Since a certain element in the Body Politick is bound and determined to kill universal health care — at least in the form of the Affordable Care Act — it might behoove our leaders to think about what (if anything) they would put in its place. They evidently haven’t a clue hidden inside their bituminous hearts. So…let’s help them out.
If you asked me, here’s what I’d tell them.
• All vaccines will be free, including flu shots.
No one can force you to get yourself or your kids immunized (although schools would retain the right to bar enrollment for kids who haven’t had a basic round of shots). But if you have to be treated for an illness that could be prevented or ameliorated by vaccination, and you cannot prove you have a current vaccination for it, then you should have to pay for the treatment out of pocket. This includes trips to ERs.
• ER treatment that’s not a true emergency — like showing up to get free treatment for a strep throat or a cold or anything else that would have been covered if you had ponied up the cash for minimalist coverage: that will be something you have to pay for out of pocket.
• All preventive health care: free.
• All birth control: free.
• Coverage for an elective abortion: you pay for it out of pocket. An abortion resulting from a medical emergency or severe pathology will be fully covered.
• Coverage for Rx drugs: chemotherapy, cardiac disease, kidney disease, multiple sclerosis, and diabetes drugs are included in the basic healthcare package. For most other prescription drugs, you can opt into a special plan, similar to Medicare Part D.
You can’t be blocked from opting in if you’re suddenly diagnosed with something that requires long-term use of drugs.
OTC drugs that have been Big-Brothered off the shelves, such as cough medicines that actually work, are to be returned to the market, so that you don’t have to go to a doctor to treat a bad cough from a cold.
• All other coverage would be handled much in the manner of Medicare, partially covered with flat fees, partially funded by taxes. Base hospital coverage would be free , but as with Medicare, more extensive Part B-type coverage would cost a couple hundred bucks a month: $134-$268, depending on your income. Expanded coverage would be available optionally through insurers or the government, but strictly regulated, exactly as Medigap plans are regulated now.
• Care for self-inflicted harm from drug use and alcohol abuse: you pay for it. This includes treatment for ODs and injuries incurred in accidents caused by your own drunk driving.
• Mental health care, even drying out from alcohol and dope (exclusive of physical disease or injury caused by abuse): covered.
• Coverage for the indigent, the unemployable disabled, and the homeless: through expanded Medicare.
How will this be underwritten? With a tax on everyone, including people who are not now working but getting income from dividends or welfare. And a no-exceptions, no-cap tax on the wealthy and the über-wealthy.
If businesses are to continue offering health insurance as a job perk, then the tax exclusion for the benefit can’t be eliminated. Otherwise, Americans will have to resign themselves to paying hundreds more in taxes, as the cost of employer-based plans will be taxable. On the other hand, it may be fairer for everyone, including employees of corporations that can afford to swing health plans, to pay their own share.
Insurance premiums, after all, ARE a kind of tax. They work the same way as a tax works: everyone pays in, for the common good. If everyone in the country is paying in, individual premiums will be lower. And if we’re not ALL paying for stupidity (drug use, alcohol use, refusal to vaccinate), then shared costs will be lower.
How would you advise our doughty leaders about replacing the Affordable Care Act?
Image: DepositPhotos, © sudok1
I’m on board with most of this.
I think employers should get out of the health care game – health care should be paid by taxes, and whether or not you’re employed, change jobs, or work for yourself should not dictate your health care coverage.
Also, SINGLE PAYER health care. Put EVERYONE on Medicare. Health “insurance” is ridiculous. Everyone needs care in their lifetime – insurance only works if you have SIGNIFICANTLY more people paying in than making claims.
If we went to single payer health care, everyone on Medicare, medical costs would go DOWN because doctor’s offices, hospitals etc would no longer need legions of people in billing and accounting departments.
You know who makes a TON of money in the health care industry? Dialysis clinics. Because every single person in the US who is on kidney dialysis, is covered by Medicare. So if you set up a dialysis clinic (and there are THOUSANDS of them in the US, btw) – your billing department only has to deal with Medicare.
I’m all for single-payer, too. It was stupid that they didn’t do that. The Dems must have figured they couldn’t faze it past the intransigent Republicans, though.
Wonder how many of all those thousands and thousands of people really NEED dialysis? It’s good that they’re all covered on Medicare, and kidney failure is hardly a minor item…but given our system’s proclivity for over-diagnosis and over-treatment, one does wonder.
Hmmm… Can’t speak for the reliability of this report, ’cause it appears on a blog, but it does ring a little alarm bell: https://glennchan.wordpress.com/2013/06/17/for-profit-dialysis-an-unethical-industry-davita-dva/
Here’s an interesting article on the general subject of overtreatment, BTW — only a word about dialysis, but overall pretty eye-opening: http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
Whoa! Waitminit: change your search term from “overtreatment” to “overdiagnosis”, and HOLY sh!t:
https://www.nytimes.com/2015/09/15/health/chronic-kidney-disease-can-be-dubious-diagnosis.html?_r=0
http://theconversation.com/making-people-patients-chronic-kidney-disease-over-diagnosis-16505
http://www.bmj.com/content/347/bmj.f4298
https://www.ncbi.nlm.nih.gov/pubmed/26976056
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001345
http://www.medpagetoday.com/nephrology/esrd/40754
It goes on and on and on…
Hmmmm….Lot of power you’re asking us to wield…Which, IMHO, has become a “power struggle”….red vs. blue….liberal vs. conservative…service.payer vs. service provider. I agree with most things you have outlined. It is crazy how expensive health care has become and Obamacare seems to have made it worse….with the excuse “we didn’t know new enrollees were this sick”…REALLY???
