This deserves a rant. The United States approach to paying for healthcare is a joke.

I’m not Mr. Lindquist, but I will give it a try. Leveraging existing processes and systems in place today.

All Americans are automatically enrolled in base (bronze level) health coverage at birth through the public exchange – using a Health Savings Account capable plan design. They can opt out of the public exchange coverage upon demonstrating coverage through an employer-sponsored plan or by posting a bond sufficient to cover the base level of coverage ($25,000 per year per person).

All non-citizens who are not lawfully present are excluded and must return to wherever they came from. No exceptions.

No charitable care. No exceptions.

No debt forgiveness. No exceptions.

Lawfully present does not include those who crossed the border illegally and who are residing in the US awaiting their asylum claims. Nor does it include individuals who overstayed their visas and who now claim asylum. Those individuals should be repatriated back across the border. They can wait there. No exceptions.

Those who entered lawfully and are awaiting adjudication of their asylum claims can remain, but are subject to the mandate of coverage as are any individuals who are lawfully visiting America (who have not overstayed their visa). For those who entered lawfully and those lawfully visiting America, they pay the full monthly cost of the base health coverage for any full or partial month (prorated) they are lawfully present in America. They are not eligible for federal excess insurance.

The automatic base coverage has a maximum covered charge of $25,000 a year. After the $25,000 maximum coverage charge is incurred, federal excess insurance applies to expenses in excess of $25,000. Those expenses are covered at Medicare allowable levels, with modest point of purchase cost sharing – 10% of the cost of services to be paid by the individual, up to a $10,000/year out of pocket expense maximum. So, 100% coverage applies once the covered charges for an individual reach $125,000 in any one year.

Individuals can purchase coverage for that initial $25,000 liability through a public exchange, or their employer can provide such coverage. This includes everyone – individuals currently covered in the public exchange, individuals covered by Medicare, individuals covered by the VA, individuals who are uninsured and individuals who are currently covered under an employer-sponsored plan. No preexisting condition exclusions, no eligibility requirements. For coverage purchased in the exchange, current premium rules apply. No older individual can be charged more than three times what a younger individual is charged. The current taxpayer subsidy features apply where the cost of coverage for a single individual exceeds 8.39% of household income, but with a minimum monthly premium based on the current Part B and Part D baseline: about $210 in 2024 (Part B =174.70, Part D = 34.70). The employer coverage can also back-fill the point of purchase cost sharing for federal excess insurance expenses.

The applicable large employer requirement is eliminated and every employer must provide access to “affordable”, “minimum essential coverage” of “minimum value” (as currently defined) to every employee and their children and spouse (those who would otherwise qualify for a federal tax exemption) or pay the current IRC 4980H(B) penalty tax that is part of the employer mandate – prorated based on the number of hours worked each month (130 in the denominator). The penalty tax applies even if the individuals who were not offered such coverage did not enroll in the public exchange and receive a taxpayer subsidy. Both eligibility and the penalty tax for employer-sponsored coverage is determined monthly and applies regardless of the hours of work scheduled.

Where a worker has access to employer-sponsored “affordable”, “minimum essential coverage” of “minimum value”, they would not qualify for any taxpayer subsidy should they decide to forego the employer-sponsored plan and enroll in the public exchange.

Costs in excess of $25,000 are covered by federal insurance, and funded by taxpayers from general revenues and continuation of the existing Medicare Part A taxes (FICA-Med). Provider charges for services once the $25,000 limit has been reached are limited to Medicare allowable amounts – which are approximately 40% higher than Medicaid, and perhaps 15% higher than the VA. Providers must continue to provide services for patients who reach the $25,000 threshold – no interruption of the patient – provider relationship.

Parents are responsible for paying for coverage for their children under age 18 and themselves. Where the household has no income, the cost of public exchange coverage will be $210 per person per month, accumulated as taxes due, and will be part of an IRS levy against future earnings, welfare or other entitlement – recovered by offsetting $.10 per $1 (from any member of the household, including a child with wages, or those who leave the household upon reaching the age of majority). The $.10 per $1 offset changes to $1 for $1 once the income, welfare or entitlement reaches the applicable federal poverty level, prorated month by month, until fully recovered.

Why this structure?

Every individual should be responsible for health care coverage – no exceptions.

For employers, it is unreasonable to expect an employer to pick up more than $25,000 of expenses for any individual worker or family member of the worker. Where the $25,000 per covered individual limit applies, the monthly cost to provide “affordable”, “minimum essential coverage” of “minimum value” requirement is a burden every employer should be able to shoulder – likely only a modest addition to current minimum wage requirements.

Medical costs in excess of $25,000 per person should be a liability born by society (taxpayers).

And, retaining the individual and employer financial responsibility should dampen excessive utilization of universal coverage which would be the most likely outcome from proposals by idiots like Bernie and Kamala.

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