. It's over priced comparative to the rest of the civilised world.
2. It is rationed based upon wealth and class.
3. The Insurance industry is not regulated to prevent rapacious business practices.
4. Healthcare is not universal and portable.
As a Citizen, with a duty to the nation, I see that:
5. Healthcare is costing huge government expenditures on entitlement programmes that will assuredly bankrupt the nation as the baby boomers retire and join medicare.
6. Left unchecked medicare will cost more and more of my tax dollars to fund. Shrinking my pay cheque and enslaving the nation to ever increasing debt.
7. Big bureaucracies are very unresponsive to changes and market forces.
But what about my duel role in society as a business owner and an employer? As an employer and business owner I see that:
6. Healthcare is costing businesses vast expenditures making businesses non-competitive on the world market.
7. Small businesses get the shaft:
I own a small start up company. To buy health insurance in California through my business for myself and 3 employees, It would cost about $800-$1,200 USD a month per person for a 70/30 plan, with a 1.5 Million USD limit, and a $500 USD deductible, no dental, no vision, no negotiated discounts on non-covered routine surgeries like lasik.
8. Big business can negotiate steep discounts:
My boyfriend works for a large wall street investment bank, with offices nation wide. His company pays about 1/2 of what my company would pay, and they pass that savings on to their employees. For he and I to be each covered by his plan it would cost out of our pockets, about $130 USD a month each.
From the insurance companies' perspective:
9. Consumers want more coverage but continue to create more unnecessary risk, obesity, smoking, etc.
So what about trying something completely different?
I was thinking how in the hell will I afford health insurance for my employees in the next year? Then I started thinking. Why is it my responsibility as an employer to provide employees with their health insurance? Seems terribly cruel and mean, huh? But realistically, In my entire life I've never been covered by an employee plan.
When I lived overseas we were covered by national socialised health care.
When I was in the military I was covered by the military's socialised health care system.
As a civilian in the US, I've or my parents always maintained our own health coverage and been horridly subject to the market forces that price our health care.
I've never been covered by an employer benefit plan.
Never. . .
So as a small business owner, my American experience is different. It screams that I should be a conservative. And in fact I am. At least in the idea that IT IS NOT MY RESPONSIBILITY AS AN EMPLOYER TO PROVIDE YOU WITH HEALTH CARE COVERAGE.
But Im still a Social Liberal. I think Health care is an essential need that ought to be available and provided to everyone, Universal, and Portable. No one should ever go bankrupt because they cannot afford to pay for health care.
As a states rights thinker, I believe that the federal governments role ought to be limited to Foreign policy, guaranteeing universal Human rights, providing a stable interstate commerce environment where citizens are protected from rapacious practices that are perpetuated by both each other and non-human entities (businesses etc.).
As a Fiscal conservative, I do not think that The Federal Government should necessarily take on the cost of insuring people. One: the Federal government is TERRIBLE at managing its debts and obligations. Two: the Federal Government is too responsive to political whim. Three: the legislative process is not one that is geared toward the goals of either business (making money) or the art of medicine (healing people). Four: The Federal Government's irresponsible management of its current entitlements system tells me they cannot be trusted to manage yet another entitlement system.
Now i like to think Im a bit of a slice of America. Socially liberal, fiscally conservative, not particularly trusting of the Federal Government's ability to manage large undertakings that last more than about 6 years or 1.5 election cycles.
So how do we do this?
Based on MY political come-froms how would I structure health care?
First off with a degree in Government Admin/International Political Economy, one thing I know is that whilst other national governments were designed to work, ours was designed specifically not to work. Not that that is a bad thing. The founders designed our system so that the difficulty of passing legislation would be in and of itself, a check on the Federal Government's ability to interfere with the several states spheres of influence, and slow its expansion. The idea was to keep it simple.
But that doesn't lend itself to solving huge problems like health care in a way that is efficient or responsive.
So what to do?
A non-federal approach. Smaller systems are more responsive to change. And until we get this thing sorted out, then a one sized fits all system isn't going to do well for anyone except replace a bad system with a system that may or may not be bad.
I think that taking a few small states and allowing each of them to try a different approach almost like little laboratories. Might be a good start.
Take Utah for instance. It is geographically isolated, Has a highly concentrated population, and is a small population of 3M. It has a very conservative slant and they would be an excellent incubator to test the following:
1. No more employer based health care. It creates a false sense of economy because companies absorb the increases in costs that result from their employees accumulation of more risk. Since UT is so conservative, and is a state full of small businesses, doing away with employer based health care in UT would work splendidly.
2. Make every consumer buy their health care from the open market.
3. Create 3 private insurance exchanges that dictate what levels of coverage that insurance exchange will offer, let the state dictate via a board of Doctors, Lawyers, elected Citizens, and insurance representatives and have that board dictate what basic minimum coverage should be, then have intermediary recommended coverage, and then have a higher tier of recomended coverage.
3. Let major health insurance providers bid for the contract to cover the pool in each exchange. Let each exchange decide what it's level of the three coverages it will offer,
4. Allow everyone to buy their insurance those three exchanges. Since oligarchy creates economies of scale.
5. Medicare and medicaid participants should be required to buy into the exchanges as well, with medicaid supplying payment via those exchanges so as to keep those people in the insurance pool.
The idea here is to make people responsive to the ways in which their behaviours affect their health care costs.
In addition take the costs off of employers, Employees will start to demand higher pay once they have to bear the cost of insuring themselves.
So what about the young who then think they are invincible and dont have to buy insurance or the ones who wont buy in?
Employers can mandate that their employees have insurance. The same way that Universities mandate that their students buy insurance. The state that can mandate that persons using certain services must buy health insurance. Example. You want to have a drivers license. You must buy both liability insurance and health insurance. All of a sudden a large segment of society will be essentially forced to buy health insurance.
Now what about the ones who cant afford, or won't buy it and take their chances.
For the can't affords we create an income based buy in system that incentivises purchase of the insurance, but still helps them NOT to have to use a huge % of their income on premiums.
The low wage subsidy basically follows a chart that says if you make this much, you must contribute this much toward your premium, and then you can buy into the exchange, and the difference in your premium and the normal amount will be made up by a user fee on all the people who use the exchange. This covers people at the bottom of the barrel.
And the folks who dont use the exchange and dont buy any insurance cause they think they can skirt by? Make a large amount of societal priviliges contingent on carrying health insurance. So much so that the dis-incentive is huge and the incentive is great. like the drivers license requirement.
Then you have pretty much everyone covered, it's Not govt run, it is govt. monitored, its not too large to make changes to, It forces people to get SKINY and healthy because they will see how the cost in the market responds to their weight loss, and health factors. And it will allow doctors to only have to deal with three health insurance companies Not a Heap of them.
Portability is an issue for out of staters coming to UT but the insurance can have an out of state supplemental coverage available to purchase OR each of the insurance companies can treat you in their provider network that is out of state.
I think this system would be far greater in terms of personal responsibility, coverage, and meeting the needs necessary. without a huge federal tax or a huge federal bureaucracy, and would provide the solution to the problem.
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