Health Care: Repair or Repeal and Replace?
As is the policy with my blog posts, I seek to share a “third alternative” to the partisan proposals on key issues that come from the political parties. I try to employ the ideology of “what works” versus either political or partisan ideology.
So within this context, today I would like to provide a suggestion
on the specific issue of a new Health Care Law.
The Republicans have just proposed the first part of their “Repeal and
Replace” approach to the existing Affordable Care Act. And I expect that the Democrats will take up
opposition to these changes, and by default, will defend the status quo of the
Affordable Care Act, without defining what changes they would make to address
the key problems that have surfaced with the existing law.
This approach is how the parties responded to the Affordable
Care Act over the past 8 years, in reversed roles. The Republicans opposed the passing of the
Affordable Care Act, but provided no alternative approach. This approach did not serve the public
interest then and will not serve the public interest now. So the attempt of this blog entry to suggest
an alternative solution that might serve the public interest by providing an
alternative worth consideration.
At the start, I have sought to understand and define the
problems that exist with the current ACA law that were not anticipated, so that
I could propose the changes to the current ACA law that would effectively
address these problems. Providing a real
Repair alternative to the Repeal and Replace approach of the Republican
Administration will hopefully help focus the debate on issues of importance to
the public interest, versus partisan interests.
Here are the key elements of the proposed Repair to the ACA:
1. Eliminate the limited number of proscribed
benefit policies, which while with good intentions were designed to ensure
that all policies provided basic care, had the unintended outcome of reducing
choice of Americans for a policy that would meet their personal needs. These plans would be replaced with a menu-based
process for “building” a personalized health care policy. The benefits of the different coverage options
would be explained, and a suggestion of the coverages that would best meet the
needs of people in different risk or demographic profiles would be
provided. However, the choice of
specific options would be left to the individual.
Each policy should start with a base policy that would only
cover emergency care and transportation in the event of a severe accident,
injury or illness … the very kind of services that would be provided for free
at taxpayer’s expense for uninsured patients. Every American should have this coverage, with
support in the areas of tax credits or subsidies if needed depending on income.
This would ensure that no one would come to an emergency room for emergency
care without a base level of insurance.
And a policy for all Americans covering only this service should be very
low in cost.
This approach is consistent with the principal that people
should take responsibility for their own health care insurance and that no one
should expect the government to pay for their emergency care if they can afford
it. But neither do we want as a society
to check for proof of insurance at accident sites or in emergencies before care
is provided.
2. Eliminate the requirement for businesses to
provide health care for employees. In fact, I propose to change the law to
eliminate ALL employee provided health care programs, and require that ALL
Americans obtain their own health care insurance plan from a national
pool. Each individual should own the
health care plan, not the employer. This
would eliminate a lot of the pre-existing condition needs that arise when an
employee leaves a company health plan and needs to purchase private insurance. Everyone should own their own health care
plan and have the opportunity to choose the coverages they need from a
menu-based plan process.
This should appeal to Americans as fair, especially to small
business owners and employees. The
current system allows large companies to negotiate health care services with
insurance companies on the basis of their employee pool, not a national or
regional pool. Further, there is a tax benefit
to employees and employers, as neither pays tax on the costs of health care
plans provided to employees. So as a
small business owner, I and my employees will pay higher health care costs than
our neighbors who work for Fortune 500 companies, and this puts small
businesses at a disadvantage in attracting talent.
The new Republican Health Care Plan would provide a tax
credit to “equalize” this benefit between large and small businesses, but both
of these policy elements reduce the income to the government, and thus have a
deficit impact. The proposal of
eliminating business owned and provided health care, and replacing this with
only individual health care plans, equalizes the playing field without a major deficit
impact. This change is important because small
businesses are the major job creators in this country and should not be at a
disadvantage to larger companies. Let’s
take health care benefits out of the employer’s package.
Any company could provide a direct payment to the employee’s
health care insurance they choose to help offset costs as a way of attracting
and retaining employees, without the cost within the company of monitoring and
negotiating health care coverages, reducing their current costs. This represents a true “win-win” for
companies large and small, and may reduce the costs for private insurance plans
due to the expanded pools.
3. Eliminate the state-by-state control over
health insurance providers and enable every insurance company to cover citizens
in every state. This is being
considered as part of a future Republican health care initiative, but could be
part of an immediate repair to the ACA.
It is expected to be a key element of reducing the costs and ensuring
broader choices in plan options to Americans in every state and situation. The policy should require the states to
continue their own oversight and to institute their own ratings systems for
company performance, costs, patient satisfaction, and allow the states to levy
fines for actions that violate the terms of their policies or for any actions
that mislead or defraud consumers.
With these 3 changes to the ACA, I believe the major
problems with the existing health care program would be repaired or completely
eliminated. Many of the concerns of both
parties would be addressed, and the interests of the public would be the main
focus of the policy. This might well be
an approach that both parties could work on together to implement with
collaboration, instead of wasting time and money on a destructive debating
process.
If you have comments or suggestions to this post, please do
leave your comments below. If you find
it worthwhile, please do share the blog with others in your network.
Robert Viney
