Monday, August 31, 2009

The Simplest Medical Care Fix

If I told you I have the fix to the current debate on medical care reform, you'd laugh.  Nobody does or so it seems.
Well, I believe that it is simpler than we are told.  Smile sarcastically and stay with me a minute.

Why is it so difficult?  I's a very complex system that touches every citizen, native, naturalized, resident and illegal.  The solution to the riddle must balance the conflicting interests at an affordable cost over a long period of time which is difficult to forecast.  In addition we want to resolve the issue to everyone's satisfaction and in a hurry with a permanent answer. This is utter nonsense.

The first step in finding the answer is in uncoupling as many of the problem areas so they can be addressed separately.  Secondly is to find strategies that permit incremental changes that are self adjusting over time.  With these two premises here is:

The solution

  1. Give every US citizen and legal resident the right to buy into the same medical care plan that covers US Congressmen and federal employees

  2. Mandate that Congress cannot legislate a separate plan for themselves and cannot have service preferences over other citizens within the system

  3. Eliminate employers' tax deductions for employee and medical benefits.  Give all deductions to the taxpayers for what they pay for medical and other insurance plans

Why would it work?

  1. Over time Congress would see that the quality of service and care is maintained.  They do it now and their service is better than what most citizens get (who said government services do not work?)

  2. Anyone who has other or better private options can use them alternatively or in addition.  More power to them.

  3. The federal medical care option would provide healthy competition to private insurers and will likely reduce costs growth rate

  4. If all care providers have to deal with the feds, electronic record keeping will be easier to implement, will reduce costs and bureaucracy and eventually will be implemented by private insurers as well.  That will evolve later and separately without impacting the policy issue.

  5. The federal claims processing system is already in place and requires no reinvention. It will require increases in processing capacity and that will create the opportunity for efficiency improvements in 4 above

  6. To provide coverage to the poor, the unemployed, those impacted by personal medical catastrophe, etc. the Congress will legislate appropriate tax credits to cover insurance fees and expenses.  That debate, however, will be separate, will be a matter of ethics and of defining our national progressivism without having to affect the "mechanical" system of medical care insurance. 

  7. The cost of services to illegal aliens and others individuals that medical providers must serve according to their oath, should be processed as costs of the federal plan.  This will ensure that hospitals do not disproportionately absorb those costs (because of location of philosophical orientation or funding requirements).  Those costs are currently borne by taxpayers but not explicitly accounted for.  This will ensure accurate accounting of costs that as a nation we must consider when planning border protection policy.

  8. By separating employment from medical care insurance we'd abandon a system created by accident in WWII (was intended as a work around to war time wage controls) and never as a reasoned policy of social insurance.  The result would be to stop the costly nonsense of employees having to change medical insurance provider simply because they change employers.

  9. In this proposal there is no expectation of complete equality for all citizens.  Those that can afford supplemental insurance to "be shipped to the moon for exotic procedures without questions or delays", will continue to be able to do so.  They have those options today and always will.  The currently uninsured however will also have a reasonable option.  That option may be subsidized to the degree that we, as a nation, feel appropriate in the future just as we do now for Social Security and Medicare (without having to change the benefits processing and accounting systems).

The current debate has confused issues to the point that even seniors covered by Medicare plus their supplemental insurance are losing sight that Medicare is serving them well for their basic needs and supplemental insurance is affordable because the basics are covered already.  It is time we extend the same functionality, albeit at a price, to the rest of the population.

Increasing the complexity of the problem and of the solution ensures that paralysis and confusion set in  That only benefits insurers and service providers that can focus their energy to exploit those niches to their advantage and profit.
It is simple than we think.


  1. Marco,
    I think your plan for Health Insurance reform is brilliant! May we elect you to serve in Washington?

    I wrote a response to a really distorted email I received a few weeks ago which I posted on my blog.

    Here's the link.

    My response set up a little firestorm of insane feedback that has led me to conclude that the far right has gone off the deep end.
    By the way, I'm Jim V's girlfriend which is how I found my way to your blog.

    Best regards and hi to Darlene,

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