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Solving Health Care

April 14, 2014

It’s bad. It’s really bad. We were finally affected by Obamacare as the company policy was cancelled because it apparently didn’t include all of the ‘goodies’ that are required now, like pediatric care for people in their 60’s, contraceptives for gay people, that sort of thing. So we were moved from one program to another. The new policy isn’t bad, except for the deductible. How do people manage this? We have an HSA account left over from prior lives and are now making great use of it, and once we move prescriptions and doctors from the old to the new, it settles down, but it all seems so senseless.

THERE WAS NOTHING WRONG WITH THE POLICY I HAD. How many billions of dollars have been wasted just moving people from one policy to another so we can provide $30 worth of contraceptives to teenagers?

Last week Obama made the statement ‘I can’t figure out why the Republicans want to take people’s health insurance away’. Beyond the obvious pandering crap this statement represents, how does he get away with ignoring the fact that Obamacare took the policies away from about 11 million people last year?

So, I thought to myself, how would I solve this? After all, I know as much about health case as Obama does…

Here’s what I came up with:

1. Eliminate all mandates. They aren’t needed in this proposal.
2. Dependents can remain on a parent policy until age 26.
3. Keep the exchanges, but turn them into a ‘medical insurance shopping system’ where insurance companies can list their products and get customers.
4. Medical insurance cannot be cancelled by the insurance company if the premiums are being paid.
5. Medical insurance is not tied to work and it isn’t tied to where you live.
6. All medical insurance programs have an HSA account requirement.
7. An individual finds the insurance that is appropriate for them on the exchanges and signs up. If they already have an HSA account, it is registered with the policy. If they don’t one is created for them and registered.
8. If an individual falls below a level as determined by specific means testing, they can qualify for government assistance for the premium.
9. Means testing requirements must be made public.
10. An insurance card is issued to the individual.
11. Current insurance brokers can become ‘Insurance aggregators’.
12. An Insurance Aggregator is a company that collects copies of all insurance cards from the employees of a client company and makes the monthly premium payments based on the client program.
13. Each company decides how much they want to contribute to an individual’s insurance premium as a benefit. This amount is paid to the Insurance Aggregator each month.
14. If the premium on an individual employee policy is greater than the benefit from the employer, the difference is retained from the employee paycheck each month.
15. The employee can have the option to have the aggregator pay the difference from the associated HSA account.
16. The insurance Aggregator makes the premium payments for each employee of the client.
17. If the benefit from the client company is greater than the premium for any particular employee, the difference is deposited in the employee HSA account for them to use as the law allows.
18. When a new employee is hired, a copy of their medical card is forwarded to the aggregator to be added to the list.
19. When an employee is released, the aggregator simply removes the employee from the client list and no future payments are made.
20. If an employee changes jobs, they simply take their medical card to the new employer.
21. If an employee is terminated and unemployed for a period of time, they can fall into a government assistance program tied to unemployment and as long as they are actively looking for work, their insurance premium can be subsidized. If they stop looking for work, the subsidy goes away.

Pre-existing conditions: A pre-existing condition situation is created because an individual lacks medical insurance and wishes to purchase a policy to now cover a medical situation that has occurred. This creates a situation where an individual can wait until they actually need insurance to actually purchase a policy. This creates an economic disaster for the insurance industry.

If the above program is implemented and people can qualify for government assistance if they fit the specific means requirements, there is no reason for someone to not have insurance. This means someone is uninsured by choice. If this is the case, they should NOT be allowed to purchase insurance to cover a recent medical issue. There must be specific tests to detect this situation.

If someone is in the situation of requiring insurance for a medical problem that has existed, there must be a reason they lost their previous insurance. With the above program and government assistance, there are very few reasons a person will find themselves in this situation, but undoubtedly there will be such situations.

There should be an ‘assigned risk’ category as in the auto insurance industry where each medical insurance company is required to accept a certain number of these specific cases where someone has a real pre-existing condition (not one that just occurred) and does not have insurance for certain specific reasons. For example, someone has cancer and goes through a divorce where they were covered by their spouse’s policy. They might find themselves in a gap where they are uninsured for a short period of time. One of the tests could be that the individual with the pre-existing condition has had active insurance in the last 60 days or has been covered at least 80% of the time over the last year. This would eliminate the situation where someone waits for a problem before getting insurance.

If someone decides to just wait it out, then gets sick, too bad. You made your bed, now sleep in it. There will always be a pool of people in any society that will just believe that the world will take care of them no matter what. If we can figure out how to help those that are really in need via means testing, situational testing and specific limited subsidies, we filter out the ‘free ride’ types and they get to fend for themselves.

Oh, and, NONE OF THIS IS MANAGED BY GOVERNMENT AGENCIES. How many times do we have to learn this lesson?

What am I missing?

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One Comment
  1. And all that took was about two type-written pages ( maybe the equivalent of four or five napkin-backs). This is why business men need to be elected into office.

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