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Last week I outlined the generic components of so-called mandated or mandatory plans. This week we will, with the help of Professor Len Rodberg (warning: it's a PowerPoint file; not Len himself, he is flesh & blood, just his slideshow) briefly outline some of specific national proposals that have been in the news lately:

  • America’s Health Insurance Plans
  • Better Health Care Together Campaign
  • Health Coverage Coalition for the Uninsured
  • Sen. Ron Wyden with SEIU & Safeway
  • Federation of American Hospitals
  • John Edwards

What they share is the goall to keep the insurance companies healthy... lets see how that works.

First a note about Len. Len is not only a great guy, but has been involved in numerous progressive health care reforms from numerous single payer plans going back at least to the Dellums bill (look it up), to early promotion of Community Health Centers, to compiling and analyzing of hospital statistics statewide. He is the only Urban Studies professor I know of with a PhD in Physics (seriously).

As we noted last week, "Universal" Health Care is back in the political arena, for the first time since Hillary-care crashed and burned in 1993-1994.  This is mostly due to the fact that costs rising far faster than inflation: From 2000 to 2006 health insurance premiums have one up 87%, compared to 20% for overall inflation and 18% for workers earnings. In our primarily employer-based coverage system more companies are either dropping coverage altogether, or raising the amount paid by employees (contributions to premium, copays, deductibles, reduced coverage).

The national average premium cost for employer-provided insurance is now up to $4,024 per year for single coverage and $10,880 per year for family coverage. Compare that to an annual income at minimum wage of $10,300 and the alleged average annual of a Wal-Mart worker of $17,114.  If you have to buy your own, even at the reduced group rate that companies get, there's not much left over for food and housing.

Not surprisingly the numbers of uninsured have been going up dramatically: from 22 million in 1975, we broke 30 million in 1985, 40 million in 1995, and are now around 46-47 million.

So what about those plans...

  • The Good News: "Universal health care" is accepted as the goal.
  • The Bad News: This is defined to mean using tax dollars to help the uninsured buy private insurance from the existing high-overhead middlemen of the for-profit insurance companies.

1. America’s Health Insurance Plans & Federation of American Hospitals

  •  - aka: "the private insurance & private hospital protection plan."
  • Expand SCHIP and Medicaid eligibility for very low-income
  • Provide federal and state subsidies and tax deductibility to encourage everyone else to buy private insurance
  • In other words: Use taxes to cover some more of the poor high risk, then give more tax dollars to the unnecessary middlemen private for-profit industry that eats up 31% overhead, compared to 4-13% achieved in direct plans.

2. Better Health Care Together Campaign

  • aka: "The Grand Coalition"
  • Members: ATT (big biz), Kelly Services (temp company), Wal-Mart (bigger biz), SEIU & CWA (unions), Center for American Progress
  • Principles but no Program:
  • a. Quality affordable insurance coverage for everyone
  • b. Individuals are responsible for maintaining and protecting their health
  • c. Improved value for health care dollar
  • d. "Shared Responsibility": Businesses, government, individuals all contribute. By business they mean both employers and the private for-profit health care industry.
  • Widely covered press Conference, but no real specifics.

3. Health Coverage Coalition for the Uninsured

  • aka: "The Even Grander Coalition"
  • Members: UnitedHealth, Blue Cross & Kaiser (insurers), American Hospital Association, American Medical Association, Chamber of Commerce & National Association of Manufacturers (biz lobbyists), Pfizer (pharmaceutical company), AFL-CIO (well national anyway; many states, councils and locals have been endorsing Conyers HR-676 "Medicare for All"single payer), SEIU (well Stern anyway, many locals endorsing Conyers HR-676 "Medicare for All", AARP, Families USA (well Pollack anyway; he's still feeling too burned by 1994)
  • Coalition was so "Grand" that they could agree only on:
  • a. Expanding coverage as a goal
  • b. Expansion of SCHIP
  • c. Tax credits for children’s insurance

4. Senator Wyden's Healthy Americans Act

  • aka: "Employer coverage is dying, so let's kill it faster"
  • Supporters: SEIU, Safeway, Families USA
  • Eliminate the tax deductibility of employer-based insurance with goal to ends employer-based health coverage.
  • Requires individual purchase of insurance
  • Transitional payments by employers
  • Subsidies to low-income individuals
  • Relies on competition between private insurers to contain costs (but unclear how this would happen since no evidence that health insurers work that way... they only compete for who can get the healthy and wealthy).

