16 May 2011

More health care reform anyone?

Nobody much on the left is talking about further reforms to Health Care and Medicare/Medicaid lately, but since the Repubs are still talking about turning Medicare into a coupon system, I thought I'd throw out my two cents for some generalized elements I'd like to see adopted, in stages.

1.   Legislation to allow regulation and price controls for most medical procedures, drugs, therapies, etc. (such as they have in France and Germany, which have private insurance systems), subject to a review system, and applicable to both private and public insurance. Obviously, this would eliminate the prohibition against negotiated prices for prescription drugs. We must get medical costs under control if we are to have any chance of adopting a system that provides universal health care for real.

2.   Phased in elimination of for-profit institutions providing health care (i.e., institutional providers receiving government funds would be required to convert to non-profit organizational status). This may be controversial, but I am convinced that for-profit health care does not and will never work; and, in fact, for profit health care and especially health insurance, because it involves inherent conflicts of interest, is essentially legalized racketeering. 

3.  Immediate elimination of any supplemental funds for Medicare Advantage and other private health care Medicare alternatives. If private plans want to take what Medicare pays, without its costing the public a dime more, OK, otherwise, forget it. This is costing billions now, in a plan originally sponsored by Repubs claiming it would save money. (It hasn't, obviously). This would be coupled to improvements to Medicare that would make supplemental insurance unnecessary and less desirable. Those who wished to purchase supplemental coverage for luxury medical coverage could do so, as they do in many European countries. But the basic system needs to be universal and medically recognized as adequate; beyond that, you pay for it yourself.

4.  First, and relatively quickly, offer a Public option, in the form of a Medicare Buy-In for people under 65.

5.  Then, after some not-too-long period of years, this would be replaced with a single payer system, phased in over perhaps a decade (with the Public Option buy-in still available for those not yet eligible). The single payer phase-in would be by age decades (first lower Medicare age to 55 (and include minors to age 18), then to 45, then 35, then everyone). (Those who prefer to pay for private insurance could be allowed to opt out, but private insurance would still be subject to price controls and required to be non-profit). All of this would be financed by "premiums" (taxes) that would be comparable overall to what employers and working people pay now, with progressive elevators to cover the cost of the currently uninsured.

My challenge to anyone reading this: apart from politics, tell me one reason why this wouldn't 1) work far better than the present system for the majority of people; 2) save a ton of money; (i.e., cut the deficit by a substantial fraction); and 3) achieve the goal of universal health care in our time.

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