A Proposal for Healthcare Reform

[TomAiello 25]

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I also assume that the money in the HSA would be tax free to withdraw for health care purposes only.

Until it exceeded the deductible on the federal policy. After that, I'd let people withdraw it for whatever they wanted. I'd prefer they be able to do that tax free, but I'd be ok with taxing it, too.

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[TomAiello 25]

And here I was going to post something about how we were actually having a productive discussion in SC, without the usual nonsense...

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[TomAiello 25]

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I kinda like it! Was this your idea on your own or did you get it from someone?

Generally my own idea. Drawing on the research (and suggestions) in the Friedman article I linked.

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[billvon 2,400]

>Until it exceeded the deductible on the federal policy. After that, I'd let
>people withdraw it for whatever they wanted. I'd prefer they be able to do
>that tax free, but I'd be ok with taxing it, too.

OK to make sure I understand:

-Money placed into the account is tax free i.e. you can deduct the amount you contribute from your net income.

-Money withdrawn from the account for healthcare purposes remains tax free.

-Money withdrawn from the account for non health care purposes _or_ money withdrawn in excess of $3000 is taxed per some formula (presumably similar to what it would have been had you just used the account as a regular taxable savings account)

That's not a bad way to handle it.

[TomAiello 25]

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-Money placed into the account is tax free i.e. you can deduct the amount you contribute from your net income.

-Money withdrawn from the account for healthcare purposes remains tax free.

-Money withdrawn from the account for non health care purposes _or_ money withdrawn in excess of $3000 is taxed per some formula (presumably similar to what it would have been had you just used the account as a regular taxable savings account)

Yes, generally.

But if you wanted to make sure people used their federal contribution for healthcare, you might want to simply disallow withdrawals below the deductible amount for non-healthcare expenditures.

Alternately, you could just say that if you receive a federal contribution to your HSA, you may not withdraw below that amount for non-health expenditures, but I think that might be prone to cheating.

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[rickjump1 0]

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Ya know, every one of us who thinks this is a good idea could email their Senator and congresscritter. It sure beats just whining about it.

Insurance companies are not the source of all evil, and almost any system like this will do away with a decent number of jobs (all those insurance-paper-processing jobs). But in the long run, reducing costs allows the reallocation of assets to something more useful.

Wendy P.

My congresscritter is in their hip pocket right now, and a lot of us are unhappy with him. Thankfully, he know it. After all, he's the chief architect.

You bet. The lives of a lot of people would be affected, but this is for the good of the country; it involves all of us. If we are waiting for the insurance industry to clean itself up, it won't happen (all those extra assets are keeping them alive on Capital Hill). On the other hand, waiting for Santa Claus, might hasten their demise.

If BHO were smart he would "attempt" to stop exclusions from the anti-trust laws, and open up business across state lines for a start. Then would see just how bad the insurance industry want to stay in business.

Do your part for global warming: ban beans and hold all popcorn farts.

[lawrocket 3]

tom: Quite similar to a post I made thee years ago. http://www.dropzone.com/cgi-bin/forum/gforum.cgi?post=2497788#2497788

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So, what can we do? Let's give debit cards with the cash on them to everybody to buy the basic health care they need. If they want to spend it on stuff they don't need, then they can, but will then pay out of their pockets for stuff they do. Want the $300 pair of glasses instead of the $80, get em! And hope that you do not break a leg this year - it'll hit you. The visits to the dermatologist are important? Cool. Spend a grand on it, but let's hope a mole check doesn't come out positive.

Let's say $3k per year for everyone under the age of 12 to cover doctor visits, shots, etc. Kids can get sicker easier and get boo boos more often.

For teenagers through age 21, get them $1k per year, which should cover most things, i.e., physicals, mild injuries, birth control. It won't cover kids being stupid, for which the parents can get them insurance. You had them, you insure them for excess.