5. John Edwards Plan

  • I give him some credit for at least making a relatively specific proposal.
  • but some do call it "individual mandate with a pretty face"
  • essentially same as Jacob Hacker plan from Econimic Policy Institute (EPI)
  • Interestingly Edward's also offered a mandate plan when he ran in 2000.
  • Employer mandate ("play or pay")
  • Individual mandate with community rating
  • Government subsidies for low-income
  • Regional purchasing plans ("Health Markets")
  • Choice of Government program (which is DISHONESTLY referred to as single-payer; shame on them) as well as Private Plans.
  • Claim: For everyone: Shared responsibility
  • Claim: For the fearful: Lets people keep what they have
  • Claim: For those worried about cost: Everyone will work together to make the system more efficient
  • Claim: For single payer advocates: Individuals and businesses can choose if they want the government plan; if so, the system will "evolve toward a single-payer approach."
  • No cost control!!!
  • Requires additional taxes and expenditure above what we pay already
  • by comparison: Single-Payer costs about 5% LESS than current expenditures to cover everybody with high-quality coverage and no out-pocket expenses. That what you can do with the $350 Billion in savings by cutting out the 31% bloat of the unneeded middlemen of the private for-profit insurers.

So, once again... What’s Wrong with an Individual Mandate?

Well among other things:

  • Will not lead to universal coverage. Comparison to mandatory auto insurance where at least 10% don't have.
  • Enforcement is anti-public health
  • Affordable premium vs half-decent coverage: can't leave private for-profit insurers in the middle and still have both, as Massachussetts is discovering. Feds discovered this when tried to have Medicare Manged Care and privates could not make enough profit and dropped out, until offered 11% higher payments than regular Medicare!
  • Employers will drop coverage ("crowd out") if play or pay cutpoint is set at affordable level.
  • Insurance companies resist community rating (same premium rate for everybody regardless of pre-existing conditions or risk) and mandatory coverage(have to take everybody regardless of pre-existing conditions or risk)
  • Leaves in place the consumer nightmare of copays, deductibles, exclusions, denials, appeals.
  • Expands the complexity (and humiliation) of Medicaid's humiliation of means testing (not so easy for the majority of workers who are not on straight regular salary; usually require income tax return to be shown).
  • Add new layers of bureaucracy such as the "Health Markets".
  • Additional high cost of about $120 Billion in Federal tax money and some unknown still for individuals.
  • No cost control, just continuing rising costs!

Len goes on to argue that none of these plans will happen, because:

  • They cost hundreds of billions of additional dollars
  • They benefit only those with low incomes and those without insurance, who are politically weak.
  • Does nothing for the 50% of middle- and lower-income adults who have insurance but still experience serious problems paying medical bills or insurance premiums.
  • Does nothing for the people with insurance and still going into bankruptcy. 50% of bankruptcies due to medical bills and 75% of those folks had health insurance.
  • Does nothing for the 12-18% of folks who are underinsured.
  • They don’t solve any of the problems (especially rising costs) that concern everyone
  • None envisions a real structural change.

In the 1940s and 1950s America moved forward with employer-based group health care coverage.

Going backwards to individual purchase of insurance is not the answer.

