Rather than address these exact things, let me address what I think needs to be done. IMO (obviously) < the closer to this ideal we come, the better off we'll be.
Government
01. Get the federal government out of health care provision for everyone but seniors and indigents (goal, get government out of senior health care and severely reduce indigent health care provision)
02. The government will not be associated with health care provision for anyone other than seniors, and it will not set mandates or requirements for insurance companies
Insurance Companies
03. Insurance companies will compete across our nation to provide a myriad of policies for individuals and families. Competition will be the goal.
Insurable
04. For people who have assets and income, they will have to pay their own way
05. People will be able to review different policies and pick the exact types of coverage they want.
06. Parents and insurance companies would make agreements how long the parents could keep their sons and daughters on their policy. Ideally, they would remain on as long as they remained in school. One year after graduation, they would no longer be eligible. If they started back to school during that year, they will be able to remain on their parent's policy.
Not Insurable
07. People in this category must sign up for Medicaid prior to needing services. They must register.
08. People in this category must also sign on to some form of employment pursuit program. They must seek work or train to become eligible to work. The goal would be to get them working and off Mediaid ASAP, hopefully before they need services.
09. This may mean that they would start paying a portion of an insurance premium as their employment started and they were able to pay at least something toward their own care.
10. For people who have assets but no income, it would be imperative that they get back to work and gain full coverage of their heath care insurance needs ASAP. If not, they will have to work out something that liquidates part of their assets to help cover their care. The rest will be covered by Medicaid.
11. For people who have neither assets or income, they will be covered by Medicaid. Foreign citizens would not be covered beyond immediate stabilizing care. To receive further care, they would have to return to the nation where they are a citizen.
[ note: It may be advisable for the federal government to take out a policy on each indigent person that registers. If the government were to take out a $20k deductible on each person in this group, it would cap government outlays on that person at $20k. That could result in a massive savings. Without access to last year's outlays, it would be hard for me to know if this was a sound idea. It may be wildly off. I'm for looking at any new way of thinking where we could reduce our government outlays for indigents. ]
12. The government should assess last year's outlays for Medicaid and seek to set up agreements with insurance companies that will cover services on a discount.
13. Bids should be requested for a given region, to cover all Medicaid provision in that region. Insurance companies and health care providers would set up networks to service this sector of our populace.
14. It may be advisable to set up some sort of reward program if people in the Medicaid service group do not use services for the period of a year, or a time period to be determined. Some studies have shown that people will avoid using services to obtain a monetary reward. This might impact overall Medicaid service costs downward.
Goals
Get government out of health care
Get people responsible for their own health care
Provide services for the poor, but do not allow them to remain on these services. They must get off of them.
Get people back to work, and paying their own way.
If this group is 50 million the first year, it should be 40-45 the second and 30-35 the third. Within five years I would want the goal to be less than 10 million
Social Security / Medicare / Medicaid / Health Care
The goal starting within 18 months, would be to eliminate government involvement in senior services, at some time in he future. Further, it should be the goal of the federal government to eliminate any provision of health care to the 40-50 million without health care today. Get them to work ASAP.
Savings Accounts
Starting when a young person first entered the work force, the federal government would advance them $10,000 in a savings account. Depending on the income level, that young person would have a certain amount of money taken out of his paycheck to pay that $10,000 back.
The goal here would be to allow this individual to obtain health insurance, vehicle insurance, and perhaps a few other types of insurance with $10,000 deductibles. This would make a very positive impact on their insurance cost outlays.
If a person had a vehicle accident that impacted their health also, the government could extend another $10,000 so that the deductible could be met on both the health care and vehicle losses. The individual would be provided with another $10,000 if their balance had fallen below the $10,000 dollar minimum, and would be paid back over time.
The goal here is to develop a quick-start savings plan that would in time be a nest-egg for a home purchase.
Ideally this plan would provide enough money for a person to purchase their own home by age 35, have it paid off by 65, and retired in the mid to early 50s, with a great nest egg in their savings account.
Savings would earn 5% over prime in this account. Loans from this account could cost 10% over prime. While that sounds high, compared to savings and credit card rates these days, it would be very competitive for savings or credit.
You would be able to take a one time hit for your first home purchase down payment.
Now, paying back that $10,000 dollars over three years would seem daunting. There would be no interest charged. Second, a big portion of the payments to retire this debt, would come from savings on health care and vehicle insurance premium savings.
A person starting work at 21 would have their loan paid back by 24. With four more three year periods by 36, without the five percent interest, you would have $50,000 dollars in savings. $40 thousand would be available for a down payment. A lesser down payment could be made whenever you could arrange it.
For one person, this would be a good deal, but it would not be as good as it would be for two people who had settled down, started a family, and were contributing to the pool.
Each person would have their separate accounts, but with combined forces, a very healthy down payment on a home by 30 would be possible. That would be at least $40k, and by 35 at least $80k.
Collective savings would then accumulate over time so that by the time these two home owners were 50-55, they would have hundreds of thousands of dollars in savings, that they could tap at 5%.
In real world terms this would present a problem.
How would we retire Social Security as we know it?
Well, first off, new people into the work force would continue to pay into a Social Security system they would not reap benefits from. On the other end, they would reap better benefits than today's Social Security recipients do.
They would have massive savings, home ownership, and a guaranteed 5% interest rate that today's seniors don't have.
They would be paying self-insurance rates for their elder years. If this all played out right, this shouldn't be a problem because of their large savings accounts, and improved interest rates.
They would still have income that would never run out.
The part about these people having to pay into a SS and Medicare system that they wouldn't be drawing from, would be a hurdle to explain, but in a rather short period of time, they would be paying out a lot less than we do today.
Think of it this way. If people lived to 105 today, they would be using SS and Medicare for 40 years. Well, not everyone is living to 105. Each year after 65, people die off. By the time folks are 75, a percentage of them have passed away. Each ten year segment would see the numbers of people still on the old SS and Medicare drop by about 25%.
In ten years the rates having to be paid in to support the old SS and Medicare system would drop due to attrition. That isn't all. As the populace expands and new people join the work force, the amount each person has to contribute to the old system would drop further. Population expansion would help increase that 25% decrease every ten years. By the end of two decades, each person contributing to the old system would be paying a rather insignificant amount.
Think of it this way. The senior segment on SS today, represents a certain percent of today's population. In 20 years that segment on the old SS would represent a much smaller segment of the population at that time. It would be a much smaller percentage of the work force than it is today.
Once again, even though people under the new plan would have paid into a system they weren't going to reap benefits from, they would also have been enrolled and contributing to a system they would benefit from. And that system would leave them a lot better off than today's seniors.
They would have massive savings, a home that was paid off, higher sustaining interest rates on those savings, and a steady income stream that could actually grow over time.
I've crunched some of these numbers, and there is plenty of good reason to speculate that this could all be possible, with the proper structure.
In 25 years or so, our government would all but be out of health care provision for everyone, indigents and seniors included.
As that time nears, competition is returned to the health care market place, and more normal capitalistic dynamics would drive health care prices down.
When government started paying for Medicare, it destroyed capitalist dynamics, and it wreaked havoc across the entire health care industry. End it and get back to sound economic dynamics.
Thanks for your post. As I understand it, a bill forcing interstate competition or malpractice reform could be filibustered (can’t be in a reconciliation bill).