Health Care Reform: Death by a Thousand Cuts or Repeal and Replace?
The vote to repeal the health care reform bill in the House scheduled for Wednesday was postponed due to the shooting of Congresswoman Gabrielle Giffords. At some future date, the repeal effort will pass the House and be defeated in the Senate. Republicans are talking about myriad other ways to attack the legislation, including refusing to fund certain expenditures required by the Department of Health and Human Services (DHHS) to keep the program on track for its full implementation in 2014. Here are just a few of the bills that will be introduced:
• Rep. Scott Garrett (R-N.J.) has a bill to repeal the individual mandate, and Rep. Ted Poe (R-Texas) would prohibit federal funds to be used to enforce it.
• Rep. Dan Burton (R-Ind.) would replace the health care reform law with “incentives to encourage health insurance coverage.”
Advertisement• Rep. John Fleming (R-La.) has two bills — one would amend the law to allow states to elect not to establish a health exchange, while the other would prohibit the hiring of additional employees by the Internal Revenue Service to “implement, administer, or enforce” the law. He also proposes to rescind funds for the law’s Health Insurance Reform Implementation Fund.
• Rep. Tom Graves (R-Ga.) would deauthorize appropriation of funds to carry out the law.
• Rep. Dan Lungren (R-Calif.) has a bill to repeal the law’s 1099 tax reporting requirement.
• Rep. Marsha Blackburn (R-Tenn.) wants to allow Medicare beneficiaries the option of choosing a voucher for a health savings account or a high-deductible health insurance plan while eliminating the late enrollment penalties for people who wait until they’re 70 to enroll in Medicare. And Rep. Ron Paul (R-Texas) has a bill to “provide greater health care freedom for seniors.”
There are, I think, several problems with the GOP’s approach. Passing a series of small bore bills in the House that die in the Senate seems like a scattershot plan. The Democrats will also continue to rely on and promote to their media allies CBO estimates of the cost of repeal — namely that for the next ten years, the health care reform bill results in overall deficit reduction (new taxes, plus Medicare cuts, exceeding new program expenditures by over $200 billion).
Even though the CBO estimate is nothing more than a product of what the Reid/Pelosi team asked them to score last year, the $200 billion in added deficits that CBO says would result from the repeal effort will be thrown in the face of the Republicans every time they attempt to reduce spending or the deficit in other areas in the coming session. The Democrats will also attempt to focus on all the goodies in the bill — especially those that are already in effect, such as elimination of lifetime caps in insurance coverage, coverage for children with pre-existing conditions, closing part of the “donut hole” in Medicare drug coverage, and enabling children up to age 26 to remain on their parents’ policies.
Of course, all of the new features will add to the cost of insurance, though DHHS is already signaling it will challenge rate increases of over 10% this year, regardless of the fact that the reform bill may be a major factor in the added cost of existing policies. If one did not know better, one might think that one of the goals of the reform effort is to destroy the private insurance business.
ObamaCare was sold as a three-pronged effort: 1. Change the insurance business to protect individuals from being dropped or denied coverage when they are very sick, 2. Require most of the uninsured to buy coverage or pay a penalty, in order to expand the pool with healthier people so as to cover the very high costs of the individuals now covered by the insurance reforms in #1 above, and 3. Subsidize the cost of the new policies for individuals covered by #1 or #2. Of course, the bill, in its 2,000 pages, did far more than that. It limits the profit margins for insurance companies, and limits the kinds of policies they can sell (rich with mandates, but restrictions on HSA type high-deductible plans). It cuts Medicare Advantage, creating a long-term insurance policy that was (conveniently) deficit-reducing only in the first ten years, and adds a slew of new taxes.
The GOP will have a real opportunity to repeal much of the health care bill , but only in 2013. And even in that year, they will be able to do so only if they capture the White House in 2012, maintain their advantage in the House of Representatives in that election, and take control of the Senate in 2012, picking up at least four seats. This is far from a lay-down, of course.
Everyone knows the CBO report from last year is another package of lies created by this corrupt administration. Add 30 million people to the health insurance mandate and it will save money?? That is what the Republicans have to prove? That putting 30 million new folks on insurance will save money?
“Republicans would be wise to launch an intellectual offensive that goes beyond repeal of ObamaCare and sets the tone for repealing it with something better and smarter.”
I thought that last year’s election results accomplished a large portion of this requirement.
Mission 1. – Stop ObamaCare dead in its tracks ASAP by any / every means possible.
Mission 2. – Abolish, repeal and get rid of <b<all of ObamaCare permanently.