What is common to these plans is that they identify the wrong problem and then offer the wrong solution:

  • Identification of the problem: too many uninsured.
  • Their solution: Require everyone to have insurance
  • Employers should contribute but not necessarily offer insurance
  • Their real mission: Save the private insurers

The problem really is the Private For-Profit Insurance Industry:

  • None of these plans does much about what is the real problem
  • Excessive administrative costs
  • Excessive complexity
  • Continuously rising costs
  • Lack of coordination, budgeting, and planning
  • Regressive financing via premiums (premium is the same if you are rich or poor)
  • Widespread underinsurance and bankruptcy
  • Interference in physician decision-making
  • The "hassle factor": paperwork at every level, filing claims, automatic or phony denials, re-submitting claims...

Solution:

  • Expand Medicare to cover everyone: The hassle difference between folks who use Medicare is astounding.
  • Improve the coverage it offers (drugs, dental, mental)
  • Eliminate private insurance
  • Automatic enrollment in Medicare for All
  • Income-based financing through employers and employees (yeah for "shared responsibility"), preferably through progressive income and corporate taxes, but possibly via deduction taxes (e.g., ~8% corporate; ~2.5% on individuals).

For more on how single-payer works: peviously I outlined and described in some depth how single payer works, and debunked some of the myths propagated against single payer.

Something else all those so-called "politically practical compromise plans" have in common.

  • They are all are just inside the beltway elites and lobbyists talking to each other (the same ones over and over, as you may have noticed).
  • None actually has any grassroots support.
  • The one plan with a grassroots movement behind it is Rep. John Conyers HR-676 "Medicare for All".

HR 676 has been endorsed by over 235 union organizations in 40 states including 60 Central Labor Councils and Area Labor Federations and 17 state AFL-CIOs (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO & MN), as have many other civic and religious organizations. Including several locals of SEIU.

The bill garnered nearly 78 co-sponsors in the last Congress, more than any other reform proposal, including the chairman of Ways and Means (Rangel, D-NY) and the chair of Ways & Means health subcommittee (Pete Stark, D-CA). At least three of the newest members of Congress made support for single payer national health insurance a key issue in their campaigns. Senator Kennedy has been the Senate sponsor in past years.

HR 676 would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident: It would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing aids, chiropractic and long term care.  HR 676 ends deductibles and co-payments.  HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

HR 676 has been endorsed by 235 union organizations in 40 states including 60 Central Labor Councils and Area Labor Federations and 17 state AFL-CIOs (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO & MN), as have many other civic and religious organizations.

So, here is what YOU can DO now:

  1. Ask your congressperson to sign-up as a co-sponsor of HR-676!
  • You can look-up your elected officials here
  1. Get any organization you belong to -- civic, religious, labor, community, etc. to pass an HR-676 endorsement resolution:
  • Here is how to do that via Physicians for a National Health Program.
  • or here here if you prefer via a non-physician group.

Just do it!

Originally posted to DrSteveB on Thu Mar 01, 2007 at 05:59 AM PST.

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Comment Preferences

  •  Tips & Recommend Health & Peace (19+ / 0-)

    "because you can tip and recommend me now, or pay the insurance industry later."

    •  please point me to a plan (0+ / 0-)

      by a democratic nominee for 08 polling at >3% that is better than Edwards'.

      thanks in advance.

      Why do Murdoch and David Brooks like Hillary?

      by inevitibility on Thu Mar 01, 2007 at 06:56:03 AM PST

      [ Parent ]

      •  Hang on (2+ / 0-)
        Recommended by:
        SarahLee, wardlow

        I won't make the perfect the enemy of the good, but I won't accept a poor choice because no one has the guts to try to get a real one passed. The Clinton plan was bad. I'm glad it failed, though not for the reasons the Harry and Louise puppets wanted it to fail. Edwards's plan is better, but still not good. People need to fight for single payer universal health as long as possible, not make the compromise before the question is actually on the table.

        I like Edwards. I would like to vote for him. That doesn't mean I like his health plan or that he shouldnt' consider improving it.

