Have been carrying on an interesting blog conversation on health care reform with someone who is probably center-left. Might there be some workable ideas the center-right and the center-left could agree upon?
There are many concerns about the health care system: quality is uneven, costs too much, access is uneven, Medicaid is going broke, Medicare is going broke, malpractice insurance is too high, not enough medical professionals, etc.
I suppose the largest problem is the ~ 15% of the people who do not have insurance. Some opt not to buy while others can't afford. I think this is the issue that should be addressed while the other problems can wait.
Thus, a modest proposal for health care reform.
(I) Increase support of community health clinics (provides primary care)
a) Greater funding for existing clinics
b) Establishment of additional clinics especially in under-served locations
c) Scholarships and loan forgiveness programs to nurses, doctors and other health care professionals who serve in these clinics
(II) Provide tax credits/voucher for purchase of health insurance (for major medical like hospitalizations) to low income individuals.
(III) Funding for parts I and II
An across the board increase to the Federal Income Tax would be easy to implement if politically difficult. If I read this right, from individual income taxes, the Federal Government collected $1,425,990,000,000. Thus, a 2% increase would generate $28 billion per year.
If there are 45 million uninsured and on average, it takes $1000 in tax credit/vouches to help them get coverage, then we are looking at raising $45 billion a year.
The House bill wants $12 billion over 5 years for Community Health Clinics.
The Senate bill wants $8.5 while the White House wants $11. Thus, about $2 billion additional per year.
The tab is now up to $47 billion a year. If 2% more taxes gets $28 billion then can we find $19 billion in cuts elsewhere in the Federal Budget to pay for this deal?
(IV) Fostering greater competition in offering health insurance
a) States may allowed sale of insurance across state lines
b) States have the option of creating health insurance exchanges
(V) All elements of this reform proposal shall be re-assessed in 5 years. Have some kind of sunset provision so that if any particular approach isn't working it is phased out automatically or re-funded after voting on a modification.
What do the dear readers of RR think?
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ver. 1.0
Have been carrying on an interesting blog conversation on health care reform with someone who is probably center-left. Might there be some workable ideas the center-right and the center-left could agree upon?
A modest proposal for health care reform.
(I) Increase support of community health clinics (provides primary care)
a) Greater funding for existing clinics
b) Establishment of additional clinics especially in under-served locations
c) Scholarships and loan forgiveness programs to nurses, doctors and other health care professionals who serve in these clinics
(II) Provide tax credits/voucher for purchase of health insurance (for major medical like hospitalizations) to low income individuals.
Might this be a way to slowly transition out of Medicaid?
(III) Initiate a national sales tax to fund parts I and II.
I have no idea how much parts I and II would cost. But for the sake of discussion since US GDP is $14.2 trillion and if 1/3 of this economic activity is taxable sales then that's $4.7 trillion. If one applies a 0.5% sales tax on that we can raise $23 billion per year.
UPDATE: Upon reflection, given that there currently is no mechanism to collect a national sales tax (though it has the virtue of being a broad based tax), perhaps an across the board increase to the Federal Income Tax would be easier to implement. If I read this right, from individual income taxes, the Federal Government collected $1,425,990,000,000. Thus, a 2% increase would generate $28 billion.
(IV) To reduce cost by fostering greater competition in offering health insurance
a) Permit sale of insurance across state lines
b) States through their insurance regulatory powers shall cap market share of insurance companies within their states to 30% (this number is negotiable, I toss this number out there for discussion purposes) or less within 5 years
c) States can file for exemption from part B.
It is possible that even with sale across state lines some rural, small population or remote states may not attract enough insurance companies to comply with provision B.
UPDATE: Don't know how that can be done! Perhaps through mandates that government employees and companies above a certain size be offered plans from at least three companies? Or perhaps, if a company wants to exceed its market share, they need to take patients in from the low income or higher risk groups? Or maybe some state based insurance exchange mechanism?
(V) All elements of this reform proposal shall be re-assessed in 5 years. Have some kind of sunset provision so that if any particular approach isn't working it is phased out automatically or re-funded after voting on a modification.
What do the dear readers of RR think?
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