health care insurance | Funny about Money

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?

Affording COBRA, the plan that allows workers to extend their health insurance benefits as much as 18 months after a job loss, is a stretch for most of us and impossible for many. After I’m canned, for example, the cost of my EPO will go from $13 a month to $485—and that’s to insure just one person!

We’ve known that the government’s stimulus plan will pick up a chunk of this for a period of nine months, but the university’s HR department refuses to provide the details. Thanks to the miracle of the Internet, though, an enterprising soon-to-be-bag lady can dig up the story on her own.

It looks like The Kid and I will fall into the eligible category. You have to meet these guidelines:
-Canned between September 1, 2008 and December 31, 2009
-Laid off or involuntarily let go (if you walked or you were canned for misconduct, you don’t qualify)
-Subscribed toyour employer’s health-care plan before you lost your job
-Had an adjusted gross income of less than $125,000 if you’re single or $250,000 if you’re married and file jointly (the subsidy phases out at higher rates as you approach $145,000/$290,000)

If you can make the cut, you get a 65% reduction in COBRA for nine months. For me, that means premiums of $169.75 a month, instead of the present $485. Since I’ve already set aside the money to cover the five months between layoff day and my 65th birthday (Medicare day), that would put a lot more in the proposed survival pool: about $1,575!

Don’t know how this will work for The Kid. She would have to insure herself and her child—until her recent divorce, they were on her (now ex-)husband’s insurance. He just lost his job. The cost of insuring more than one person on the university’s plans is pretty high, and she may not be able to afford it on her grandiose $16,000 salary.

If you’re about to be laid off or if you were laid off after last August and turned down COBRA because you couldn’t afford it, look into this. The government is giving people who rejected COBRA a second chance to sign up. They say it will take most employers a couple of months to send out letters to eligible ex-employees. Obviously, though, if you’ve moved and your employer doesn’t have your current address (is there mail delivery under the Seventh Avenue Overpass?), you’ll need to be proactive.

So…How Would YOU Replace Obamacare?

Stimulus program makes COBRA affordable