I've looked at the numbers and have devised a grand health coverage plan that is prudent and meets most major goals from all sides. I started from the 1.7 trillion dollars of health costs that the US incurred in 2007 according to government figures and assumed the same level of costs (they should go down dramatically, but I didn't want to assume that).
Here is my great Heath Insurance plan. It has been researched and is very plausable and I believe passable. It can be broken up in pieces to satisfy the masses/ political necessities, but every party is essential to the whole. Shoot any holes you see.
- Every person gets a $2000 medical H.S.A. with annual rollover. Costs for this include $200 per person to administer.
I would mandate this to be paid in the form of raising the current "Medicare tax" that comes out of paychecks with employer/employee splitting the costs. My calculations come out to this costing $2,168.89 per job (you need to subtract $2000 per person from current Medicare & military healthcare costs and divert those funds to this new program.). This would equal a 1.77% payroll tax per employee (and equal amount per employee paid by employer) or close to double what we pay now. This tax increase should be offset by an immediate lowering of health insurance costs.
- Create a public insurance option. You would have to pay out of pocket 100% for your first $1,000 of medical expenses (beyond the $2000 M.S.A above). After that, it’s 10/90 co-insurance up to $15,000 total annual incurred medical expenses. After that, you are completely covered for the year (no more out-of-pocket expenses). I would mandate that all federally paid-for programs that currently subsidize private insurance chose the cheapest option with certain neccesities. That would pull a lot of people into the pool to start out with. I would also make all coding standard and available so private insurance companies can save costs by using government tables.
By my calculations, the premiums would be $69.02 per month per person. An individual’s total annual maximum costs would be $3028.14 (not including the new tax).
- Allow all up to 21 million low/no income to enroll in the above for free. Assuming costs would be the same for this group as above, that would cost the government $63 B which I believe is in line with rolling back Bush’s taxes on the wealthy tax bracket. I would also use Nate Silver's suggestion and tax DUIs which could defray 10% of this cost and pull another 6 B from cigarette taxes.
- If you are still uninsured (by my figures that would be no more than 21 million) and incur more than your $3000 grand in total medical costs, then you are automatically enrolled in the Federal government insurance for that year---EDIT: with some stipulations like responsibility for $10 K, otherwise no one would carry insurance, they'd just hop on when they needed it and that would kill the actuarial tables-----. This will bite some people but would insure that no medical bill gets unpaid, thus lowering costs for everyone.
- For the time being, keep Medicare, S-Chip and military medical programs as they are now. My guess is the costs for all of those will plummet and they could each eventually be rolled into the public option. Technically, I’d include the above as a new option from Medicare and use tables from the VA/military to determine what is covered and what is not and at what pay rates. You may need to require doctors to accept the public option.
- (Get ready, because you probably won't like this) Money from the new tax subsidies goes to current health insurance company if they subsequently lower their premiums by an amount equal to the average new tax (employer + employee) amount. This will actually help lower middle-class working adults because their tax increase would be less than the premium drop. Of course, the premiums should plummet with new actuarial tables accounging for the $2000 MSA.
In short, this is a compromise among the things everyone wants. Liberals are happy because everyone gets some form health insurance and there is a public option. Republicans are happy because the HSA's encourage competitive pricing which will keep prices down using their beloved "market forces." Insurance companies are happy because they get a pretty much guaranteed stream of revenue, as long as they stay competitive. Hospitals and doctors are happy because their services will be paid for by someone and they won't have to make up the costs elsewhere (by charging $34 for an asprin). Economists are happy because rolled over HSA's will help stabilize medicare and defray future costs.
The public option insurance plan is almost identical to what I personally have. It took some getting used to, but I really like it. I am much more aware of how much I pay per doctor's appointment and my health care costs have come under control.