      •  Edwards better than anything Hillary will do,but (2+ / 0-)
        Recommended by:
        katiebird, SarahLee

        I guess the counter argument would be, what bill has strongest support in Congress, by people who are already elected and in charge of committees?

        HR-676:

        • 80 co-sponsors after reintroduced a month ago.
        • Main sponsor is Chair of Judiciary committee
        • co-sponsors include chair of Ways and Means (Rangel, D-NY) and the chair of Ways & Means health subcommittee (Pete Stark, D-CA)
        • Hundreds of Union groups all over the country.

        That ain't chopped liver either.

    •  DrSteveB great diary as usual (0+ / 0-)

      I was talking this over with co-workers yesterday. One of them is unsure on how HR 676 is funded. That seemed to be the mainsticking point with him. I'm not sure how it is funded and I'm not sure where I would find the statistics to support the figures.

      Any clue?

      •  HR 676 is funded in three ways (1+ / 0-)
        Recommended by:
        SarahLee
        1. Eliminating private insurers and recapturing $350 billion in waste
        1. Rolling in all current federal health funding (Medicare, Medicaid, SCHIP)
        1. Replacing the amount currently paid directly by individuals and business in premiums, OOPs, etc. by some kind of progressive tax structure to roughly replicate what we have now (20 percent business, 20 percent individuals, 60 percent government). There is no one way you could design a tax structure. For example, a 2 percent income tax and a 7 percent payroll tax would probably do it, but there are lots of conceivable ways to do it.
    •  Wow (0+ / 0-)

      great overview.  Thanks.  Sending to the nurses!

  •  Any requirements for employer-provided (4+ / 0-)
    Recommended by:
    SarahLee, bewert, TexDem, Hens Teeth

    insurance should have some clear guidelines on cost structures, else you'll see vast discrepencies in costs and  growing trend of employers having to fire people with chronic medical conditions.

    One of the problems of pool-based insurance is size of the pool. In Maine, where I live, purchasing any insurance is an expensive proposition simply because of the state's small population. With a large ageing population and a large low-income population, there are fewer and fewer people paying the rates that support the aging and chronically ill.

    Personally, a national system that eliminates the health-insurance industry altogether as the best option. Every cent of profit is a cent that should have provided hands-on benefits for consumers.

  •  How not to do it (5+ / 0-)
    Recommended by:
    SarahLee, TexDem, BR Janet, DWG, Hens Teeth

    The Wall Street Journal, well-known radical newspaper, has another article about badly conceived and implemented health care bandaids. This one is the Health Coverage Tax Credit, tucked into a 2002 trade bill to win support in Congress for the bill. Not surprisingly, it's a failure. Only 11% of the potentially eligible are taking advantage of it, probably because:

    • unemployed people cannot afford the insurance even with 65% paid by the government;
    • waiting sixty days or more to quality puts too much of a dent in the savings of someone making $8.00/hour;
    • the bureaucracy requires that a number of hoops be jumped through.

    Imagine. It sounds good, but fails dramatically.

    The issue is on vivid display in Galax, population 6,800. More than 2,000 jobs in this western Virginia town have been eliminated over the past two years as several furniture manufacturers and textile plants either closed or reduced their work forces in the face of cheaper imports, mostly from China.

    Almost all of the displaced workers were eligible for the federal health-insurance subsidy, yet only about 100 have signed up, says Linda Nuckolls, who works in Galax for the Virginia Employment Commission. "These people have worked in a furniture factory for $7 or $9 an hour and they just don't have the money," she says.

    Results were similar in a January 2006 survey by the Government Accountability Office, the investigative arm of Congress. The GAO looked at five trade-related plant closures and found that no more than 12% of workers at any site were taking the credit. Among those who knew of the program but didn't use it, the most common complaint was that they couldn't afford to pay their part of the premium, the GAO said.

    Piecemeal and patchwork is no way to run a health care system.