Mission 4. – Make Bush’s tax cuts permanent.
Mission 5. – Secure the borders and deport all illegals that are in our country now.
Mission 6, 7, xxx, xxx, xxx. – The list goes on and on and on.
It is a huge, malignant monster that got that way because our elected politicians failed to represent the Constitution and the People.
Instead, they caved in to the 24/7/365 hordes of emotional hyper-entitlement justifications that were / are virtually identical to the recommendations written in this article.
Republicans will never be able to over any acceptable alternatives to the crap liberal Democrats come up with. It is silly to even consider it.
Our health care system was fine. At this time it still is. The only thing needed now is for our elected representatives to do what they are sworn to. Get the excessive government control out of the way.
That means saying, “No!” and meaning it, not coming up with intellectually smart alternatives that continue to sink our country.
If the oil needs changed, change it.
And leave the transmission to hell alone!
WHY DO ALL THE BLOGGERS AND REPORTERS SAY THE SAME THING, BUT DON’T HAVE ANY IDEA IF THE REPUBS HAVE AN ANSWER OR NOT.
This is the GOP’s philosophical problem. For 233 years Americans paid for their own doctors and health insurance. Three months ago, a socialist piece of crap President and his fringe left congressional allies lied and thieved their way into a law which will eventually ruin that system, but hasn’t been implemented yet.
Largely due to this awful law, Americans threw the liberals out of the House, and nearly the Senate.
And now most commentators on the subject of repealing the law which gave Republicans over 600 new elected offices nationwide say they need to replace this bill with some lesser bill if we repeal it.
No. We don’t. Baehr’s liberal premise explains why conservatives hate Republicans almost as much as we hate Democrats.
You are so right. The federal government has absolutely no business whatsoever making any laws with regard to medical care.
Regrettably, the federal government has gotten completely out of control. It no longer enjoys the consent of the governed – especially not the consent of the productive portion of the governed who has to pay the freight – and there is very little we can do about it.
That is why secession is most likely the only option for breaking free of federal tyranny and ruin.
That won’t work either. Last time it was tried it got an awful lot of people dead and no secession. The only thing that will work is for the government to be forced to follow the constitution. Begin by repeal of the O-care law. Go on to the rest of the illegal, unconstitutional programs and agencies created over the years… HUD, Dept’s of Education, energy, EPA, and a host of others. Abolish SSI, yes fine, I will not get my money back that I paid into it but I’m OK with that if they will just abolish the unconstitutional programs.
“Of course, the U.S. Supreme Court could invalidate the individual mandate in the health care reform legislation, potentially leaving the bill in a chaotic state without a significant funding source.”
This is probably where Obamacare will either live or die. It will come down to whether or not nine people think this law is unconstitutional. But, even if they do find it unconstitutional, what’s to stop the Democrats from simply calling the “mandate” a “tax,” as they are doing now? I think what infuriates people so much is not only the shabby way this bill became law (through “reconciliation”), but also that the American people had no say in the matter. A handful of votes in the Senate (not even an up-or-down vote) determined how over 300 million people would get insurance. Now nine judges will determine if those handful of Senators were wrong. And the American people never voted on any of this or approved any of this. Something very very wrong with this picture.
All the more reason to vote out as many democrats as possible in any election especially in 2012 and go to TEA Party meeting and or rallies and send out E-mails and letter to not just your own representatives but also those in other states to express your opinion against this horrid bill.
Just kill the present bill in it’s entirety and then have a well reasoned dialog to make a better law that actually works! This one clearly does not and introduces many new taxes as well as regulation and new governmental agencies along with new bureaus. It is hideous and insane not to mention Unconstitutional!
‘Why should health insurance cover “everything”?’
Because health insurance deals with the most important thing in a person’s life: themselves. If you skimp on oil changes or forget to get the air filters changed on your car the very worst outcome is that your car might break down and lead you to pay a more expensive repair bill later on.
If you have no health insurance because it’s too expensive and you’re skipping regular doctor visits the worst possibility is that you’ll die. Die from some disease or ailment that wasn’t detected until it was too late. Yes, I know the possibility is very low this will happen but you only get one life to live. Why take chances with it?
That’s why health insurance should cover “everything”.
