Proposal for Health Care Reform
Advocates of health care reform face two problems. First, it is too easy to opt out of paying for services and secondly, there are too many unaligned interests in the health care market unlike other commercial markets. The proposal below defines the health care market as medical, dental, mental and drug services and providers.
The first step is to require all people in the United States to enroll in a healthcare payment program or demonstrate that one has sufficient liquid assets to pay for services that can be attachable by a healthcare provider.
Employers, state and federal governments, providers, patients, drug companies, and insurance companies are currently involved in the marketplace. Each has different and conflicting interests. Of those involved, the employer has the no legitimate interest in health care. Eliminating the deductibility of health care expenses and rewarding companies who increase employee pay for the loss of this benefit would be the next step.
The third step would be to create independent consumer consortiums which would negotiate directly with insurance companies for benefit packages and premiums. Costs would become more apparent to potential patients, and patient needs more apparent to insurance companies.
Insurance companies would retain their care delivery contracts with providers. By being in direct conversation with subscribers, the insurance companies can more effectively pressure hospitals, physicians, drug companies, and other providers to meet changing consumer demands and to minimize expenses. Insurance companies who fail will become less competitive and lose subscribers. Providers would be more effective in negotiating their reimbursement levels given their knowledge of their patients and their needs.
State and federal governments would be the primary payer for indigent and special needs populations. They could enter into agreements with insurance companies to administer these programs or contract directly with delivery systems or specialty clinics. State and Federal government certification and licensure programs would be the only quality assurance standards for delivery providers. The federal government would be the reinsurer for extraordinarily expensive cases and for experimental efforts that show promise for a wide swath the American public. For example, the Federal Government would have reimbursed providers for Tommy John’s surgery in 1974, not the Los Angeles Dodgers.
Medical expenses incurred by a taxpayer are now an itemized deduction on Schedule A. Under this proposal, medical expenses would be an adjustment to adjusted gross income on a personal 1040.
Like any proposal, the devil is in the details. The transition period would be complicated and involved but removing the employer from direct involvement in the health care marketplace should make reform easier.
[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]