  •  It's interesting to think historically... (4+ / 0-)
    Recommended by:
    katiebird, SarahLee, TexDem, DWG

    Modern medicine really was not born until WWII.

    Before that, we didn't even have effective antibiotics. My grandfather died of a heart attack when he was 54 that would most likely have been eminently survivable (if not preventable) today. Heck, there wasn't even an emergency medical system back then. My grandmother, who didn't drive, waited  for hours for the doctor to come to them (note to the kiddies: it was called a "house call"), but by that time, it was too late. Compare that with the current standard 6-minute response time for paramedics to come to you with medicines and an ambulance to whisk you to the heart cath lab.

    Back then, no cancer was "curable" unless it could be cut out of you.

    Orthopedic surgery? Hip replacements?  Colonoscopies? Heh, funny. Laser eye surgery? Heck, there weren't even lasers (except in the comic books).

    And so we have a healthcare delivery and payment system born out of the Depression that's trying to fund something it could not possibly have anticipated would exist.

    The only analogy I can come up with is air travel. And it seems we're trying to fund modern jet travel with a funding system more appropriate to manufacturing biplanes and the Spirit of St. Louis.

    Time to rethink the system. Totally.

    The power of accurate observation is commonly called cynicism by those who have not got it -- GB Shaw

    by kmiddle on Thu Mar 01, 2007 at 06:34:04 AM PST

  •  costs (1+ / 0-)
    Recommended by:
    SarahLee

    It's not highlighted enough how expensive insurance costs are now.  Many are paying over a $1,000/month already for inadequate insurance, and with that, they have copays and paperwork, and coverage refusals, and hours, usually on hold, to fight for their benefits.

    The other half of the equation must also be addressed, exhobitant incomes for big pharma and some doctors.  How about a cap on income for these guys.  They're gonna be against any plan anyway, so make them the villains and make them shoulder more of the expense.

  •  Nice summary of the major proposals (2+ / 0-)
    Recommended by:
    SarahLee, DSPS owl

    The number of proposals is a sign of growing awareness of the problem.  The Conyers bill is definitely needed.  If something is not done quickly, we are going to see life expectancy in this country shrink after decades of steady increases.  

    A tyrant must put on the appearance of uncommon devotion to religion. - Aristotle

    by DWG on Thu Mar 01, 2007 at 07:10:11 AM PST

  •  Do you know what the 15-year phase-in period is? (0+ / 0-)

    Do you know what the 15-year phase-in period is?

    Buried deep inside the bill is a sentence that refers to a 15-year phase-in period.  But I haven't found anyone who knows what would be phased in (people-who? services-what?)

    I'm not even sure who to ask, since my Congressman would never support it.

    Eat 4 Today: Defeating Republicans through diet and exercise!

    by katiebird on Thu Mar 01, 2007 at 07:26:53 AM PST

    •  That's the time we think it would take (1+ / 0-)
      Recommended by:
      SarahLee

      to do all the legwork: evaluate investor's existing equity in insurance companies, etc. and cash them out, all that stuff.

      Please don't read too much into HR 676. It should be pretty obvious it's not a "real" bill.

      •  I don't understand. Why isn't it a "real" bill? (0+ / 0-)

        I don't understand.  Why isn't it a "real" bill?

        With so many sponsers and so much national interest & enthusiasm, what makes in unreal?

        Eat 4 Today: Defeating Republicans through diet and exercise!

        by katiebird on Thu Mar 01, 2007 at 08:05:54 AM PST

        [ Parent ]

        •  because (2+ / 0-)
          Recommended by:
          katiebird, SarahLee

          The whole thing is like 23 pages long and full of holes, ambiguities and unclear definitions. The whole idea behind the bill when it was introduced was that it was supposed to be an organizing tool (i.e., something tangible that people and groups could endorse and have a reason to talk about) to raise awareness about single payer, not to consume a whole bunch of energy talking about the fine points of exactly which tax structure is best, exactly how long the phase-in should be, etc.