Mongo, I agree with you, to a point: Health insurance such as you describe should certainly be available, if it works in the market. It should not be mandated by government. However, plans where doctor’s visits and other small stuff is not covered but major medical conditions (e.g. catastrophic coverage plans) should also be available. Of course, your preferred plan will cost more, but if you’re willing to pay the freight…
Or are you suggesting that people should be forced to do thing your way? Or that your preferred plan should be mandated to cost no more than a catastrophic care plan? If you think about it for a second, under your plan, what’s there to make people visit the doctor, even IF it’s covered?
Nonsense. Health care INSURANCE was never intended to cover cut fingers or minor sniffles and colds. It was intended to cover major costs of major illnesses and/or injuries. People, however, decided to “save” a few bucks and started relying on their insurance carriers to pay for EVERYTHING that happened to them…from boils to bulemia to botox. That’s simply stupid. If you think you need a doctor’s opinion when you get a paper cut, pay cash. If you get a runny nose, buy Kleenex, aspirin and a decongestant over the counter. Quit running to the doctor and expecting your insurance to cover it.
NO! Totally wrong! A person’s health care is totally their own business, to maintain themselves or not. Forcing coverage a person does not want is slavery.
Some good thoughts here but are they good enough? We have a lot of propaganda to make insurance something it is definitely not, a prepaid health plan run by the government and paid for by taxes.
For an example, and I am not trying to be accurate in my amounts, only illustrative.
Say we have a pool of a thousand members who have paid into the health pool. The pool pays all medical expenses and at the end of the year the total costs of the medical attention plus the cost of administration is totaled and then each member is assessed this cost divided by a thousand. Each member pays the same amount. That would average the total cost per member but would also carry the administrative cost which, without the pool would be his responsibility. This is not the same as the median cost which would be the total paying more than the average and those paying less. Such a system spreads the cost of high cost treatment but can discourage healthy members from being in the pool. These plans have been tried and they can work pretty well. The larger the plan the less the variation per annum. In any case the money is there to pay for the service. Under the Obama plan it looks like either the taxpayer pays or the service is not performed. Medical insurance is not free medical care but third party care for which we contract and pay for. This bait and switch is both deliberate and dishonest. We should confront this head on and not play word games. If you will not work witout pay neither should you expect your doctor to work without pay. If you object to a cut in your pay you should not require your doctor to take a cut in his pay. That is the essence of do unto others…. That is as much for your own protection as it is for you neighbor.l
What amazes me is that everything hinges on repeal and replace.
Why is it necessary for the federal government to be in healthcare at all?
I see no reason that anyone that is responsible enough can take care of their own with private insurance.
Having owned and operated my own business for over 40 years, I carried my own family insurance to cover my family.
The fact that Congress, any Congress have to stick their noses into matter outside of military protection is beyond my comprehension.
Boehner has already stated that he is at loss to where to start and with what program. Here is a start; Dept of Education, EPA, NEA, Dept of Energy and that is only a start.
Bill, doesn’t your short list cover unconstitutional bureaus? I agree, that is hardly enough to get out of first gear but we do need to start. I would suggest checking these departments with their compatibility to our Constitution.
I believe the USDA was started to disseminate information, not to enforce the adoption of any of that information. The whole farm program is incompatible with our Constitution and has been counterproductive its entire life including the current Pigford scandal.
Since there was no need for it and no Constitutional basis for the federal government to be involved in it,why does the author think any replacement is needed or even legal?
Cut it off, kill it, and forget it. Get the federal government back to doing the limited number of things it’s supposed to do like protecting the border and get it the hell out of social engineering.
If the GOP “replaces” it it will continue on it’s path to becoming the third party. Savage got it right years ago, the dems if you want a fast boat to socialism or the reps if you want a slow boat to socialism. geeze
The repeal of this defective bill in its entirety must be done with all contingencies considered where if somehow there is push back in an effort to preserve the bill, the house insures the bill has NO funding. If the bill exists in name only with no possibility of draining our economy, there exists at least the prospect of the brick by brick disassembly of this ill-gotten legislation.
Actually, conservatives DO have a “replacement for Obamacare.” It’s just not a single, all-encompassing bill, but rather a series of smaller bills that address what is wrong with our present system–most of which can be traced back to government interference in the Medical Delivery System of this country.
Pappadave none of your money comes from the government, not the first dime. It all come from private industry through, taxes, fees and mandates. The whole government payroll come from the private sector and their profits. To redistrube the wealth is not the same as distributing the wealth by profit making commerce. That is the only way ever devised to be fair. Your willingness and abilities have a lot to do with the size of your personal share. The government can only have money to distribute by restricting your earning capacity.
