Let’s get past Obamacare, and Trumpcare. Let’s just call it Healthcare. A lot of the partisan problems we face in developing quality insurance options are created by one party or the other taking credit or placing blame.
The Republicans have over demonized the 2010 law. It isn’t failing, it isn’t in a death spiral, and it isn’t ruining America. The Democrats are returning the criticism by abasing current Congressional efforts and cling to keeping the law as a tribute to President Obama’s legacy. Republican repairs have not been healthcare based, rather tax based. Democrats haven’t spoken of fixes much at all. None of these are good reasons to leave citizens’ health insurance options hanging in limbo.
In theory, Republicans would like to return to a free market, private company based system that would rely on competition for cost control while Democrats would nationalize healthcare and cut out profit to help keep cost down.
Neither will happen in one step. There isn’t enough support for jumping to single-payer healthcare, and few are interested in gutting Medicare and Medicaid, turning old and poor people over to private insurance–especially the insurance companies. So …
Let’s think about fixes–fixes that have a chance of being enacted into law. Republican Senator Rand Paul (KY) has stated that those getting individual insurance policies from the exchanges should be able to join a large group or association like the Chamber of Commerce and purchase group policies, avoiding the unstable exchanges. I agree, but why stop there? We already belong to a huge group. We’re 320 million strong as citizens of this nation. Why not get our group policy all together. The more people involved, the better the prices that can be negotiated. I realize this option won’t be on the table because it is national healthcare and the opponents, including Sen. Paul and his sorta big groups, are afraid of creeping Socialism. He claims that if we turn to Medicare for all, in no time the government will want to nationalize the sale of ice cream and tennis shoes. I don’t believe that, but this column is supposed to put forth ideas that can get bipartisan congressional support.
Moving on, Republicans have spoken, for years, of buying policies across state lines. This is suggested to give buyers more options of both sellers and policies. The biggest snag is that every state has it’s own insurance commission and they all have distinct laws about what policies need to include.
If insurance companies can modify their product and offer it to a wider swath of the population, Republicans can get their wish. The compromise should be that the way those policies are sold is through the high functioning, cost controlling, state exchanges. Contrary to what is often heard, there are such animals. The Washington D.C. exchange is likely the best in the nation. It is stable and has costs under control. One of the reasons is that this is where most of Congress and their staffs buy their own personal healthcare insurance. The California exchange has kept costs down and offers more than a dozen different choices of companies with a variety of policies from each. New York, Kentucky, and several other states have good exchanges too. So, let’s tap those exchanges and sell policies to anyone in the country. This would calm insurance companies fears and may encourage them to return to individual states or offer an exchange through a bloc of states creating a larger market.
Another chance to compromise is within Medicare itself. Medicare is divided into four parts. Part A is free if we’ve worked for Social Security for at least 10 years and covers major medical events. Part B covers doctor trips and is the part for which we pay a monthly premium. Part C is the supplemental portion to original Medicare, which covers 80%. Part C offers policies to offset individuals’ out-of-pocket 20% and is sold through private insurance companies. Part D is the prescription drug coverage that is also covered by private insurance companies. All of this kicks in at age 65 for U.S. citizens. One way to work within these parameters would be to lower the start age to 55. This serves two purposes. It takes the oldest and sickest age group out of buying private insurance, making selling policies cheaper. Conversely the 55-64 year-olds would become the youngest and healthiest members of Medicare and would add revenue through Part B while demanding the fewest needs–good for both sides.
There are other ways to tweak the public/private ratios within the four parts of Medicare: means test older citizens and send those who can easily afford to do so, back into the private market offering companies more clients, and perhaps nationalize Part D to negotiate 320 million strong with Big Pharma for the best drug prices for U.S. pill buyers.
None of this is all of what I want for our health insurance system and likely not all of what you as consumers want either. But hopefully, there are some ideas here everyone can agree to, or spur other ideas in the spirit of stabilizing our current system that offers sound care delivery, but is wobbly and neglected in the cost/organizational structure. If the administration will commit to paying the healthcare bills being acquired through this current law and if they will support and enforce the law, even though it isn’t theirs, and Congress commits to work to keep the currently insured citizens and offers ways to get even more people insured, we can stabilize a viable system that is simply Healthcare.