Comments on: A Health Plan for Barack Obama

By: The Republican Health Plan | John Goodman | NCPA

The Republican Health Plan | John Goodman | NCPA — Tue, 26 May 2009 15:33:10 +0000

[...] the Coburn plan is very similar to John McCain's health plan, which I have discussed here, here and here, I won't dwell on details — other than to explain two main features which [...]

By: Roger Beauchamp

Roger Beauchamp — Wed, 07 Jan 2009 14:36:50 +0000

John

The McCain plan requires the tax subsidy to be spent for insurance, rather than health care per se. This dilutes the purchasing power of those dollars significantly. (Anywhere from 18% to as high as 50% for some of the least cost effective insurers). Money spent directly for care should have the same tax treatment as money spent for insurance.

Purchasing mandate free insurance across State lines is a must. Sixty plus years ago all two-party contracts had benefit dollars that could be applied at any doctors office or hospital in the country without penalty to the insured. • The Obama plan.

There should be no mandates for insurance.
Subsidize low income after implementing a Universal Heath Account (UHA).
Play or pay is a bad idea. Ones health is their responsibility, not their employers.
A UHA would provide equal treatment for all who do not have employment based coverage.
Your final four points.
Avoid a mandated package. I agree
Risk rate insurace premiums. I agree
Commit to safety net institutions. Not a good idea. Place the money in their UHA. People will choose the most cost effective service in their area, not the local hospital emergency room. Hospitals will be able to access this as well as any other qualifying provider.
A new HSA approach is not needed with a UHA.

By: Dr. Bob

Dr. Bob — Tue, 06 Jan 2009 14:17:38 +0000

He probably needs some physician input from someone who has no ulterior motive, i.e Drs Woolhandler and Himmelstein, and I can think of no one better able to provide that counsel than me.

Cheers.

By: Stanley Feld

Stanley Feld — Tue, 06 Jan 2009 14:16:08 +0000

John

Great comment.
You have to speak out louder and clearer. You got it.

By: Steve Bassett

Steve Bassett — Tue, 06 Jan 2009 02:05:02 +0000

John, thanks for continuing to fight the good fight -persistence is so critical. Here’s my deal for the devils that want a single payer. THEY CAN HAVE IT:

1)Make HSA accounts available to all Americans for any 213d item -no plan design strings.
2)Order CMS to hire all of the programmers at the CBOE to create a health care exchange. A table of allowances based (eg. on the average price of hip surgeries) will ebb and flow through the day. Exchange rules would be hammered out by market participants with guidance from a CBOE economist. Once that was done doctors and patients would collectively thumb their noses at anyone who had hoped to be a member of Daschles ‘independent’ health care board.
3)So let us have a single payer then, but based on the average marketplace price table of allowances, a minimum income specific deductible (5% of gross income), and the right to raise ones deductible up to 100% of ones income or 50% of ones net worth, whichever is greater in exchange for tax credits (lower premiums). Individuals would be allowed to keep 30% of the difference between the table of allowances and any price they can find below that (creating competition). In addition individuals could choose which 213d items they would like covered in their ‘government plan’ (fewer covered items more tax credits). Let the IRS be the keeper of what is an eligible medical expense.

In exchange the socialists in this country can have their damned individual mandate and their single payer. Number crunchers that keep the RBRVS tables will get their pink slips, and the payers like children at the beach – sand sifting through their fingers – will sit thinking what might have been had they thought of this idea first.

By: Bart

Bart — Tue, 06 Jan 2009 01:09:22 +0000

Ralph, one thing McCain didn’t explain well was his Guaranteed Access Plan (GAP). I’m still having trouble finding a good description of the GAP, even though it was the sole part of McCain’s plan to address the problem of affordable coverage for people with pre-existing conditions. All I can find are some vague statements about providing federal funding to states for the purpose of establishing risk pools. Nothing about how much, or how the money would be used.

By: Gary Conwell

Gary Conwell — Mon, 05 Jan 2009 23:06:07 +0000

I understand your frustration. Also I think the current meetings around America led by Tom Daschle and the transition team are interesting. It seems to be oriented toward building a consensus on elements of a health plan that they plan to submit. Not necessarily a bad thing… certainly the opposite of the closed meetings Hillary had during her shot at a national healthcare plan.

By: Ralph F. Weber

Ralph F. Weber — Mon, 05 Jan 2009 19:28:51 +0000

John,

Happy New Year!

It was a decent plan, but they did a crummy job of explaining it.

Anyway, in an effort to help explain the plan, I published the following article. View it here.

By: Ann Robinow

Ann Robinow — Mon, 05 Jan 2009 18:46:42 +0000

Great suggestions. I would like to add 3 more:
1. Creation of a mandatory risk equalization fund to which all insurers must contribute would enable an insurance market that actually caused insurers to want to attract chronically ill patients (this may have been what you were getting at with “risk rating”). Within this fund, the risk attributes of each insurer’s patient populations would be periodically evaluated. Those that attract sicker than average populations would receive dollars from the fund and those that skim risk would lose dollars to the fund. This would all be done behind the scenes, but could be combined with insurer developed products that reward consumers for healthy lifestyles and patient efforts to cooperate to optimize their conditions. Insurers who do the best job managing chronically ill patients will save costs through complication avoidance and will attract greater revenues through fund directed dollars. Risk skimming insurers will see a corresponding drop in revenue.
2. Refine the rules for HSAs to allow more products that create cost sharing throughout a longer period of health spending in exchange for reduced deductibles, and/or, allow richer benefits for proven interventions with leaner benefits for preference based or unproven care, and/or, have benefits scaled to income.
3. Provider payment reform is essential to sustainability. Payment models need to reward outcomes, not volumes of high profit services so providers will allocate their investments appropriately. Also, the standard for non-profit status should be tied to community health and resource use standards, not the ability to create ridiculously high charges so when they are written off it looks like a lot of charity care was provided.

By: Bart

Bart — Mon, 05 Jan 2009 18:35:22 +0000

John, thanks for the response. Outside of community-rating states, the only cross-subsidies in the individual market that come to mind are guaranteed renewability clauses and prohibitions against using certain information, e.g. DNA screening, in the underwriting process. I don’t see how this comes close to group insurance that doesn’t permit underwriting and often doesn’t even segment by sex or age.

I agree that an insurance payout on an accurately-determined risk premium should not be regarded as a subsidy.