If we go back to being personally responsible we will still have the poor and we will also have the rich who do play an important role in our welfare but not according to our rich bureaucrats. Prices will be lower but purchasing power will be higher and there will be those with the money to support the necessary charity for those who need it. Much more can be said in this line.
Why the pressure to repeal and immediately “replace” ( or depending on your perspective — have another big idea shoved down our throats) ? Despite it’s shortcomings our healthcare system meets the needs of the vast majority of citizens including the elderly and the poor and drives medical and pharmaceutical innovation for the rest of the globe.
How about if we focus on a robust public examination of ideas or issues and an honest assessment of expected cost, access and quality consequences ? I think the last sentence in the column is the point. Without a very public and honest dialogue on all of these ideas there will always be a faction that feels as though their perspective is not being given a fair hearing.
We can’t even agree on what problem we should be solving — hence Obamacare’s indifference to disrupting what is generally satisfactory coverage for 90 % of the population to try to cover 30 mil more people and talking about budget savings in the same breath.
Letting a quest for health care perfection (by what definition and in whose eyes??) erode what is very good belies aims that may go beyond beyond healthcare and as such, these political ideas of role of government should be part of the public dialogue as well before anyone does any “overhauling”.
How about just repeal for now and have the public transparent discussion BHO promised ?
Doesn’t take long does it. Why talk of replacement. The entire process by which the bill was placed is illegal. AND yet another abrogation of the RIGHTS / responsibilities of Free citizens. The manner in which those “brave” Congressmen forced it through shows they know it to be illegal. Are they now just to “apologise” for another abrogation of Rights of Americans and go back to business as usual. I thought the mid-term election sent a different message.
But that usual ploy when somwething illegal , unwanted and forced onto people the fiddling with words comes into play when required to do their jobs. And there are plenty of people who take them up on the subject in the sidesteps they propose.
No wonder they, these contemptible “public servants” think Americans are idiots, ignoramuses, easily gulled as long as 1. the right brainless celebrities are touting it, 2. the right glamourous talk show host/esses,3. the right “news readers”, 4. the right “elite” journalists etc. They’ve ALL said Americans are idiots, ignoramuses, vulgar, gun happy, etc.
HOW DID THE DIALOGUE CHANGE? We now know that Ezra Klein and his ilk among the “best and brightest” and the LEFT in the “Democratic” party, au fait only with some personal language do not understand words of more than one syllable. BUT How hard is it to understand the word REPEAL.
REPEAL DOES NOT MEAN REPLACE. It means throw it out altogether. The entire idea is another one of those little totalitarian actions that happen “for thr good of the People”. BUT REMEMBER that the people who decided on this “good” exempt themselves from its requirements and costs.
REPEAL MEANS GET RID OF IT entirely and forever.
This is a junk piece of legislation that once in my life I have actually read it. More than I can say for Pelosi, Reid and the rest of the Democrats. It took weeks and I needed help from an accounting firm to decipher the purposely vague ramblings. What a mess! This needs to be repealed NOW! It will damage the economy if the economy was rolling. It will destroy the economy in its foreclosure state compliments of Frank and Dodd Fannie and Freddie. School teachers and the other misinformed keep harping on the “donut” hole and how important this is. They need to learn how to read.
We – that is to say, the every-day working folks of the U.S. – don’t need a “replacement” for the ObamaCare law. First, we need to remember that there is no Constitutional authority for Congress to pass anything even close to that law or any other “reform” of health insurance or health care. Second, examine the history and reality of both insurance and health care and you’ll see that the problems which those parts of our economy have were created and are maintained by governments – federal, state and local – passing laws to benefit their friends in insurance and health care and other narrow interest groups. Third, other problems of more immediate concern exist – remember the gazillion-dollar debt? – on which Congress ought to spend its time and effort.
Genuine reform of health insurance and health care would require repeal of large parts of the existing body of federal, state and local laws as well as doing away with many of the bureaucratic agencies whose activities are the cause of much of our problems. The problem is, however, that politicians at all levels of government make laws for their political advantage, for their personal financial benefit and for the financial advantage of their college class-mates, the people who grew up with them in their lily-white suburbs, the people who finance their fancy charities, and the people who blindly vote them into office year after year. Not one law is or has ever been made for the benefit of all of the people of the nation, instead of some narrow particular group of parasites. There! I feel better now and we can return to discussing how to mess up health care and insurance and everything else in the nation by more laws and regulations and foolishness. Thanks for reading!
