Now that the Massachusetts Senate election is over, the idea for real health reform (rather than a socialist mess) is alive once again.
These points lay out a general outline that I feel make a good first step towards reforming healthcare to reduce costs. These points are designed to provide maximum flexibility for the individual. No individual is required to buy insurance, but if they do not have coverage, then they will pay the consequences.
In the end, the only way to do this is to make people more financially responsible for their care so that they become more aware of the costs of these services. This is what I would like to see in a health reform bill:
1. True Portability: Insurance benefits should not be tied to any job or state, but employers should be encouraged to provide them with tax credits. If I leave my job, I should be able to keep my coverage for as long as I am willing to pay the premiums.
2. No denials for pre-existing conditions: If I have a pre-existing condition, I should not be denied coverage, providing I have not had a gap in my coverage greater than 60 days. If I have had a gap, then I should be subject to an 18 month waiting period before the insurance will provide coverage for my existing condition. The insurance will cover other things, as long as they aren’t caused by the pre-existing condition. This will prevent people from waiting to buy insurance policies until they get sick.
3. No policy cancellations except for fraud: If I get sick with cancer, the insurance company should not be allowed to cancel my insurance. If the insurer wants to cancel coverage for fraud, they should go to court at their expense and prove that fraud was committed.
4. Tax credits for individuals and families: if I buy my own coverage, I should get a tax credit comparable to what businesses get for offering a comparable policy.
5. Provide income-based assistance through Medicaid for those with low incomes.
6. No medical bankruptcy. If someone doesn’t have insurance and cannot pay immediately, then they should be put on a payment plan and remain responsible for 100% of the amount they owe. The provider can deduct what is owed from their pay and/or other government benefits until the full balance and interest is re-paid. This will serve as further encouragement for people to take responsibility for their health insurance.
7. If an insurance policy is offered for sale in one state at a given price, it must be offered to anyone nationwide for the same price. The benefits must be explained in plain English (not legalese) so that people understand what coverage they are buying. These policies can be sold online through a national exchange, and customers should be able to review coverage in detail before buying.
8. No subsidies for illegal aliens. If illegal aliens want insurance, then that’s fine but they should not receive taxpayer-funded subsidies.
The government will have to create an appropriate system for examining the insurance market to ensure that the law is being followed and customers are not over-charged for coverage.
Overall, I believe that these points will allow people to keep coverage they like and buy whatever coverage they believe they need. If someone wants a high deductible policy with a HSA, then they can buy it. If someone wants a traditional HMO or PPO, then they can buy it. If a consumer wants to forgo insurance, thats fine, but they will be fully responsible for the costs of treatment. Creating a national market will help keep premiums low, and individuals will be encouraged to buy their own coverage without mandates.