          I don't mean its not "real" in the sense that people shouldn't organize around it...that's exactly what they should do, and what its there for. But when the financing section of your national health insurance bill is about a half a page long, its pretty obvious that there's a lot missing. That's mostly on purpose, because we want to bring people into the discussion about how it should be financed and structured, etc. But that doesn't change the fact that it is nowhere near implementable as it is.

        •  it's an oultine (2+ / 0-)
          Recommended by:
          katiebird, SarahLee

          drawing on single payer concepts from the PNHP and other proposals over the years. It is kind of a place-holder to sign on to. It is more detailed than any of  the other proposals cited above, with the possible exception of Wyden.

  •  Just posting to REC n/t (1+ / 0-)
    Recommended by:
    SarahLee

    Means-testing veterans is DEMEANING! Do YOU CARE? PLEASE HELP US. NOTE: Vet with PTSD. Doesn't play well with others.

    by glbTVET on Thu Mar 01, 2007 at 07:54:47 AM PST

  •  John Conyers talks about working for (1+ / 0-)
    Recommended by:
    MarketTrustee

    Universal Health Care

    Inspiring

    http://www.youtube.com/...

  •  Here's something to think about: (0+ / 0-)

    Their real mission: Save the private insurers

    . . .  Referencing the forced-buy plans of Schwarzenegger and Romney et al.

    Let's turn this coin over. Corporate insurance companies will do everything in their (gigantic) power to preserve themselves. Since this is the case, we should be helping them (and their employees) survive in a different mode by discussing ideas about alternative areas of risk (no longer healthcare) for them to insure and other businesses to get involved in. They're big boys and don't need our help to survive  -- but they do need help in how they perceive themselves -- expanding the frame of possibilities for private insurers away from and beyond healthcare where  they are, indeed, not suited to succeed well in  human terms and too well set up to implode economically.  

    We can let the Overton Window move along the imaginative spectrum of getting private insurers out of the healthcare picture -- from unthinkable . . . to possible . . . to acceptable. . . to sensible . . .  to popular  . .  to the natural way things work best . . . with corporate insurers gone from the healthcare scene. But they have to go somewhere and we have to start imagining that. Until then, with Big Insurance standing there, we have a perceptive block to the public imagination that single payer will ever be possible. We know single payer makes the best sense but this entire debate/discussion is stuck in this jam until the frame is made bigger, Overton moves it along toward the absence of multiple wasteful, expensive private policies . . . to the presence of a streamlined single paying fund finally becoming the natural fact of our health lives.

    So, in fact, we really do need to think of ways to "save private insurers" by giving them something profitable and safe to do -- but not in the healthcare field because private corporate insurance of healthcare is inherently unsafe for humans (although wonderful for Wall Street stockholders coffers). If we begin thinking in terms of moving corporate insurance into other fields of business and investment (think of all that capital they can invest in other businesses -- maybe sustainable energy, for example) -- and if the newsmedia cover it (a big "if") -- we have a chance of making progress toward opening the way toward single payer in the public -- and business -- imagination and eventually in reality. All we need is great leadership to take us in this direction, leading us through these views via the Overton Window.

    Hint: One foot in a corporate solution, like Clinton or Edwards, won't cut it. We need much greater, more imaginative leadership than this. When it comes to health insurance, it's time to stop bargaining with the corporate devil as a means of avoiding leadership.
    __________________________________
    Get on board California's Single Payer!  

  •  great diary, drsteve (0+ / 0-)

    i delight in how edward's "plan" is nailed to the floor. can't wait (actually, othewise pre-occupied) to diary on "health markets": new word for IT industry sector created by bush, regional health information organizations (RHIOs).

    in short, insurance underwriters' tool.