We all know that once a law is in the system it is so very hard to remove (or repeal);Obama and his leftwinged cronies understood that when they rammed it through Congress last year. With that said, it almost seems impossible to repeal the entire ObamaCare law….but what the Republicans can do is slowly whittle it down, bit by bit by bit. The American people need to support their efforts in doing that; if we don’t and we knock any efforts the Republican controlled Congress is doing, chaos will ensue and nothing will get accomplished…which is what the left’s want. Go to http://www.takingonissues.com for a reality check.
Government interference is what got us here. Why do the same thing and expect a different result?
Repeal and Replace.
http://www.youtube.com/watch?v=TDr7D7nLty0
Forgive my bluntness:
Repeal (Full stop).
If we really care about insuring people with pre-existing conditions, or worry about people running through their benefits if they contract cancer or something similar, create a charity and endow it for that purpose.
Government does not belong in health care. This applies to Medicare as much as to ObamaCare.
Agree and I am dependent on some expensive medication. I still say there are better ways to tackle this problem. Had we been following that better way there is a good chance that I would not have the expensive condition I now have due to earlier diagnosis and there is also the possibility that I would be dead. I came pretty close the way it was. I have a vested interest in continuing my medication but not if it will bankrupt the nation. My days are numbered at best but not the days of our country.
Pardon me for picking nits, but New York is not “generous” in what has to be provided. They impose mandates on private companies.
No, Republicans don’t need to replace Obamacare with “something better”.
They need to start obeying the Constitution!
And all you RINOs need to get out of town!
While meddling in health care is NOT a constitutional function of the Federal Government, Republicans have had an excellent alternative to HMO mindset – HSAs. HMOs are not really insurance – they are more like an all you can eat health care buffet, hence the skewed incentives among the insured. The reason people have HMOs is because companies can offer them as fringe benefits with tax savings. (The other reason is that they think it is “free” because it isn’t listed on their paycheck – sigh.)
Currently, an individual can buy real (high deductible – ~$5000/yr) medical insurance, and open a Health Savings Account. The HSA is tax free, just like an IRA, and can be used for qualified medical expenses and even retirement income. The cost of the high deductible policy, plus funding an HSA sufficiently to cover the deductible for a year, is about the same as an HMO for the same coverage – and it has similar tax benefits. The difference is that if you DON’T get sick, you get to KEEP your money (for retirement, anyway). Thus, the incentive is to stay healthy and not spend HSA dollars needlessly.
Since the policy is individually owned, this also solves the problem of losing coverage when you change jobs.
What it DOESN’T solve is:
1) changing insurance companies with pre-existing conditions. (Once you get a chronic condition, your carrier has a monopoly and can jack your rates with impunity.)
2) preventative care for the poor – providing “free” insulin is cheaper than patching up the result of not having it at the hospital.
Here is an idea: while the Feds can’t constitutionally do anything about (2), they *can* issue “guidelines”, laying out a national consensus on what states ought to provide. If a state is too poor to meet those expectations, it would be a charity case instead of an unfunded mandate. If a state is too rich, greedy, or fiscally irresponsible (Hi CA!) to meet those expectations, it would be a subject of scorn instead of an unfunded mandate.
I agree, HSAs are the way to go for many people. And yet, Obamacare does away with them entirely and runs the opposite direction- into covering people for every little thing. That is extraordinarily wasteful, because most preventive care (with a few fairly well-known exceptions) DO NOT lower overall costs.The insulin issue you described is not actually preventive care- it’s cheap outpatient care to avoid expensive inpatient care, and yes, there needs to be a way to cover that.
I agree that the pre-existing conditions exclusions need to be eliminated, and they can be even without mandates. There are such things as waiting periods and defined enrollment periods that strongly encourage people to purchase health insurance before they get sick without making them do it. But if you don’t buy coverage even if you get sick you’ll eventually be covered- but you’ll pay for your gamble.
The thing is, Obamacare completely takes the individual and his choices out of the equation. It doesn’t allow us to choose what is best for us as individuals. Some people need the money more than they need the coverage, yet that option will be completely gone.
Virginia Delegate Bob Marshall is pushing a rule (in Virginia) that insurers can not exclude pre-existing conditions when the applicant is already insured for the same condition by another carrier. This would at least provide some rate competition among carriers. While I think that is a good rule, I don’t see how the Feds can constitutionally mandate such a thing. Most of the health care problems are caused by Federal meddling in the first place: HMOs became popular because of the tax benefits.
Your proposal below, to mandate acceptance of uninsured preexisting conditions after a waiting period, might be reasonable also, and give people a chance to recover from a bad decision. (And remember Libs, government bureaucrats are people and make bad decisions too.) But again, are we going to argue that a Federal mandate of this sort is somehow “regulating interstate commerce”?