Between 22 and 45? Hey, you are usually the healthiest and cheapest to privately insure. Plus, they are prime working years. Pay your way or get your own insurance. Health care will cost you. And your kids are covered.

46-55? Guys get $1,000 and gals get $1,500 - more things go wrong with women that age, so let's get that working.

56-65? $2,000. You've been able to save and have assets that you can use.

After age 66? $3,000 per year. Your costs are higher.

This cuts overhead dramatically because there is so little billing overhead to deal with. People don't use all of their money in a year? Roll it over to the next year.

Private insurance Go for it! Insurance will be cheaper and easier, and there for other problems such as catastrophic illness and accidents. In a sense, all health insurance will be like an umbrella policy.

Also - emergency rooms will be authorized to charge 50% higher than the average rate for all non-ambulance visits that did not result in admission to the hospital or transfer to another hospital. This will cause patients to seek help through other practitioners and keep the ER's open for true medical emergencies.

Billing problems? Let the government have an appeals board to act as an arbiter in disputes.

The most important feature is that these cards can ONLY be used for medical purposes. The transaction costs and administative costs are cut dramatically. In a sense, it's cash pay. Everyone will have the "cash on hand" to pay "cash" for regular treatments. Everyone gets the minimum care, and people may buy more coverage through insurance. Choose to go uninsured? That's fine. You'll face the consequence if you femur in while skydiving.

My wife is hotter than your wife.

[kbordson 8]

OK...

not to make this more complicated, because I LOVE the simplicity

But how do you encourage patients to shop for cost reduction when they might not feel that they have the ability to do so. (not that they don't have the ability... but they feel that they don't)

There will have to be a bit of re-education on patients rights and responsibilities.

And PHYSICIANS would have to do that too.

Typically our clinic sends labs to one of two companies, depending on the patients insurance. With this new program, will patients will have to research which lab has cheaper GC/Chlam screening. Will the patients be "allowed" to pick and chose options? (example - my "typical" STD screen would be GC/Chlam, RPR, HIV, Hep B/C, HSV) She comes in after an event of unprotected intercourse and only wants screening for HIV because that's what shes really scared of (but doesn't understand) [note.... in my clinic, I would then explain to her about all the testing and encourage her to do a full screen, but even currently, she would have the right to refuse.... but when I took my oral boards, I didn't tell them that, I just stated that my STD screen was xxxx]

[kallend 1,625]

Cool - now expand it to 1600 pages and put it in cryptic language so it looks like Congress wrote it.

...

The only sure way to survive a canopy collision is not to have one.

[TomAiello 25]

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There will have to be a bit of re-education on patients rights and responsibilities.

And PHYSICIANS would have to do that too.

Sure. Physicians and the other providers (like the labs). In some cases, they'd be advertising their services, to attract business, which might include include advertising prices.

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Will the patients be "allowed" to pick and chose options?

Sure. They're the ones paying for them. Of course, if you, as their physician, aren't happy with the choices they make, you can try to convince them otherwise, or even just "fire" them as a patient, and refuse to see them anymore, because you don't want to be responsible for their bad decisions.

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[lawrocket 3]

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But how do you encourage patients to shop for cost reduction when they might not feel that they have the ability to do so.

It's easy. Even the most uneducated know how to get value. People tend to spend their own money in the most cost effective and efficient manner - unless they think that somebody will be there to cover their ass (they'll spend like mad with other peoples' money). They learn.

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There will have to be a bit of re-education on patients rights and responsibilities.

And PHYSICIANS would have to do that too.

I am unsre of this. Should a physician be the financial fiduciary of the patient? Or were you referring to physicians needing to be educated?

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Will the patients be "allowed" to pick and chose options?

Perhaps. Indeed, probably. We have the right to our bodies. The lab testing is somewhat difficult because it can be inefficient. However, there is still that choice.

My wife is hotter than your wife.

[TomAiello 25]

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Should a physician be the financial fiduciary of the patient? Or were you referring to physicians needing to be educated?