My thought is perhaps we should just open Medicare up for everyone with a corresponding increase in funding. Dollar for dollar Medicare seems to get the most “bang for the buck”. In this neck of the woods when one applies for Obamacare if your income is below a certain thresh-hold you are placed into Medicaid….(“Medicare’s step-sister” by all accounts”) and to be clear this coverage is better than I pay TOO MUCH money for with BCBS. IMHO the real heart-breaker is the choices for health insurance on the Obamacare website around here. I’m talking HMO’s with $13K deductibles with $13K out of pockets before a dime is paid out….with $1K premiums for a family….SAD. But it’s clear a replacement should be put in place before Obamacare is put to rest.
Well…. it IS, after all, OUR country. Seems to me it would be useful to know what we citizens think would work (as opposed to the ruminations of insurance companies and politicians who have their own coverage that we hoi polloi can’t access).
When you ask people, you find a surprising amount of consensus across party lines. Conservatives as well as liberals seem to agree, in principle, about what is needed and even…yeah…probably even about how to fund it. At least in a general way.
I think most of this sounds very good. “The devil is in the details,” of course, and I’m noting some to consider.
RE: ER treatment. This can be tricky. If there is no Immediate Care facility in the area, what do you do when you experience a sudden change in symptoms OR have to see a doctor outside normal physician office hours? People who work 10+ hours a day, or who have long work shifts and long commutes have limited ability to see a physician for an illness that starts progressing in a disturbing direction.
Also, there’s the problem of lack of diagnostic equipment at physician’s offices. I’ve had to present myself to the ER (even during “normal office hours” for my physician) because I needed to get imaging to confirm my diagnosis. Waiting several days to a week for a CT scan to confirm that, yes, I have a raging infection in my gut and need antibiotics to treat it, would have been outside of a reasonable standard of care. It stinks that this has to happen, but I’ve experienced it both in both the “big city” and my current “small town,” so I think that’s standard. If you need an x-ray or CT scan to diagnose a condition, you usually MUST go through the ER. 🙁
Coverage for elective abortion: I say all abortions should be covered. Let’s just stop the slut-shaming and ridiculousness of determining if a woman “deserves” to have a pregnancy terminated, depending on her intentions. A woman should be able to have sex with a man and be experiencing “momentary insanity” or whatever we want to call having sex without effective birth control, yet NOT be forced to continue any pregnancy that may result. It happens. Birth control fails, is misused, or is just forgotten. Yet the man in such a situation is allowed to slink off and forget about everything, but the woman is not? That’s just biased and wrong.
I’m also conflicted about the care for “self-inflicted” harm. I have known enough people with truly f****ed up mentalities that have done harm to themselves to know that they don’t usually realize what they are doing. They are incapable of seeing how self-harming they’re being. Who gets to determine where they cross the line into being mentally unstable and “deserving” of care?
I wish we’d just institute single-payer and get it over with. Even the demonized insurance companies want a stable model on which they can plan their businesses. No one likes this teeter-totter mess around healthcare, except the politicians who don’t have to experience the problems first hand.
Yeah, the ER thing was elicited by memories of what ERs were like before ACA. When I had appendicitis — about 20 years ago — I went to the ER of a nearby Huge Regional Medical Center.
It was Christmastime, and there was a flu and cold epidemic going on. The ER’s waiting room was PACKED with people who had sore throats, sniffles, and coughs, seeking what should have been covered by their GPs if they’d had insurance. An ER is not allowed to turn you away, and so they just tell you to take a seat.
Three hours later, I hadn’t even been triaged!
It was midnight, I hurt so much I was crying, and I couldn’t get these people to even look and see if something was really wrong. I finally called some friends and had them drive me home, figuring I’d rather die in my bed than on the concrete bench where I had been sitting next to a woman who was miscarrying and who also hadn’t been seen in _hours_.
The following morning I called the Mayo; they told me to call 911 and have them bring me in, but the ambulance crew refused to take me there. I put up some other friends to driving me to the Mayo’s ER, I was slapped into emergency surgery within minutes after I staggered through the door.
That, I think, is WHY visits to ERs need to be limited to credible emergency conditions. Offer insurance coverage that’s either genuinely affordable (such as Medicare) or even free on the taxpayer dime, and then tell people who decline to be covered that they have to suffer the consequences of refusing coverage: that they can’t use an ER as a substitute for a GP without paying the full fare.
A raging infection in your gut (such as appendicitis…or any number of other conditions) is different from a cold or the flu.
Like you, I think abortions should be covered, but realistically that isn’t going to happen. Too many people think abortion is immoral and should be illegal…and they have seized political power in our country. IMHO American women will be lucky to retain any reproductive rights at all.
If an elective abortion were not paid for by the taxpayer or one’s fellow insurance customers, then possibly at least SOME of the screamers would pipe down. But termination of pregnancy for medical reasons should be covered, period.
It’s pretty hazy, the question of mental illness and drug use. Intuitively, we sense that drug abuse IS a function of mental illness. And yet…you can be mentally ill without being stupid. Any fool knows drug abuse is going to wreck your health and may kill you. Yet the woods are full of people who understand this but find drug use so gratifying they don’t care — just as many of us use alcohol and tobacco knowing that those drugs entail real risk. Google the popular names of a few street drugs, and get an eyeful of the exchanges on drug users’ forums.
The underlying mental illness should and MUST be covered. But the consequences of deliberately doing something you know will cause expensive and potentially fatal harm…maybe not so much.