Jim Jordan on the real dysfunction in Washington DC

12/30/18 | CQ Livingston

[Political Junkie Too]

I think what Republicans need is a major paradigm shift. We need to reframe "healthcare" in different terms.

By way of metaphor, let's look at "haircare" and "autocare" instead of healthcare.

When I was a child, I remember that going to the doctor for a checkup or a vaccination was a point-of-sale transaction, like getting a haircut or a tune-up. Insurance wasn't needed to cover the cost. Something more serious, like a broken bone from a fall or a fender-bender, might have required a payment plan (or credit cards), but not insurance.

Something more serious that required hospitalization, like having tonsils removed, would be more costly. Some things, like a tonsillectomy, might be more expected in young children and not something requiring insurance (partly because the timeframe is so short and the costs still relatively low), but an unexpected event like appendicitis would be a better candidate for insurance. Even then, known childhood diseases like measles, mumps, and chicken pox, should be handled through payment plans, not insurance, again because most children are expected to get this before they turn 10.

Severe care, like a heart attack, would be a better thing to cover with insurance, as it is significant but unlikely to happen to any single individual. This would be like getting into an auto accident -- nobody expects it but they can't entirely prevent it from happening.

Then there is catastrophic care, something that is long-term and potentially fatal. Cancers, diseases, and traumatic injury would fall into this category. Insurance should be purchased to cover the costs of long-term care for highly costly but low likely conditions.

What Republicans should do is propose a free market where basic care is again affordable as a point-of-sale purchase. For basic needs, competitive pricing directly from doctors should be available. Doctors can offer "family plans," where a fixed price covers a family for a year of routine care. Extended care packages could be offered for families who want more, like outpatient care after short-term hospitalization, should it be needed, or more frequent visits (first broken bone free?). Families who have an established relationship with a doctor over the years shouldn't worry about "pre-existing conditions," as annual renewals should cover another year of health care needs.

To take this to the next step, local physician health care could be treated like mortgages; by a 15/30 fixed or ARM plan, and let it be traded by the patient or doctor if they move or the doctor retires. This can also cover pre-existing conditions, as the patient has a "title" to coverage based on an amortized payment plan.

True health care insurance should be limited to high-cost, low-likelihood events, not routine care coverage. Heart attacks, traumatic injury, sudden intensive illness, are candidates for this coverage, and is separate from local physician plans.

Finally, we have the case of the poor and the long-term terminal care. There will always be the irresponsible poor, and there will always be end of life elderly care. The poor mostly need coverage for basic care, but the elderly will need long-term managed care for several years. It could be debated that this specific category of health care could be funded by taxpayers via the federal government, if not through the states. For the poor, local hospitals could submit vouchers to the government for reimbursement. For long-term catastrophic or elderly care, the government could run facilities like they do for veterans care.

I know the arguments against government care are many, including 1) it's not in the Constitution, 2) government can't run any bureaucracy efficiently, 3) government can't run any bureaucracy competently, 4) look at the VA for proof, etc. I think it's worth a look at what the true numbers would be if the demand on government were off-loaded as stated above, and limit the government to only truly poor and elderly care, leaving the rest to the free market.

Congress has gotten itself "stuck on stupid" with the evolving desire for "omnibus" or "comprehensive" solutions. Obamacare, like Hillarycare, as well as recent failed immigration reforms, are prime examples. Republicans should try to change the narrative away from one-size-fits-all government solutions, and try to push most of it back into the private sector free market with local physician and hospital solutions, leaving catastrophic care and safety nets for the poor for the government to address.

-PJ