Stuart, I think insurance is one of those areas where some government intervention is reasonable, primarily because it tends to be the resource of last resort for most people. It’s necessary to avoid total financial annihilation, and people should be helped in purchasing it, lest they and we as a society reap the consequences of their not doing so. It’s a responsible and eminently reasonable thing to do. There’s a huge middle ground between the insurance industry being completely determined by market forces and being completely dictated by the government, and I’m sure we can find a solution. But running through all of the debate over the healthcare bill is the essential issue of fairness. As I said, most illness is totally unpredictable. This country was founded on the concept that all men are created equal- so what do we do when we find out that they actually AREN’T- through no fault of their own? Say screw you, that’s the luck of the draw? That just doesn’t sound right to me, it smacks of the concept of genetic superiority that runs completely counter to the concept of inalienable rights and individual worthiness.
Stuart one of the things we have been missing in this discussion is the need to make a profit. The liberals are knee jerk opposed to profit and that is where the whole problem lies. Insurance is a spreader of risk not a guarantor of payment. They exist to make a profit by assessing the risk of liability plus their service charge for taking that risk. Thus car insurance will cover the expense of a fender bender by charging you enough to recoup their service charge after settling your claim. By spreading the risk over the many non-fender-benders it is affordable but ever vehicle is at risk and is an affordable option. When an insurance company does this for profit the need to define the risk they are covering. It is not an open ended agreement. There are few risks that cannot be insured for a price. It is as simple as that but the government wants to pull more money out of the hat than is put in the hat and that never works. We need to make that profit and it is the most economical way to get good service.
I wonder who cares then? Health is something we all care and it doesn’t look like that.
The process of replacing Obamacare doesn’t have to wait until O’care is dead. The Republicans should immediately introduce legislation for Tort Reform, Buying insurance across state lines, and anything else that can be presented as a single item bill. Present these separately to avoid delays from bargining over different unrelated policies stuffed into a single bill.
I think pre-existing conditions really do need to be covered by insurance. Most people with serious, chronic problems (despite what we hear and read every day) just have bad luck. Most of it can’t be prevented, and to frame it as a matter of character or laziness does not serve conservatives well at all.
Mandates aren’t the only answer to spreading the risk (and costs) around, though. Waiting periods (so people just don’t sign up when they get sick) and defined enrollment periods (people get one month each year to sign up, if they don’t they must wait until the next year) both will encourage people to purchase insurance without forcing them to. In both cases, people would eventually end up with insurance, but if they chose to gamble and not be covered, they’d get bit a little. IIRC, forms of these have been written into the Republican plan.
So it is possible to set up plans where people voluntarily spread the risk around, keep the premiums down, and make their own choices, while still helping the truly ill amongst us.
Nice try Dana, only problem is it won’t work. These things have worked in private practice but not under public law. It is self-defeating for a number of reasons to lengthy to go into here. Honesty and the chance to make a profit are the best guarantors of economical health care. Charity is necessary for some but not all health problems. Remember we have survived down through the ages without all this so-called health care. There is no doubt that we are living longer and better because of it but that is not the responsibility of our government. Honesty is, including government honesty.
I think that there are a couple of reforms that might take quite a bit of the urgency out of the health care crisis.
1: Permit insurance companies to compete across state lines.
2: Eliminate the anti-trust exemption for health insurance.
3: Make it illegal for any hospital or other provider to charge an uninsured patient more than it would charge a Medicare patient. I believe that 90 percent of the health care mess is a function of the ridiculous gap between published hospital charges and what they really get from insurance companies. As an example an open heart surgery episode might be billed at $150,000; but Medicare or an HMO would pay only $20,000. One is a mortgage; the other a 2-year burden that most people could bear, if with some pain. The insurance companies get their massive power over our lives solely because they can enforce steep discounts to published charges for their customers. Why the hospitals collude in this scam is not entirely clear to me, but it is the reason that any sane person feels that he has to have insurance.
4: With 3 in place, you could sell moderately high deductible insurance policies to almost anyone for a reasonable price. Provide tax rebates for the poor if you must.
5: Keep HSAs so people could fund the deductibles.
6: Let Medicare act solely as a tax collector. The government can define the Medicare benefit and then let private insurance companies bid for he right to administer the individual accounts and to try to develop models for managing care. Consumers could buy supplemental benefits if they wanted or could afford them.
That’s all