Op-ed views and opinions expressed are solely those of the author.
No topic has drawn more discussion or scrutiny than the nation’s health insurance crisis!
Notice I did not say “health care” crisis. We already have the world’s finest health care! This issue is with insurance.
The “Affordable Health Care Act,” aka “Obamacare,” brought more people into the family. But it fell woefully short of its goal. There are entirely too many people still not covered. Many have watched their premiums skyrocket; their deductibles jump ridiculously.
There have been winners and losers with Obamacare.
I know a family of three previously not covered, that qualified for better than $20,000 in free health care last year. They have had zero deductible coverage for five years. Not one cent out of their pockets! Life is good!
Conversely, I know an “empty nester” family who pays $1,600 per month in premiums because the woman had breast cancer several years ago.
I recall hearing from a “thirty-something” woman, a part-time realtor for Keller Williams singing, “hey, hey the witch is dead. Which ole witch, the wicked witch.” You recall that iconic song from the Wizard of Oz? She was singing it the day after Hillary Clinton’s presidential defeat. Her husband is self-employed. Her family’s monthly insurance premium was $990 per month. Naturally, she blamed Democrats.
Donald Trump’s proposed healthcare plan ran off the rails, thanks in part to the late John McCain. The newly elected president never was in sync with then-Speaker of the House Paul Ryan. In retrospect, Trump would have been better off tabling Health Care until after the Tax Swap.
We are paying entirely too much for pharmaceuticals in the U.S. Worse still, many of our political leaders are receiving monetary help from “big Pharm.” Nobody likes to bite the hand that feeds them! As would be expected, it opens the door for corruption. Herein lies the dilemma.
Bernie Sanders and Elizabeth Warren advanced their aspirations for “Medicare for All.” In theory, we do have a rich nation and probably could afford to provide something for everyone. There would need to be conditions and restrictions. It’s probable that neither Warren nor Sanders would demonstrate much flexibility.
So, we are back to square one. Is there a middle ground here? And, assuming that there is, could this middle ground be found that utilized capitalism and the free market to bring the cost of good healthcare to affordable levels?
Maybe. But it would require a compromise. Any real compromise will result in neither party being totally happy. That’s why they call it a compromise. So here goes! And I guarantee you, Neither Republicans nor Democrats will be overly thrilled.
The starting point is “pre-existing conditions.” All of the Democrats and the majority of Republicans are together on the need to protect Americans with pre-existing conditions.
The watchwords are, “it could be me.” For those who have faced insurance companies and been doomed to impossible costs understand. Nearly half of the bankruptcies in America are due to medical hardships.
This brings us to the proposal: What IF we designated a national sales tax, perhaps as little as “one-fourth of one cent,” and used it to establish a nationwide “Catastrophic pool.” The “pool” would be unavailable until annual cumulative claims reached $10,000.
Upon reaching $10,000, 80% of subsequent claims would be covered by the “Cat Pool.” This would leave the insured with a $20% co-pay. It would climb to 85% when a claim or cumulative claims reached $50,000 and cap at 90% when the claim/claims hit $100,000.
For example: Cumulative claims of $13,800 would qualify for $3,040 from the Catastrophic pool. ($3800 X .80 = $3,040). $65,000 in annual cumulative claims would yield $44,750 from the pool. ($40000 X .80 = $30,000 $15,000 X .85 = $12,750. $30,000 + $12,750 = $44,750). Remember the first $10,000 would be on the insured.
We currently have 1,300 insurance companies nationwide. This number would increase dramatically. The consumer would be allowed to cross state lines, as they do with auto insurance. “Aflac-like” companies selling inexpensive “Cat Pool” supplemental policies would appear overnight.
I can hear the moans and groans from both sides!
Democrats would say (correctly) that “this is a regressive tax.” Proportionally, “more of the burden will fall upon the poor.” They would also likely say, “Besides! It simply isn’t enough.”
Republicans would say (correctly) that “this is universal health care. Besides! Can we trust the federal government with such a money pot?”
All concerns are valid. Let’s address the last one first. Clearly noted stipulations prohibiting “Cat-Pool” monies to be used for other needs would be an imperative! There would be “no borrowing from Peter to pay Paul!”
Regarding the “regressive tax on the poor” argument, remember this: The poor will continue to buy beer, cigarettes and eat at McDonald’s! A Big Mac, fries, a pie and a milkshake come to $10. The buyer would have contributed 2.5 cents to the pool. Smart money says, “they won’t miss it!”
Meanwhile, new insurance companies will be popping up all over the place! The typical American family seeking an “80-20 co-pay, featuring a $500 deductible for $150 per month,” will be in luck! A family in Waynesville, North Carolina might ultimately contract with Sun Valley Health Insurance of Pocatello, Idaho. The options will be there if they are willing to shop!
This would be possible because the “Cat Pool” would serve as a backstop in the event of a large claim. The small, Idaho-based company could offer inexpensive policies to middle-class American families, without the worry of a few large claims putting them out of business.
Americans with pre-existing conditions would have protection. There would be companies offering “not so good” deals to cover their first $10,000. There would always be the option to self-insure. This would be a godsend if the insured were a cancer survivor, an HIV survivor, was diabetic, was taking nitroglycerine, or suffered from any affliction equated with high risk.
There would be losers. The large insurance companies would ultimately become reassurance companies, working on a lower margin. I recall a Blue Cross-Blue Shield representative telling me that their profit margin was 12%! Pretty lucrative!
What about the pharmaceutical companies? Why are we paying twice as much, or more as compared to the rest of the world?
Give Trump credit! He took on the problem, angering the pharmaceutical hierarchy immensely. Most conservatives think that Fox News turned on the president for this reason! Watch their commercials! It’s painfully evident. A lot of politicians likewise fall into this bucket.
Would “1/4 of a penny” be enough? Not certain. It would be a starting point.
Republicans could accurately say that they “lowered health care costs for all Americans including those with pre-existing conditions.”
Democrats could accurately attest to accomplishing a long-sought after party goal: “Universal health care for all.”
Not perfect, but fair.
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