Merinda Care

We've heard of Hillary-Care, Obama-Care, Romney-Care, sick-care... every politician has a vague solution to the health of the nation. Rather than bagging on all their bad ideas, here's my bad idea.
This is political, so feel free to skip.

Also, my opinion on how to solve things is likely to change, as it has been changing over the last year or 2. It's on my mind.

Assumptions:
First, people will get the best value when people are making their choices for themselves.
Second, transparency helps people make decisions.
Third, the deal your insurance company cuts with the hospital doesn't save you money; it shows what the procedure might really cost in actuality.
Fourth, 200 mg of ibuprofen does not cost $1.57. If you're already paying for the hospital room, the nursing staff, etc., then shouldn't the drugs be the cost of the drugs?
Fifth, Government does not and can not create efficiency.
Sixth, if you're budgeting for something, you will continue to budget for it. Food, and car insurance, for example.

So here's my plan:

• 2 tiers. Health plan, and health insurance. Two separate things.

1. The health plan is stuff that you expect. Health Maintenance. Annual exams, screenings, maternity, well baby, flu shots, common stuff like strep throat tests, amoxicillin for your annual bronchitis, immunizations, memberships to gyms or health clubs, contraceptives, prosthetics, and things that you do and need to control your health. Chronic or lifetime things included, like high blood pressure and diabetes. This should be more of a budget or savings tool, like a payment plan. Pre-tax, ok. This is where the tax deduction emphasis is.
2. The health insurance is for unexpected. Health Emergencies. Broken arms, cancer, heart attacks, birth complications. Also, help to adjust during the onset of lifetime chronic things like diabetes or chronic heart disease or whatever.

• Divorce your health insurance from your employer. [incidentally, this will greatly benefit small businesses.] Each individual or family can then select the best plan at the best value that encompasses their needs and their budget. It's portable. It's tailored to your situation. The day of the switchover, companies could give you a raise that's equal to what they used to spend on your health care costs. Yay, you get a raise, and companies can remove a headache and you can take control of your destiny.
• The price is the price. No more deals cut for insurance companies to pay lower prices for procedures. When you buy groceries or get a hamburger, the price list doesn't change. (so sometimes it does, coupons and senior discounts... but you get the idea.)
  
• Phase out Medicare. Slowly. The folks who are about to retire have planned for this; but people who are a decade away or 20 years away can certainly plan differently. You don't plan for the government to start paying your car insurance when you retire. You don't plan for the government to start paying for your utilities and your groceries when you retire. (social security is a-whole-nother topic for a different post.) Yep. I said it. I'm a heartless cruel rotten horrid excuse for a person. End Medicare. In 30 years it doesn't exist.
• No public option. Not initially anyway. The US Postal Service compared with UPS and FedEx is a brilliant example, Mr. President. It's not sustainable without significant tax increases and rate hikes. Don't do it. No. Please. The fall of the Roman empire, the decline of the British empire, the dissolve of the USSR... they weren't caused by a public health option - but you could argue that they committed more resources than they could sustain to efforts that weakened them enough that they lost world power.
• No "mandatory participation" -- however -- significant encouragement. Tax deduction related. Like your taxes are lower if you take care of yourself and your family. If you don't play alont, then your taxes are higher to support the government subsidies for "free" healthcare for people who don't have insurance. If you choose not to participate, don't plan on getting free care. Don't plan on getting world-class care. Don't bang on about your rights and ethics and privacy and such if you don't pay for it. But also, complusion is not the American way.
  
• I'm still working on the uninsured needing care. There's an ethics vs. money debate. I'd like to say no money, no care; but that isn't reasonable. A cap? Hmm. Garnish wages and seize property to pay debts? Seems iffy. Clog justice system with individual cases? Not really. This needs help. But here's the basic point: if you don't buy insurance, if you don't plan for expenses, you don't get free care. There would have to be exceptions. I'm suggesting a line at what is ethically required. This probably exists already. The line would be there for both health maintenance and health emergencies.
• I love the pre-tax Health Savings Accounts. This is intelligent to me. High deductible plans are almost like the 2-tier idea; but the 2-tier takes it a step further.
• The cool thing about the HSA is that you are your own death panel. As you save, as you make decisions, as you spend and save, you build up your account. When you get old and need a hip replacement, you look in your account and see if you can afford it. Maybe you've got enough, or you have insurance that will cover it. If not, you look at your other assets. Can you sell your RV? Downgrade your house? Do you want to? It's up to you. Yay! No assets? Not enough dough? Kids won't pay for it? Maybe the doctor has a cheaper hip procedure. If not, then, use the old hip and you've made your decisions.
  
• Help for the poor, mostly in the form of tax deductions. There are local free clinics in a lot of places around the nation where people can get immunizations, flu shots, and basic, basic things. These should remain and continue to fill their current role.
• Good bye to the prescription drug benefit. It's been around for fewer than 5 years. Let it die a fast and hard death. Plan for retirement, folks. We've known for a few years that you get more medical expenses as you age. Put on public service ads that say, "talk to your doc about what she's prescribing, why. Ask whether their is a less costly alternative for your case." And other public service ads that say, "If you get old, you're going to need some pretty spendy meds later on, so die young or plan for your retirement."
  
• Don't let the insurance companies merge into a behemoth so that there are really only 4 options anyway. Foster competition, and this will improve your product and reduce your cost. I know, free-market principles are totally out of vogue right now.
  

I was working on another plan altogether for a while. I'm not sure it's all that great, but more liberal than this one. Takes a little more heed of the poor and the decision-impaired.

It completely wipes out SCHIP, Medicare, Medicaid, and every other federal assistance for anything from hangnails to cancer to AIDS. Then, everybody is taxed for support of a program that would provide payment for a basic set of healthcare. This would include annual exams, screenings, broken arms, and the 70-80% of the most common and easiest to treat medical stuff, or certain procedures. Then, those who want coverage will pay for insurance for things that are expensive and not obligated under the federal system. The expensive new drugs, the better quality pacemaker, the optional parts of your cancer treatment, the optional parts of your heart-attack treatment, IVF, or whatever.

But in deciding for the decision-impaired, you impair the rest. Furthermore, you enable the decision-impaired to remain impaired. This is part of the problem with big government and government-sponsored health care. Those who could do better don't bother, because the easy way is good enough.

And also, in providing more and better welfare, you make it more attractive to be poor and dependent on the government. I think that's cripping for generations. I see them; some live in my building. So my older plan isn't really my favorite any more.

Plan A, plan B. Couple different things to consider.

So clearly my ideas haven't been fully vetted; there are likely several flaws and people would get really mad about some of the elements of my plan. It would benefit some and would be a bit worse for others. It's untried and might not fix the problems that we have in our nation. It's a lot of risk; but it might work. It needs a really good sales job, and a lot more study.

Is the plan under debate right now any better?