There might be one last chance to get rid of Obamacare IF the right people are elected and IF legislators are willing to take a bold stance. When I state my opposition to Obamacare, I am frequently asked what I would do to “solve the problem.” I put a proposal on the table before the Affordable Care Act was passed, but it’s time to address it again. You might not like everything I have to say, but don’t decide until you read the entire post. I’ll try to keep it as short as possible.
First things first…we must identify the problem, and it must be significant enough to warrant government action. It’s a problem when Americans without insurance get hit with a huge medical bill. They get treated anyway (EMTALA), so either the bill either destroys them financially or gets passed along to the taxpayer, or both. This problem is substantial and it MIGHT warrant government action IF the action actually helps solve it.
It’s also a problem when Americans do not take care of day-to-day health issues because they choose not to. The CHOICE to which I refer includes those who “cannot afford” to go to the doctor but seem to find a way to pay for their cars, cell phones, and cable TV. This is an unfortunate situation, but it is not a problem that warrants government action. As a matter of fact, Washington is already doing too much harm in this area already.
Distinguishing between these two types of problems is important because those on the left emphasize the first kind when proposing alleged solutions to the second kind. In other words, they carp about the $100,000 cancer bill that wipes out a family and offer all-inclusive Obamacare as the solution. If you have a mouse loose in your kitchen you need a mousetrap, not complete fumigation of your entire property.
So let’s talk about the first problem, catastrophic health care. Even if you don’t like the idea of the government paying for anyone’s healthcare, EMTALA already guarantees it and this policy is not going to change. Besides, this is the problem that concerns many Americans. If you don’t address it, you won’t gain enough momentum to win the battle. I suggest that we do the following legislatively as a package:
- Repeal Obamacare.
- Provide a government-financed, basic catastrophic healthcare plan to all American citizens not on Medicare. For example, it might pay 75% of medical bills in excess of $15,000 per individual per year. The plan would be administered by insurance companies base don a bidding process. You don’t choose your doctor or your hospital. The idea here is to make a catastrophe manageable, NOT pay the entire bill or provide special benefits. If that’s not good enough for you, then you need to purchase an additional policy on your own.
- Finance the catastrophic plan with a payroll tax added to Social Security. This means that ALL WAGE EARNERS must pay for it up to the current wage limit.
- Americans who buys their own policies get a credit for the average basic catastrophic healthcare cost. For the sake of argument, let’s assume that this is $1500 per person per year. When someone purchases a more complete policy (i.e., lower limits, choose your own doctor, etc.), this $1500 is transferred to the new insurance company and reduces the cost accordingly, so those who buy their own insurance aren’t paying twice.
- Other provisions, such as the ability to purchase health insurance across state lines, flexibility for health savings accounts, etc, would also be included.
This type of plan offers many benefits, including:
- It addresses the trauma of catastrophic healthcare coverage and removes it from political debate.
- It requires ALL wage earners to pay for the program, although low wage earners will pay less.
- It makes the issue of pre-existing conditions less relevant because everyone receives catastrophic care.
- It reduces the amount of unpaid hospital bills passed along to those who are insured because a significant portion would be covered by the catastrophic plan.
This plan isn’t ideal. For example, some will argue that a government-financed catastrophic plan can easily expand, but this expansion is already happening anyway. Some (like me) who want to eliminate payroll and income taxes altogether would argue that this plan expands the roll of the IRS. I would prefer a complete replacement of income taxes with a sales tax, in which case the catastrophic care tax could be rolled into the sales tax. Those on the left would argue that it still leaves unpaid bills for those who receive catastrophic care. This is true, but it’s their responsibility to purchase their own policy or budget accordingly if they want additional coverage. They will argue that we’re creating a two-tier healthcare system. I agree, but there’s no alternative unless you are willing to merge both tiers in the middle. I’m not.
If you still have doubts, ask yourself why such a simple, limited, and clearly defined approach like mine was rarely if ever discussed by those on the left before Obamacare came along. The answer is twofold. First, by addressing the real problem and nothing more, it removes much of the emotional appeal for national healthcare—what socialists really want. Second, this plan requires that all wage earners pay for it through payroll taxes; on net, it doesn’t add to wealth redistribution.
I believe we can only get rid of Obamacare if we offer a package deal that takes the catastrophic card off the table in a simple and efficient manner. This is one way to do it.
3 problems, Parnell.
1- why do I have to pay more payroll taxes for someone else’s coverage?
2- if I get the government plan why can’t I choose my own doctor and hospital?
3- what about illegals immigrants?
GeraldS-
Q1. You’re already paying for others because EMTALA guarantees coverage whether or not individuals can afford it. Your payroll tax gets you barebones catastrophic coverage. If you want more, then you get a voucher equal to the value of that plan to spend on a better policy (i.e., what most Americans already have). It comes out in the wash.
Q2. The barebones catastrophic coverage is based on simplicity and efficiency. If you want more choices, you need to get your own plan (see Q1).
Q3. Illegal immigrants are not covered.
It’s immoral to create a two-tier health care system. We’re talking about life and death here. Nobody has a right to more health care and to extend life unless others have the same access.
Proudlefty-
If a two-tiered system of healthcare is immoral, then why is it moral for Americans to create a single tier for ourselves that’s much better than most non-Americans get? Assuming you are an American, are you willing to lower YOUR health care to the level available in most of the developing world?