She's saying that the doctors would have to explain the new system to the patients, including the patients right (and need) to shop around for services. In a lot of places, patients are currently unaware that they even have options, and just go wherever their doctor sends them. I've seen unethical doctors use this to pad their wallets (for example, sending patients for outpatient MRI's at a facility the doctor owns and never telling the patient there are other options).

It's definitely an issue, but I agree with you that a little education goes a long way when people understand their self-interest and have their own dollars at stake.

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[funjumper101 15]

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ok... did you even really READ it?! I would cut and paste his post directly to your arguments to show that your comments do NOT seem directed to his idea AT ALL - but I don't want to waste that bandwidth on something you won't read anyway.

Read it. Think about it. THEN POST. m'kay.

I read the so called "proposal". I completely understand it. It is a pathetic piece of shit.

It is time for the USA to join the rest of the civilzed world.

Screw the right wing shitheads that are too ignorant to know what is working well for the rest of the world.
I don't want a half baked, cockamamie contraption of bullshit.

SINGLE PAYER NOW!!


BTW, my IQ is in excess of 140. It takes me very little time for me to read and comprehend COMPLETE BULLSHIT!!

[rushmc 18]

Tom, I dont think funjumper likes your plan!



Nice work. I like it.

I would add that it should be allowed to let the companies custom build plans to fit deductibles, coverage and limits to allow premiums that an individual can afford based on their personal situation. Opening up the states borders would allow companies to compete and specialize in they types of coverage they want to specialize in. Groups, individual, small business ECT.

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[Rookie120 0]

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Cool - now expand it to 1600 pages and put it in cryptic language so it looks like Congress wrote it.

SWEET!

If you find yourself in a fair fight, your tactics suck!

[kbordson 8]

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BTW, my IQ is in excess of 140.

Congratulations... I'm glad that you think that you're so smart, but that has NOTHING to do with this.

If you want to joint this actual conversation, READ his proposal and suggest ways to actually improve his idea. Otherwise.... in the words of President Obama " Stop 'Talking' and 'Get Out of the Way'"

[georgerussia 0]

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Here's a pretty good proposal:

a) create a national health insurance policy with a high deductible (say $3000)

b) create a tax free health savings account for each citizen

c) deposit some amount into the health savings accounts (or just those of people under a certain income level) every year (for example $1000)

d) allow people to withdraw (tax free) any amount in their HSA that exceeded the deductible (in this example $3000)

This proposal is good, but it only covers one part of the problem - which is also the least important in my opinion.

Some clarifying questions:

- Should it cover pre-existing conditions? The reason current HSA policies are much cheaper is generally because the insurers are allowed to cherry-pick the customers to make sure the chance that they would have to pay anything are very low (all routine stuff is covered by the insured via deductible, and being healthy it's unlikely he'd go over the deductible). Even within the insurance company (at least Blue Shield) switching from non-HSA to HSA plan is considered upgrade, and requires medical underwriting. As soon as you require insurers to cover pre-existing condition, the costs would go much higher.

- What does the plan mean in terms of payment, i.e. who pays for the policy (everyone individually or like NHS, i.e. assuming everyone is covered)? How would the plan cover those who cannot afford the policy costs, and how would it deal with those who can afford it, but do not want to? Would ERs still be required to treat uninsured?

- What does the plan mean in terms of coverage? Are there country-wide lowest acceptable minimum standards of coverage (i.e. list of things which must be covered everywhere, by every doctor/hospital), or the states are allowed to have their own minimum standards as long as they are above federal ones? Also existing HSA plans are pretty weak in covering maternity and mental health - is it covered?

- What does the plan mean in terms of acceptance? Is every hospital and doctor required by law to accept the plan, or they're free not to, or there are "incentives" (like you don't have to, but then no federal money for you)?

