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The US Federal government spent more than $808 billion in 2007 on health care (medicare, medicaid, Federal workers, VA hospitals, etc.). If you divide that number by every American citizen, that comes out to $2640 per capita. If that $808 billion in Federal health expenditures were utilized as an 80% subsidy for a single-payer health care system then the Federal government and its citizens would be spending approximately $3300 per capita, which would be a higher per capita expenditure than in Ireland, Japan, Italy, Spain, Singapore, the UK, Canada, Sweden, Australia, Germany, and France, all with higher health rankings than the US according to the World Health Organization. So the US Federal government already spends enough money on an annual basis to provide quality health insurance for every American without any private health insurance dollars at all, if these Federal dollars were used as efficiently as they are in most other advanced nations.

Its my argument that a Federally subsidized health insurance credit card system is the best way to utilize the health care dollars currently spent by the Federal government. And in order to implement such a system, I would do the following:

Illustrations of what these health care credit cards would look like can be found at:


First I'd immediately replace the current Medicare system with a Federally subsidized Senior Care credit card insurance system for all American citizens 67 years and older:

Senior Care health care card
Senior Care credit card:

No purchase fee for seniors ,
$10 user fee,
80% Federal subsidy,
<$25 (final payment), $25, $50, $75, $100 fixed monthly payments. Maximum unsubsidized debt: $25,000 <br>$10 late payment fee
$100 delinquent payment card reactivation fee

Monthly payments for unsubsidized debt on health care credit cards for seniors:

$25 per month for unsubsidized debt of $300 or less
$50 per month for unsubsidized debt of more than $300 to $900
$75 per month for unsubsidized debt of more than $900 to $1800
$100 per month for unsubsidized debt of more than $1800 to $25,000

So if you're a senior and you use your Senior Care card to pay for a simple $200 physical check up, 20% of those charges would be billed to your from the HHS (The United States Department of Health and Human Services) plus a $10 user fee. So you'd be charged $40 for a $200 physical check up plus a $10 user fee ($50: $25 per month for two months). That's it!

If you're a senior paying $100 per month for medicine, $20 of debt plus a $10 user fee would be added to your monthly credit card debt. If you had to use your card to pay for a very expensive procedure like a $50,000 for a hip replacement and short hospital stay, the HHS would charge you $10,000 ($100 per month for nearly the next 7 years until monthly payments would finally go down to $75 per month for a year, then $50 per month for another year, and finally down to $25 per month). Of course, you could always use your card to get your hip replacement in an HHS approved country like the UK which would cost you only $2800 instead of $10,ooo ($14,000 charge to the HHS) or $2400 in France ($12,000 to the HHS) or $1200 in India ($6000 to the HHS).

Secondly, I'd provide all parents and guardians, both citizens and permanent residents, in the United States with the opportunity to purchase Child Care credit cards from the HHS for a $50 purchase fee (this would be charged to the card):

Child Care credit card:

$50 purchase price,
$10 user fee,
$10 late payment fee
80% federal subsidy,
<$10 (final payment), $10, $20, $30, $40, $50 fixed payments Maximum unsubsidized debt: $100,000 <br>$50 delinquent payment card reactivation fee

Monthly payments for unsubsidized debt on children's health insurance credit cards:

$10 per month for unsubsidized debt of $120 or less
$20 per month for unsubsidized debt more than $120 to $360
$30 per month for unsubsidized debt more than $360 to $720
$40 per month for unsubsidized debt more than $720 to $1200
$50 per month for unsubsidized debt more than $1200 to $100,000

If you use a Child Care card for a $200 dollar check up for your child, the HHS would charge you, the parents and purchasers of the card $40 plus a $10 user fee ($10 per month for 5 months). Need $5000 braces for your 12 year old? The HHS will charge you $1000 dollars ($40 per month for 7 months, followed by $30 per month for a year, $20 per month for the next year, and $10 per month for the final year). What if your child's medical credit card still has debt on it even after he or she becomes an adult. Well its not their debt. Its your debt. And you have to continue paying off their unsubsidized debts until their gone no matter how many months or years it takes. So if the poor health of the child your brought into the world accumulates very high medical debts on the Child Care card you purchased, be prepared to pay $50 per month for many years after your child has become an adult (this system is affordable but not free!).

