Undoing Obamacare- part 3

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In my last post, I questioned whether the Republicans have the courage to do what needs to be done with healthcare. Let’s talk specifics.

In an ideal world, everyone would purchase private health insurance to cover large, unforeseen medical expenses, and budget accordingly to pay for routine visits to the doctor. Those who genuinely cannot afford a basic policy would pay what they can, with government help in the equation. Insurance companies would be prohibited from dropping customers just because they get sick, so pre-existing issues would be a non-issue.

But we live in a different world. Healthcare is seen by many as a right without regard to cost. Unlike other forms of insurance that are purchased to protect against disasters, health “insurance” is considered insufficient if it doesn’t cover routine medical visits and prescriptions. This is a huge misnomer because insurance (by definition) is only intended to address the unexpected.

Our warped view of healthcare has created serious problems. EMTALA already guarantees “catastrophic care” for those who cannot pay for it, so why should low income Americans purchase their own? Over-regulation makes is almost impossible for consumers to handle routine medical issues efficiently. With co-pays embedded into every visit to the doctor, consumers have no incentive to shop around for the best deal. And billions are spent managing endless paperwork.

Obamacare has further distorted our collective notion of healthcare by over-subsidizing costs, requiring Americans to purchase insurance, while also requiring them to choose from a limited array of plans. Moreover, those who ignore the mandate and pay the “fine” instead need not worry; they can obtain coverage after they get sick from providers who cannot turn them away. Obamacare defenders demand that reform plans reinforce this monstrosity. Most Republicans aren’t addressing this head on.

Of course, we need to be realistic. There’s no way we will create an ideal system from where we are now. However, choosing the right kind of reform can be a huge step in that direction. Assuming we can’t rid ourselves of the income tax, here’s are a few basic steps that can be taken within the current system.

1. Repeal Obamacare but allow Healthcare.gov to continue without additional subsidies. It will die on its own as providers and consumers drop out.

2. Permit providers to offer catastrophic, “bare bones” plans, and permit consumers to purchase policies across state lines. Without co-pays governing every medical situation, costs and premiums for such plans will be much lower. This allows everyone to get a policy that does what insurance is supposed to do—take care of emergencies.

3. Replace the tax deduction for healthcare premiums with a direct write-off in an amount that would cover a catastrophic plan for most Americans. This creates an incentive for everyone to get a basic policy. There would be no mandate to purchase a policy, but not doing so means that you would forego the write-off.4. Create a high-risk pool to subsidize the cost of insurance for Americans whose current state of health prohibits them from purchasing a basic policy.

There are other good ideas as well, but by taking these steps, everyone will have access to a private, catastrophic health insurance plan. Those who do not purchase more extensive plans will be required to budget for routine health issues, with local health departments providing basic services to the poor.

Opponents would counter my argument by contending that the poor won’t have the same options as everyone else and simply won’t make routine trips to the doctor without low co-pays built into the policy. But insisting that policies cover regular doctor visits raises costs. If a large percentage of Americans had (catastrophic) insurance without co-pay features, then providers would respond by offering more basic, low-cost options. Changing the entire incentive structure for providers and patients is necessary to make this happen.

Government subsidies will be required if the truly needy are to obtain insurance, but this can be managed if we are willing to institute real reforms. I’m just not sure most Republicans are willing to do so.

11 Comments

11 Comments

  1. Mike C  •  Jan 16, 2017 @11:49 AM

    so how are average people supposed to pay for trips to the doctor without copays?

  2. Jack T  •  Jan 16, 2017 @1:18 PM

    Mike–answer the following questions:
    1. Do you own a house?
    2. Do you have Netflix, a dish or cable?
    3. Did you take a vacation last year?
    4. Did have a car less than 5 years old?
    If you answered yes to any of the questions, then you have enough money to pay for a doctor visit if you really need it.

  3. Arthur W.  •  Jan 16, 2017 @3:45 PM

    Three fourths of those newly covereds under Obamacare (about 15 million) are in Medicaid. That doesn’t change. Others would be okay with a catastrophic type policy. Some like Mike who want more coverage will face higher premiums. The high cost of insurance to cover what he wants was supposed to go down, hence the Affordablle Health Care Act. It had the opposite effect. Deductibles and copays went up as premiums were going through the roof. So they paid more and got less. And they were forced to buy it under the mandate.

  4. Mike C  •  Jan 18, 2017 @8:07 AM

    Hey Jack T, you must be part of the 1%. I have 3 yeses out of 4 but that doesn’t mean I can afford to pay for doctor visits out of my pocket. Am I supposed to spend everything I have on medical?

  5. John C  •  Jan 20, 2017 @9:19 AM

    Get of your entitlement Mike C. If you have money for other things, then why not healthcare? Where do you think the money comes from if you don’t pay for it? Why should someone else pay for your trip to the doctor so you can buy a new car?

    If all the Mike C’s out there would stop expecting someone else to pay for their trips to the doctor, we could cut taxes and keep government out.

  6. Mike C  •  Jan 21, 2017 @6:15 PM

    Another 1percenter John C? You apparently don’t know what it’s like to live like the rest of us.

  7. Aliza  •  Jan 22, 2017 @4:32 PM

    Why should we chose between a doctor visit and a car? Health care is not a luxury good. It is a necessity. It’s basic. We, the 99% , cannot afford paying out of the pocket for routine doctor visits. Costs of health care services in this country are extremely high. That is why we need an insurance.

  8. Arthur W.  •  Jan 22, 2017 @7:44 PM

    Medicaid is available for low income qualifiers. In addition, there are hundreds of free clinics for primary care. Your question has to do with a moral not a legal obligation for the government to pay your doctor bill. The only government assistance is through laws that have been enacted like Medicare, Medicaid, VA and currently Obamacare. If you want to change that then you have to win elections, not debates.

  9. Aliza  •  Jan 23, 2017 @11:03 AM

    I’m talking about the working class people — those who are not qualified for Medicaid and who are too young for Medicare.

  10. Trip  •  Jan 23, 2017 @12:38 PM

    Hey Aliza, it’s not about choosing between a car and a doctor. if healthcare sustains life, shouldn’t the doctor come first? Why do people expect to pay for a car (and buy a nice one) but don’t think they should have to pay for a visit to the doctor?

  11. Aliza  •  Jan 23, 2017 @8:55 PM

    We need to find our balance in life. If we spend the lion share of our income on out of pocket medical expenses, we will not be able to live comfortably nor to save for retirement, our kids’ college, etc.