    Diversity is the key to economic and political evolution.

    by MarketTrustee on Fri Mar 02, 2007 at 08:54:52 AM PST

  •  Two more big problems (0+ / 0-)
    #1. All proposals basically leave people who make $50K to twist in the wind

    $50k is the median household income; how good it is depends on where you live and your individual circumstances. Nevertheless, few people who make $50k have a spare $10k a year lying around to buy their own health insurance. It's a huge hit.

    #2 What happens when the premiums aren't paid

    Even in a world of perfect subsidies, it is simply going to happen that premium payments will be missed. Maybe the car needed a  repair, maybe Mom & Dad are just not good at paying their bills, maybe the employer was late with his checks, maybe someone just lost a job, maybe whoever paid the bills is the one in ICU. Maybe mom & dad don't have a checking account.

    So what then? What happens if there's an accident on March 2 and the payment didn't arrive on March 1? Will the state pick it up? Will they be able to retroactively pay the bill? Will we just put them in jail - where ironically, there is healthcare available?

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Fri Mar 02, 2007 at 09:32:06 AM PST

  •  A Democratic Party solution to the Health Insuran (0+ / 0-)

    The Democratic Party should submit legislation to create an "At-Cost Universal Public Health Insurance Program" to be managed by the Social Security Administration.

    My proposal would be to have separately priced coverage for the following classes of coverage:

      1. Preventative Care
      2. Walk-In Clinic Care
      3. Outpatient Illness & Injury Care
      4. Emergency Illness & Injury Care
      5. Chronic Illness & Injury Care
      6. Major Illness & Inpatient Hospital Care
      7. Long-Term & End-of-Life Care
      8. Catastrophic Care

    Each class of coverage would be priced "At-Cost" with the Social Security administration negotiating discounts with doctors, clinics, hospitals and drug companies for the required products and services and passing the savings along to the public.

    A separate financing provision can be provided by funds from Medicaid, AFDC, WIC, SCHIP and welfare block grants to progressively subsidize the premiums of people making less than 4 times the poverty level income and fully cover the premiums for people below the poverty level income.

    Any drug required by or prescribed for any of the classes of coverage should be available at a negotiated "Best-Available-Discount" price from any pharmacy or directly from the clinic or hospital.

    Actuarial tables should be calculated for each class of coverage and price schedules should be set up just like regular term life insurance where the price is lower the earlier you start your policy.

    By providing the coverage At-Cost the cost to the government would be just the plan management overhead which should be the same 0.6% as the existing Social Security administrative cost.

    All employers with 15 or more employees would be required to offer the policy to their employees and to deduct the premiums (Before Taxes) and forward the premiums to the Social Security Administration along with the existing Social Security and Medicaid Taxes. If the employer offers employer subsidized health insurance the employer would be required to offer the same amount of subsidy for the government plan (in which case the employer should be able to allocate it's subsidy as it chooses).

    Medicare, Medicaid, and State AFDC, WIC, or Workman's Compensation Insurance departments would use the plans services where appropriate and would pay the same amount into the plan as any employer or citizen would for the same class of coverage.

    Any unemployed or self employed individual and anyone working for an employer with fewer than 15 workers could purchase any or all of the plans at cost. Coverage would not terminate at 12-18 months after leaving an employer like Cobra Insurance does.

    Coverage would move with the individual from job to job or between jobs as long as the individual or employer continues to pay the premiums.

    If an individual is healthy, a portion of the unused premiums should be transferred to a Health Savings account to be used to cover future deductibles or costs in excess of the covered amounts. The remainder of the unused premiums should go to a fund to cover care for uninsured patients with no means to pay.

  •  a data point from the breadbasket (0+ / 0-)

    I got a mailing from my insurance provider informing me of changes in coverage. There will now be a higher deductible for half of the emergency rooms in my city. So I guess, when in that ambulance, I better be conscious and tell the driver to go a little further to get to a cheaper emergency room.

    Am I wrong in thinking this should be boggling minds, and grassrooting/groundswelling people? Do insurance companies think it isn't obvious that this is some price renegotiation gone awry, with the cost now shoved onto the patients?

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