I like this idea. Everyone pays and it doesn’t screw up the private market. But won’t the left say that it’s not compassionate to leave seriously ill people with 25% of the bill?
In an utopist world, we would solve all the problems of the entire world. The fact that we cannot make healthcare in the developed world as good as ours does not mean that we should not strive to behave morally in our own society.
If the problem is that some wage earners do not pay for their healthcare, than in a national healthcare system they would, because in such a system everybody pays through payroll taxes and even the unemployed pays through their unemployment money. Shall we embrace that? LOL
EMTALA was passed without any way to pay for it except to pass the costs along to those who have insurance. We’re stuck with the problem now. I see Parnell’s point. It calls the bluff on the left. It might be the best option out there.
Hey Barry, the left will say we don’t care about the poor if we don’t pay all their bills. Let them say it. That’s not the point.
Aliza fell into Proudlefty’s trap. She says it’s moral to require someone to pay for another’s healthcare in your own society, but utopia to require someone to pay for another’s healthcare in another country. She can try to explain it away, but she really wants someone else to take care of her without the responsibility of taking care of others herself. This is typical leftist hypocrisy.
Hey Doc, your idea is interesting but it sounds inconsistent because it nationalizes catastrophic health care. Help me understand this.
Here’s the problem, Jerry. Catastrophic healthcare has already been nationalized. You get it if you need it and you can’t be required to pay. The irony is that while this system won’t change, the left has complained incessantly that catastrophic healthcare is the major problem. They always talk about average Joe who is working hard to make ends meet and either can’t afford health insurance, can’t get it because evil insurers won’t write him a policy, or can’t get it from his evil employer. Someone in Joe’s family falls off the roof or gets cancer and runs up 100K in medical bills, leaving Joe with no way to pay. Obamacare is supposed to be the solution but most of what it does has little to do with Joe’s situation. Maybe it’s a tragedy for Joe, but I’m not convinced that’s usually the case. The truth is that Joe probably won’t pay most of the bill anyway. The rest will be absorbed by those with health insurance. This is the real tragedy.
EMTALA requires health care providers to treat Joe and his family in emergencies even if they can’t pay. It created an entitlement without creating a payment mechanism. Like it or not this law will not change, so my solution is to give everyone the same catastrophic care that Joe gets and finance it through a payroll tax that Joe has to pay. Anyone who wants to get other insurance instead gets a credit voucher for the value of the catastrophic coverage ($1500 in my example). This–plus the fact that hospitals will have fewer unpaid accounts because everyone has catastrophic coverage–will reduce what you pay for your own policy, so you should break even and will be able to get your own insurance.
This is a good strategic move because (1) Joe gets what the left claims that he really wants, health insurance in the event of a serious illness or injury, BUT Joe has to help pay for it. (2) Everyone else breaks even (more or less) and retains complete control over what insurance, if any, they wish to purchase. (3) The left can no longer play the catastrophe card when talking about healthcare. This option is not what I would propose if I could create my own world, but I don’t have that luxury.
David, I don’t want someone else to pay for me. I’m the one who is willing to pay another’s healthcare. Due to the limited resources nature of the world, I’m realistic about our ability to solve ALL the problems in the world. However, it does not prevent me from donating to people in other countries as much as I can. Altruism, anyone?
Aliza- So it’s an ethical requirement for me to pay for other people’s health care in my country but I am free to donate to those outside of my country? Why can’t I just choose to donate or not to donate to anyone?
I am undecided about this but I understand the thinking. Washington would be involved only when there is a very costly illness and people don’t buy their own insurance. The rest of us would break even and get plans we like. It might work.
won’t work…it’s a step back from ACA…people need complete protection not just help in an emergency…
I like it. A lot. Which means it probably won’t get anywhere. Why? It makes too much sense. We give everyone a safety net and we offer a way to pay for it. That and breaking down state barriers and throw in tort reform and you have a winner. I would add a national medical database, accessible by fingerprint or retina scan. If we are going to have national health care even at this low level, we have to give up something and that something is your medical history. It would save hundreds of millions. .
But not so fast. This is not the battle we are fighting. Listen to Dr. Ben Carson, who says intelligent people can figure this whole thing out if we just get together. Democrats don’t want that meeting.They want Obamacare, period. They don’t care about enrollment or websites or how many have coverage. They care about getting control of healthcare in this country. They do this through controlling the insurance providers through legislation, and by bailing them out.
It must be repealed. Even with both houses, it can’t happen until Obama leaves office because he will veto it. But winning the Senate is a huge first step. With control of congress, we can repeal the mandate, which would be hard for Obama to veto. The politics are going to get real interesting. The Republicans have been dealt the winning hand. Let’s see if they can cash it in.
I think the idea has political and practical merit, plus it is simple, not 2,000+ pages. It would clearly expose the hypocrisy of the left, which would be refreshing. Several concerns however, based on mistrust of Washington. I fear it would not be too long until the catastrophic coverage would be made progressive in nature, like income tax, i.e. if your income was $x you would get 75% coverage, but if your income was greater than $x you would get 50%. Also, it would encourage lobbying by hospitals, medical providers, big pharma, and the left to expand the definition of “catastrophic”. It would require an engaged and vigilant public to prevent these insidious wealth transfers and expansions. Sadly, there may be too many takers and not enough makers to prevail. Nonetheless, it is worth a try and probably would fix a lot of things at least in the short to intermediate term.