Enough

The Health Care solution is much more complex. Sorry about the length of this response.

Here’s the solution I have suggested for over 30 years – yes it predates Hillarycare and Obamacare. I updated it in 2007 to include Health Savings Account access.

The structure is in three parts:

Part 1 – That which employers and employees cannot, and should not be responsible for as a function of employment. This is the portion of health costs that exceeds some specific dollar amount. The last time I updated this, my suggested threshold was $25,000. So, once an individual’s expense exceeded $25,000 for a calendar year, this would become society’s issue (i.e. taxpayer funded with FICA-Med which would broadly redefine covered compensation as the greater of FICA-Wages or Adjusted Gross Income). Because over 50% of all medical expenses are incurred by about 5% of all Americans, this socialization of expense would significantly reduce the burden on individual/private sector coverage. I would use Medicare or Medicaid reimbursement rates – as, obviously, these are individuals with significant medical conditions. This would likely cost ~2% of covered compensation – adding 150% to the current 1.45% of FICA-wages cost for Medicare Hospitalization Insurance. . I borrowed this from proposals by Senators Ted Kennedy, John Kerry, Jack Reed (all Democrats), Bill Frist (Republican), and Tennessee Governor Phil Bredesen.

Part 2(a) – This would be employer sponsored coverage, up to the $25,000 limit. The only available plan would be a Health Savings Account-capable plan, where the plan would have a minimum deductible for each covered person of $1,400, 80%/20% coinsurance, applied to the first $25,000 of covered expenses (out of pocket maximum of $6,120. Covered expenses would be limited by Reference Based Pricing to no more than 150% of Medicare allowable charges. So, yes, a provider could bill an individual who is 64 years and 364 days old 50% more than they could bill her if she were 1 day older. Upon reaching age 65 (or qualifying for Social Security disability benefits for 30 months), employer-sponsored coverage would stop and individuals would be automatically enrolled in Medicare. Cafeteria plan and other existing employer-sponsored plan provisions would continue to apply. We would deploy automatic enrollment in the Health Savings Account, with a default deferral equal to the annual deductible ($1,400 a year), then escalated 25% every subsequent year until we annual deferral reached the Health Savings Account maximum annual deferral, currently $3,650. The default deferral would apply to every individual covered under the plan. The participant could always opt out of coverage and deferrals. The $25,000 limit is a variant of the CoverTN implemented by Tennessee Governor Phil Bredesen. https://khn.org/morning-breakout/dr00044339/ Per person cost of coverage using this benefit structure would likely decline to less than $2,000 a year.

Part 2(b) – For those who are not eligible or eligible but not enrolled in an employer-sponsored plan (either as an employee, a spouse or a child), they would be defaulted into Medicaid (eliminating the exchange based coverage options) – so there would be universal coverage. The premiums would be age based – based on historical claims experience. At age 65, every individual would be defaulted to/automatically enrolled in Medicare. Medicare would apply to those who qualified for Social Security Disability Benefits (after 30 months, same as today). Every individual must file a tax return. They would be required to pay 100% of the premium, however, if they were not financially able to pay the premiums, the amount would be due on their tax return, and they can make arrangements with the IRS to make scheduled payments. Here, the per person cost of coverage would likely be less than $1,000 a year.

Keep in mind that American taxpayers would continue to pay 75% of the cost of Medicare Part B and Part D coverage through general revenues (mainly income taxes).

So, the positives on this one include:
– Removes the largest medical expense and socializes it – as the burden of such spend is not appropriate for an individual nor an employer.
– Eliminates so-called Medical Bankruptcies – the BIG LIE from Obamacare days,
– Reduces the cost of employer-sponsored coverage and creates an incentive for individuals to save for out of pocket costs.
– Encourages individuals to secure employment with an employer who sponsor’s coverage, if only to avoid the cost of the Medicaid premiums.
– Leverages existing systems and processes – Medicare, Medicaid, employer-sponsored plans, income tax system
– Moderates inflation – average annual increase in cost of Medicare cost sharing provisions has been 3% – 4% since 1983
– Addresses the #1 challenge of socialized systems everywhere else in the developed world – where people want the best health care coverage YOUR MONEY WILL BUY.

LikeLike

A universal retirement plan has been available to all American workers with wage income since 1982 – that’s 42 years. The same plan has been available to those American workers who do not have access to an employer-sponsored retirement plan since 1975 – that’s 47 years. It is called the Individual Retirement Account. Only 11% of eligible Americans currently contribute to an IRA – according to IRS statistics. Combined with Social Security, all but the highest paid American workers (all but the top 10%, generally earning $130,000+) have had access to this fully tax advantaged retirement savings structure which, if utilized to its fullest extent, will replace 90+% of pre-retirement income.

LikeLike