Third, Federal employees, veterans, and military personal would be immediately issued Adult Care credit cards:

Adult Care credit card:

$1000 purchase price (charged to the card),
$20 user fee,
$10 late payment fee
80% federal subsidy,
<$25 (final payment), $25, $50, $75, $100 fixed monthly payments Maximum unsubsidized debt: $25,000 <br>$100 delinquent card reactivation fee

Monthly payments for unsubsidized debt on health care credit card for adults:

$25 per month for unsubsidized debt: $300 or less:
$50 per month for unsubsidized debt: more than $300 to $900
$75 per month for unsubsidized debt: more than $900 to $1800
$100 per month for unsubsidized debt: more than $1800 to $25,000

Non Federal employees could purchase the card for $1000 (charged to the card after it is ordered). Private employers would also be given the opportunity to purchase the Adult Care card for their employes. A $1000 dollar one time purchase fee for employees would obviously be a lot better than paying the private health insurance companies $4700 on average per employee every year. Unions might also insist that employers pay for the purchase an Adult Care card for a spouse ($1000) and children ($5o for each child).

A $200 medical check charged to your Adult Care card would cost you $40 plus a $20 user fee ($25 per month for two months plus $10 for the third and final month). If you're pregnant and are having a baby and you charge all of your doctor appointments and delivery cost on your card to a total cost of $10,000, the HHS will charge you $2000 ($100 per month for two months, followed by $75 per month for a year, $50 per month for the following year, and $25 per month for the final year of your 20% debt).

What if you're a non-citizens?

Under my plan, all adult permanent US residents would be eligible to purchase a Federal Guest Care credit card:

Guest Care credit card:

$100 purchase price (out of pocket),
$10 user fee,
$10 late payment fee
no federal subsidy,
<$25 (final payment), $25, $50, $75, $100 fixed monthly payments Maximum unsubsidized debt: $25,000 <br>$100 delinquent card reactivation fee

Total Debt on health care credit card for permanent US residents:

$25 per month for a total debt of $300 or less
$50 per month for a total debt of more than $300 to $900
$75 per month for a total debt of more than $900 to $1800
$100 per month total debt of more than $1800 to $25,000

The Guest Care credit card will be pretty much self financing since no Federal subsidy is provided and since user fees are also charged. The advantage to non-citizens who are living and working in the US is that they will still have the convenience of paying off their health care cost gradually over several months. I should note, however, that under my scenario, the permanent resident will still be able to purchase the same Child Care credit cards as the children of US citizens. Of course, permanent residents would still have the option of purchasing health insurance from private companies. But I would require by law that no one could work in the US without some sort of public or private health insurance.

A $200 physical would cost a Guest Care card user $200 plus a $10 user fee ($25 per month for 8 months plus $10 for the final month of payment). A $10,000 charge on a Guest Care card related to pregnancy would cost the card holder $100 in monthly charges to the HHS for at least 6 years until the next lower monthly charge would be reached. Still there are monthly premiums charged to individuals with private health insurance a lot higher than that.

But what happens if you're one of those rare individuals that ends up having extremely severe medical problems and expenses and your unsubsidized health care credit card expenditures exceed the $25,000 maximum unsubsidized debt? One option is to simply start paying down more of your unsubsidized debt ($100 in debt reduction gives you $500 in available health care credit). Another option would be to replace your Senior Care or Adult Care credit card with an HHS Critical Care card.

Critical Care card:

$150 purchase price,
$150 fixed monthly payments (for the rest of your life),
5% of annual income (for the rest of your life)
Maximum total outstanding debt: $1,500,000

After purchasing this card, if your annual income declines-- so will your annual additional payment to the Federal government since part of the payment is based on 5% of your annual income. However, if your annual income should increase after purchasing this card, then your annual payments will also increase. So if you should win the lotto it will be happy days for you and for the Department of Health and Human Services!

Further details on how these Federal health care credit cards will be introduced to the public and financed by the Federal government and secured against fraud and abuse will be discussed in the final part (Part 3) of this diary.



Originally posted to newpapyrus on Fri Jul 24, 2009 at 12:22 AM PDT.


What type of health insurance system would you prefer for the US?

50%13 votes
23%6 votes
19%5 votes
7%2 votes

| 26 votes | Vote | Results

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Comment Preferences

  •  You've clearly put a lot of thought into this... (3+ / 0-)
    Recommended by:
    moodyx, happy camper, newpapyrus

    ...but it's way the hell more complicated than it needs to be.

    How about instead we make it like Canada?  Everybody gets a card.  Everybody pays into the system via taxes and a basic insurance premium that ignores age, sex, and 'pre-existing conditions'.

    You go to the doctor and give them your card.  There is no charge to you.  The doctor submits the bill to the gov't agency responsible and gets paid in a timely fashion.

    That's all it needs to be.  Only there's no excess profit to be sucked off by the parasites, and no debt to drive people into bankruptcy should they be unable to draw an income.

    And that, my friend, is the flaw in your system: It assumes people have money.  Or, if they don't, that they will get it eventually.  Life doesn't always work like that.