- Items c) and d) create a pretty large incentive to cheat the system, for example, for a family of three by billing only one person in the family for the services provided to the whole family. This way they would get $2000 cash each year, and preventing this kind of fraud is not easy.

Anyway, so far the only difference of your proposal comparing to healthcare bill is the HSA/deductible thing.

* Don't pray for me if you wanna help - just send me a check. *

[funjumper101 15]

The proposal is a complete violation of the so called "core principles" of the reich wing. A massive giveaway to the insurance companies, a huge burden of bookkeeping for the IRS and the individual taxpayers, and all around bend us over frontwards so we can keep taking it in the ass.

Nicely done. A completely bureaucratic and onerous approach to the issue. I thought that reich wingers believed in minimal governmant mandates. Nice to see that that only applies now and then.

The real answer is a single payer system. The strongest western economies have it, in one form or another. Gone is the burden of "pre-existing conditions". Gone is the fear of bankruptcy due to medical bills. Gone is the lack of job mobility due to health insurance issues. Gone is the un-equal playing field when it comes to insurance for small businesses. Gone is the LOSS OF ONE THIRD OF THE MONEY spent on health care that goes to to enrich the executives and stockholders in corporate insurance companies, as well as administrative overhead.

The dirtbag Reagan signed into law that which allowed health insurance companies to become FOR PROFIT organizations. That has worked out really well for the average citizen, hasn't it? War on the middle class, executed to perfection. Reich wingers are PROUD of that president. Creepy, isn't it?

The Rescumlicans have fought tooth and nail against Medicare. They delayed the start by more than 20 years.

You ignorant reich wingers might have a shred of credibility if you had even a remote understanding of the facts of the history of the health care issue. You don't, so take a big heaping helping of SHUT THE FUCK UP, and get out of the way.

As much as the reich wingers HATE medicare, they sure seem to like it a lot for something they fought against so hard, for so long. You all still fuck it up when you get the chance. The ShrubCo reforms that created the "donut hole" is a perfect example. I am sure that you are very proud of that accomplishment. It didn't hurt anyone except those that really needed the assistance. Pretty much like all reich wing accomplishments. Stomp on those that are most vulnerable. Enrich the rich even more. They sell the "vision" to the nitwits like laundry soap.

Single payer NOW!
The time has come for the USA to join the rest of the first world.

[mnealtx 0]

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BTW, my IQ is in excess of 140.

And someday, your posts will even prove it.

Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

[rushmc 18]

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BTW, my IQ is in excess of 140.

And someday, your posts will even prove it.

With the terms used lately I wonder if this is Amazon?
(not really, but a clone maybe?)

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[likearock 1]

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Here's a pretty good proposal:

a) create a national health insurance policy with a high deductible (say $3000)

b) create a tax free health savings account for each citizen

c) deposit some amount into the health savings accounts (or just those of people under a certain income level) every year (for example $1000)

d) allow people to withdraw (tax free) any amount in their HSA that exceeded the deductible (in this example $3000)

There's your problem. A pity, it is a good plan.

[pirana 0]

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e) Substantially reduce the (massively expensive) influence of the health care finance companies (health "insurance" companies)


What do you think?

This comment shows a huge lack of knowledge on the actual impact insurers have on charges. If billed charge was paid on all claims, health care costs to the consumer would approximately double overnight.

There are some very good ideas here; but handing admin completely over to the government and expecting them to foster any kind of competition in general, or keep pressure on prices specifically is wishful thinking.

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley

[justinb138 0]

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There's your problem. A pity, it is a good plan.

While I agree, if you could roll medicare into the same system, I think bringing back some semblance of market forces would be a net cost savings when compared to the current system.

Removing the perception of spending other people's money is a necessity if costs need to come down.

[Rookie120 0]

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I wonder if this is Amazon?

What ever happened to her?

If you find yourself in a fair fight, your tactics suck!

[rushmc 18]

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I wonder if this is Amazon?

What ever happened to her?

I have no idea

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln