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Wednesday, June 27. 2012
What the US needs is bipartisan health care reforms, not the partisan ram-down that we’ve experienced with Obamacare.
Everyone has a prediction for tomorrow’s Supreme Court decisions on Obamacare, and no one has a clue, including President Obama who has three different speeches prepared for different decisions. Regardless of the decisions, all except those addicted to government-run and single-payer medical care recognize that either Obamacare will need serious revisions or that we will need to start from scratch.
Below is an op-ed that I had in the San Diego Union-Tribune with proposals based on my decades of experience and credentials in health insurance. Republicans and Democrats should be able to agree.
No GOP ideas? Try these 10
By Bruce Kesler
Friday, February 5, 2010
President Barack Obama and congressional Democrats swung their 2008 majority stick, poked the health care hornets nest and are being chased by a popular uprising saying “no to Washington.” Obama now says he is willing to listen to Republican proposals for improving health care. Republicans believe that just passing an ObamaCare-lite will still move us toward government control, toward larger deficits and higher taxes.
Instead, improvements should be separate and incremental to improve health care without financial excesses or intrusion into personal lives. Here are 10 proposals that would work, cumulatively helping the poor and middle class, be affordable, enlarge care without taking away deserved care, and be supported across party lines.
• Allow tax deductions or refundable tax credits for premiums, so more people would be encouraged to obtain insurance. The poor and middle-class uninsured would be on equal terms to those receiving employer-paid benefits.
• Allow individuals to use savings of pretax income, allowed to accumulate, for health care expenses. Include professional long-term care and over-the-counter medications if prescribed by a doctor or dentist. The middle class would benefit. This also allows more people to choose lower-premium, higher-deductible policies.
• Retain Medicare Advantage programs, whose higher benefits and lower co-pays than straight Medicare are more widely used by the poor. But limit those higher benefits and lower co-pays to core medical, dental and vision care.
This allows some reduction in government subsidies. Medicare Advantage plans use networks with negotiated rates and usage monitoring, which reduces their costs.
• Require full portability of individual medical insurance to other carriers at the same or lower actuarial level of benefits, reducing loss of coverage when moving to another area and increasing competitive measuring across carriers that reduces confusion. Rather than motivating people to wait until after they’re sick or injured, driving up the premiums of others, individuals would have more incentive to at least lock in more affordable catastrophic benefits.
• Allow insurers to offer plans nationally, with fewer mandates, to increase choices of benefit levels and premiums. Premiums in each part of the country would reflect local costs, which would increase knowledge of local variations in costs and competitive pressures to reduce higher outliers.
• Allow immigrants, legal or illegal, to enroll in private or government plans but require full payment of premiums. This would reduce uninsurance among those who are able to afford premiums. Legal immigrants could not be naturalized unless providing proof of basic comprehensive medical insurance from the date of entry into the country.
• To apply for government assistance, means-test income and all financial assets of uninsured citizens and legal immigrants. If premiums plus out-of-pocket expenses during the year exceed 10 percent of means, provide a refundable tax credit. For those still uninsured, require providers’ charges to be capped at 20 percent above the same rates as the provider’s highest rates negotiated with their largest private insurer. Currently, “list” prices charged those uninsured may be 30-100 percent higher than negotiated with insurers, with no cap. This would reduce provider charges due to competition, protect the poor and provide incentive to obtain coverage, at least cheaper catastrophic coverage. Those otherwise qualified uninsured would be required to enroll in the appropriate government program.
• Require tort medical cases to be heard by specialized expert courts to reduce the sway of emotions for outsize judgments. Tort attorney commissions on settlements would be higher for pretrial negotiated settlements than for trial judgments, encouraging more reasonable and less costly results for those who deserve recompense.
• State Medicaid or SCHIP programs offering benefits above the federal level of benefits or enrollee income would be ineligible for any federal subsidies. Higher “welfare” states would not be able to pass their largesse on to taxpayers elsewhere and would have to justify them to their own voters.
• Private or government retiree health programs should be required to become fully actuarially funded within five years. If not, private plans would lose tax benefits. Private and governmental plans could reduce benefits, including at the next negotiation of union plans.
The Democrats’ vision of the perfect is the enemy of the good. There is little public support for the Democrats’ overexpansive, excessively costly intrusion into our very lives. There is widespread support for the above reasonable improvements.
Kesler, a resident of Encinitas, is a former corporate finance and business operations executive. For the past 20 years, he has been an independent health care and benefits consultant.
Tracked: Jun 28, 05:45
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It's often said (although perhaps not necessarily vindicated by the data) that most of our health care costs arise in the final three years of our lives. None of your suggestions seems to deal directly with that issue. Does anything you propose actually expand coverage and yet significantly reduce the cost of health care if it does spike so dramatically at the end of life?
PS to Bruce: The reason I raise the issue is because I see a lot of punditry and political posturing on the funding side of health care, but I don't think I have ever seen a solid analysis of the cost and benefits side of health care. Why are we arguing over how health care should be funded if we have so little understanding of where and why the money is being spent, and whether it's being spend wisely in return for the benefits people want? The Dems argue the rising cost of health care is a sufficient reason for a government takeover of the US health care system. But I don't see the rising cost of health care as the crisis they say it is. Instead I see it as an indication that (1) modern medicine is improving and providing access to better life-saving technology and (2) these days more people have more disposable income that they are WILLING to spend on health care if it improves the quality of their lives. That's no crisis; it's PROGRESS.
I agree, and have written so in other posts or venues.
And, BTW, one of the ways to control costs is by having choice, so each can choose what works for themself, instead of being forced to have a Cadillac regardless. As to end of life costs, no I didn't mention anything. But, many make a choice then, too, for less suffering or debilitation, in consult with their doctors and family or by themself. I can accept that. BUT, even for many who sign do not resuscitate docs, family often overrides it or the doctors ignore it in order to avoid a possible lawsuit in this litigous area. I do suggest, however, tort courts to control some of that excess cost.
End of life decisions are indeed hard on families. All the more reason why government bureaucrats and budget/pay/cost panels should not have the power to make life and death decisions over Americans. God willing, tomorrow will see that threat to every one of us struck down by the Supreme Court.
Allow tax deductions or refundable tax credits for premiums, so more people would be encouraged to obtain insurance. The poor and middle-class uninsured would be on equal terms to those receiving employer-paid benefits.
Currently, self-employed taxpayers are permitted to deduct health insurance premiums.
I don't know about taxpayers who are not self=employed.
Bruce writes:"Require full portability of individual medical insurance"
I'd go further, banning employer-paid health care plans or at least eliminating the tax subsidies of such plans. Allow and encourage people to obtain health insurance from civic or fraternal organizations; the Masons could have a health plan, the Elks could have one, the Rotary could have one. Put these civic organizations on the same footing, so that people could sign up for health insurance that wouldn't be terminated just because you moved or changed your job. Allow interstate competition; as a California resident, I am NOT ALLOWED to purchase health insurance from a business in any other state.
Banning employer paid health insurance is just as evil as requiring them. The government should step out of the way and let free employers decide how and how much they wish to compensate their employees and let free employees decide how and by how much they wish to be compensated for their labor. NO GOVERNMENT DICTATES, for or against, is the best policy.
And don't start with that canard that an employer-paid health plan is "subsidized" by taxes. It's a justifiable business expense if the employer decides he must offer one in order to attract and keep good workers. The only thing that is "subsidized" by our taxes is the vastly bloated and incompetent government we are now saddled with, and it is the overburdened taxpayer who is doing the subsidizing.
For tort reform, simply ban punitive damages in civil cases, and require that all compensitory damages be limited to actual expenditures made by the plaintiff (for pain and suffering, this would mean money spent on counseling).
"Require tort medical cases to be heard by specialized expert courts to reduce the sway of emotions for outsize judgments. Tort attorney commissions on settlements would be higher for pretrial negotiated settlements than for trial judgments, encouraging more reasonable and less costly results for those who deserve recompense."
expert courts? using former plaintiff's counsel as judges? or former defense counsel / former insurance industry executives? or do you mean blue ribbon juries? sure. how about a select jury made up of individuals with experience in insurance company delays, red tape, coverage denials and medical malpractice, or is this a tad too unbalanced? maybe one made up of medical and insurance industry flacks would be more fair. all this is typical elitist distrust of the average citizen's sense of justice when its the industry's ox getting gored. sometimes egregious misconduct whether by insurers who delay or deny coverage or the medical industry misconduct needs to be slapped with heavy punitive damages.
"commissions"? -- the word is "contingency". guess who benefits from discouraging trial? hint: it won't be the victims.
as anyone in this field knows, the threat of a trial and the threat of a jury verdict* and the threat of getting hammered with trial costs are the main whips for making insurers negotiate fair settlements with claimants. take away that threat and you'll wind up with second rate and underfunded legal hacks convincing their clients to settle for second best industry offers. again, who does that benefit?
I've settled and tried medical malpractice and insurance coverage cases and I know exactly how this game is played -- our whores I mean expert witnesses against the defense whores, defense firms who must earn their bucket of blood in hourly fees** before settlement is even possible, defense tactics of outwaiting and outspending plaintiff counsel with said whores and abusive discovery practice.
This is why trial fee contingencies are higher than pretrial settlement, because plaintiff's attorney funds litigation expenses and fees out of his or her pocket, and these expenses can go into the tens or hundreds of thousands of dollars.
last: no one should believe, not for a second, that insurance companies have any interest in making fair settlements for just compensation, any more than plaintiff's attorneys and clients are interested in the same. defense wants to pay as little and late as possible, plaintiffs obviously want to strike gold. but, its this mostly unfettered greed and a reasonably level playing field that results in mostly fair settlements and mostly fair verdicts.
I swear on all that's holy if I spent a month foreclosing on orphanages, I'd feel cleaner than after a single day dealing with this morass.
* excessive jury awards can and are set aside or reduced by post trial motions and appeals.
** the insurance industry is definitely getting screwed by their own counsel. reform that. limit defense costs and see how quickly disputes settle.
This will never fly, there's no role for fed gov meddling meaning no hundreds of thousands of no value add jobs that are committed Dem voters.