    •  No charge? (0+ / 0-)

      If there's no charge for something, what incentive is there for the consumer to reduce cost?

      While the Canadian system is half the cost of the US system, its still three times as costly as the Singapore system.

      With a health care credit card system, I believe the cost of health care can be driven down to Singapore levels of cost which would free up hundreds of billions of Federal dollars to use for other programs such as Federally subsidized Advanced Education Credit Cards where college and trade school tuition could be subsidized by the Federal Government by 80%.  

    •  Australia already has something similar and (0+ / 0-)

      possibly a little less complicated.
      My two diaries on the subject.
      Australia - Public Health-Care since 1975
      10 reasons why an Australian prefers universal health coverage

      I think what you have suggested does have merit, as the United States is in a unique situation where they could in fact look around the functioning universal health care systems and pick the most effective elements of each. That is if political realities allowed it, of course.

      "In our every deliberation, we must consider the impact of our decisions on the next seven generations." Law of the Iroquois Confederacy

      by Unenergy on Fri Jul 24, 2009 at 01:16:50 AM PDT

      [ Parent ]

  •  You really put a lot of effort into this (2+ / 0-)
    Recommended by:
    moodyx, newpapyrus

    and I respect that. Your idea is very interesting, and it is a good one. What I like about it, is people will be able to budget their medical care. I am somewhat conflicted on this whole healthcare reform and single payer vs. public option with private health insurance. I think rates need to come down, but I like the idea of people having choices. If you want to spend the money on health insurance then feel free to do it, this is still a free country and you are allowed to spend your money on whatever you want. The one thing about this plan is no one must be allowed to deny you coverage for pre-existing conditions, and no hospital or doctor will be able to turn you away because you have a public option plan rather than a cadillace health insurance plan. I remember my Mom being on Medicare and she also paid for a supplemental insurance which paid the 20% that Medicare didn't cover. It would only approve he same procedures as Medicare, but she just paid her monthly premium and didn't have to pay anything else. Wouldn't something like that work, for those who would just want the less expensive public option and pay for the percentage they didn't cover fine. If people wanted full coverage they could purchase a supplemental plan to pay for the rest.
    I do think we all have to pay something into this, we can not get something for nothing, even if they have it that way in other countries.  

  •  Democrats in "Conservative districts/states" (1+ / 0-)
    Recommended by:

    Call it what it is.

    Democrats with less educated constituents.

    I see Blanche Lincoln and Mark Pryor in Arkansas and Ben Nelson in Nebraska, and I don't see states with a lot of millionaires walking around, or even the highest income earning constituents in the Country.

    It's not that the things being proposed by the Democrats are not in the interest of their constituents.

    What it is is they have ignorant constituents who are afraid of change because they don't know much about the issues, and are therefore GULLIBLE because they are able to be manipulated because they don't know much, and one of the biggest causes of fear is lack of knowledge.

    "Conservative districts".
    "Conservative state."

    Why?  Because many of them just have constituents who don't know what the heck they are talking about, and who have historically had biases against other groups that have allowed the little talk show options that they have, like Rush Limbaugh, to brainwash them because THEY ARE STUPID.

    It's not about the "tax cuts" or the "deficit."

    It's about their cuts in education and their deficits in intelligence, so of course they are resistant to change, especially if they believe it's being brought about by a black President, instead of their white Senator or Congressperson.  

    It's the truth, whether anyone wants to hear it or not.

  •  So basically,you want to give people a card & (0+ / 0-)

    tell them to get a passport and get their surgeries overseas? Or pile on masses of personal/generational debt to take with them to the grave? Or even manage to do both of those things in one lifetime? I don't think so.

    "You can't have a third party in the United States as long as you have one party operating under two different names." ~~ Prof.Irwin Corey

    by tardis10 on Fri Jul 24, 2009 at 05:41:41 AM PDT

    •  Health Care is not free (0+ / 0-)

      Private health insurance as it exist today is gradually destroying the American economy. The bankruptcy of GM and Chrysler are just two prominent examples of what's been gradually occurring in America for a few decades now. The private health insurance system as it exist today is inherently inflationary. And premiums can easily rise to such a level that they can easily bankrupt a business or individual.  

      We can't continue going around pretending that health care in America is free because that will only lead to economic disaster for this country. In order to mitigate and possibly even stop health care inflation, people need to be aware of the cost.

      Freedom of choice is a good thing, IMO. And the more doctor, hospital, and clinic choices you give Americans, the better it will be for both the system and the individual.

      Paying my fare share for affordable health care for myself and my family doesn't really concern me. But being bankrupted by high medical cost or seeing good jobs go overseas and my country's economy collapse because of the ever increasing cost of private health insurance seriously concerns me.

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