After my review about some of the news coverage of Hillary Clinton’s proposed government healthcare plan, I did some more digging. The Kaisernetwork.org review is here. A Wall Street Journal editorial is here.
The proposed Clinton plan mandates coverage and depends on 1/3 of its revenue from “$35 billion in savings to the government through a more efficient health system.” (I wonder who will be considered less “efficient” – doctors or very sick patients?) And mandates that insurance premiums remain below a certain percentage of household income and that tax rates increase in households above $250,000.
All of which, the history of HMO’s, capitated plans, and most especially government funding tells us, will result in restrictions in services, long waiting times, and less convenience combined with loud demands for more.
I know it seems a cliché, but how does government “efficiency” work at the Post Office? Fed-ex, UPS and DHL don’t have nearly the restrictions medical care does: They charge according to weight, size and distance, but the customer and the recipient decide the contents of the package and the destination. I’ve never heard of Fed-Ex telling a customer that their package wasn’t necessary or couldn’t be moved because some Ph.D. (Doctor of Packing handling) had set a formulary – or that they’ll take the package 100 miles and no farther. The biggest difference is convenience and the variety of options offered. Although they are able to compete financially and functionally with the US Postal Service, the lines aren’t as long and the system is built to handle the unusual. The unusual is a large part of our business in Family Medicine.
The US First Class stamp is great for letters that don’t need to be delivered for a day or two. Maybe the government should cover preventive health and let insurance cover sick people.
Mandates don’t guarantee coverage. In Texas, we have to show our insurance card when we register the car, get our license renewed and each year when we have the car inspected. The uninsured rate is estimated to be around 24% (anywhere from 20 to 60%, according to the numbers of tickets issued in the big cities). In Colorado, it may be as high as 35%. (More here.) To compensate, Texas will soon begin correlating driver’s licenses, car registration and insurance by a data bank accessible to the police car behind you in traffic. Wait ’till Bubba catches wind of this.
A little bit for everyone from the first dollar that cuts off above a certain level is dangerous. I know Medicare eligible patients who had great drug benefits through their retirement plans. They were forced to go to one of the “donut hole” plans, and now pay more out of pocket than before. We now have a good indication that the “donut hole” in the Medicare Part D drug plan leads to an increase in hospitalizations.
However, while researching all this, I did read about one plan that seemed to make sense to me. I’ve copied, pasted, and changed the name to “the Plan.”
The Plan Gives All Americans The Same Tax Breaks For Health Insurance And Helps States Make Affordable Private Health Insurance Available To Their Citizens.
1. The Plan Will Help More Americans Afford Health Insurance By Reforming The Tax Code With A Standard Deduction For Health Insurance – Like The Standard Deduction For Dependents. The primary goal is to make health insurance more affordable, allowing more Americans to purchase coverage. The Plan levels the playing field for Americans who purchase health insurance on their own rather than through their employers, providing a substantial tax benefit for all those who now have health insurance purchased on the individual market. It also lowers taxes for all currently uninsured Americans who decide to purchase health insurance – making insurance more affordable and providing a significant incentive to all working Americans to purchase coverage, thereby reducing the number of uninsured Americans.
* Under the Plan, Families With Health Insurance Will Not Pay Income Or Payroll Taxes On The First $15,000 In Compensation And Singles Will Not Pay Income Or Payroll Taxes On The First $7,500.
o At the same time, health insurance would be considered taxable income. This is a change for those who now have health insurance through their jobs.
o The Plan will result in lower taxes for about 80 percent of employer-provided policies.
o Those with more generous policies (20 percent) will have the option to adjust their compensation to have lower premiums and higher wages to offset the tax change.
2. The Affordable Choices Initiative Will Help States Make Basic Private Health Insurance Available And Will Provide Additional Help To Americans Who Cannot Afford Insurance Or Who Have Persistently High Medical Expenses. For States that provide their citizens with access to basic, affordable private health insurance, the Plan’s Affordable Choices Initiative will direct Federal funding to assist States in helping their poor and hard-to-insure citizens afford private insurance. By allocating current Federal health care funding more effectively, the Plan accomplishes this goal without creating a new Federal entitlement or new Federal spending.
There’s no list of covered benefits, no mandates. However, each family would choose how much and what kind of coverage to buy. The current system of larger tax breaks to employers for more expensive health insurance and smaller breaks for less expensive coverage would disappear. Tax breaks for insurance would no longer be tied exclusively to a given job. Government subsidies would only be necessary for the indigent and those “hard-to-insure.”
The plan was proposed by President Bush in his 2007 State of the Union address and is outlined here.