Politics: Repeal and replace?

Of course it won't actually happen. The House could pass a repeal bill and it will die in the Senate.

But as a thought exercise, what would a "replace" look like in my opinion as a pajama wearing blogger?

People say, we need a "comprehensive" solution to the problem of health insurance availability.

But that presumes a solution from DC is the best solution. The problem is that too much power is consolidated into the hands of a few regulators in DC.

Realistically, the health care system in very rural North Dakota is going to be somewhat different than a more urban state like New Jersey. As such, right now, health insurance is regulated at the state level.

So, how does one develop policies that help the people in the upper right quadrant of the matrix?

What about block grants to the states for the states to use in any combination of the following manners:
(1) To expand their current Medicaid program
(2) To expand or create government run hospitals and clinics to provide care to the underserved, uninsured and underinsured
(3) To expand or create a voucher program to help people buy health insurance who currently can't afford it.

Thus, the people of rural South Dakota (less than 1,000,000 people) can look at their situation and decide which of these methods actually helps the most people. Their solution might be very different than California (38,000,000 people with ginormous urban areas).

How to fund?

The just passed health bill has a mix and match of taxes and fees that essentially picks winners and losers among various industries and groups of people. More fair and effective is a broad based tax since any general public good should be paid for by the widest possible tax base. The tax could be indexed to income groups so higher income groups pay a bit more and lower income groups pay a bit less.

The problem of the bottom left group!

Initially, I was hesitant to support the idea of an insurance mandate. But I'm beginning to shift my view on that especially if the mandate is imposed at the state level much as the auto insurance mandate is controlled at the state level. The state governments already have records of companies licensed to sell health insurance in their states so they are in the best position to verify compliance.

And finally, the most radical reform ... in exchange for lower over all income tax rates remove the tax sheltered status of insurance premiums. Companies will still offer a menu of insurance plans but employees will now have a more complete understanding of the cost of the coverage they buy. Competition works best when the true cost of something is more apparent. With the lower tax rates they have more money in their pockets to decide which plan they want to enroll in.

Comments

Anonymous said…
I think you missed the point of the health care reform. If you believe in the right of every American to have access to health care, then you wouldn't have insisted on the wholesale state-level control. You would not want the Bill of Rights to be legistlated at the state level, would you? How about the Civil Rights act? Should we let state and local governments decide whether to discriminate against blacks or women?

The health care reform merely sets the rules on guaranteed access. It does not preclude any state level control of delivery. In fact, it counts very much on it. Everybody still needs to buy insurance from companies in their states (although most of them are multi-state conglomerates and not local). They will then use that insurance to buy service from their local clinics and hospitals.

You said:
"(1) To expand their current Medicaid program
(2) To expand or create government run hospitals and clinics to provide care to the underserved, uninsured and underinsured"

I think you have way too much faith in the state governments. They do not necessary run things better. Just look at how well California has managed its budget!

You said:
"(3) To expand or create a voucher program to help people buy health insurance who currently can't afford it."

This looks suspiciously like the subsidy in the health care reform!
Rene said…
Another example of the "if you are against the health bill you must be evil" argument ... ?

I'm sure most people opposed to the health bill aren't against the Bill of Rights, Civil Rights or racists.

Is it possible that one could support some parts of the health bill and oppose other parts?

Certainly, in the USA, there is uneven distribution of health care and health insurance. It is inevitable with a country this big with 300+ million people.

But no state in the USA denies health care to anyone and we can/should do a better job for those less fortunate.

I applaud the possibility the new bill could open the doors to vouchers for the lower income. I can support that. I am leaning toward supporting the insurance mandate implemented at the state level. So these aspects I could support. But the regulatory over-reach is troubling.

If the California government can make a mess for 38 million people then I think we should take that as cautionary as to what a heavy Federal footprint might do to 300+ million people and 17% of the economy.
Anonymous said…
I am in no way trying to say you are evil. In fact, I am glad you are approaching the subject rationally.

The examples I quoted, i.e. the Bill of Rights and the Civil Rights Act, are just there to make my point easier to understand. And my point is there are principles that need to be universally applied and that means they cannot be left to individual states to legislate.

You said:
"But no state in the USA denies health care to anyone and we can/should do a better job for those less fortunate."

Do you have evidence to support this statement?

In the contrary, I know people get routinely denied coverage because of pre-existing conditions. Has any state attempted to stop that? Note that I am not limiting my discussion to those who qualify for medicare, if that is what you meant by the less fortunate. There are 30-45 million Americans who do not qualify for medicare.

You said:
"I applaud the possibility the new bill could open the doors to vouchers for the lower income. I can support that."

It is not merely a possibility. There will be subsidies to lower income people (income up to 4 times poverty line). These people will buy insurance from any company and will have some of their premium subsidized. It is no different than what I imagined a voucher system is.

You said:
"...I am leaning toward supporting the insurance mandate implemented at the state level."

Are you proposing mandate only for some but not all the states? You know there will be states that will opt out. Again, the question is whether you believe every American should be covered.

You said:
"If the California government can make a mess for 38 million people then I think we should take that as cautionary as to what a heavy Federal footprint might do to 300+ million people and 17% of the economy."

Why not leave the clinics and the hospitals privately run, as the way it mostly is now? The health care reform is not about the Federal government running insurance companies (note the public option was killed) or hospitals (it was never in the bill). In a nutshell,it is about laying the ground rules for what should be included in basic medical insurance and how to get everybody into the insurance pool
Rene said…
As a pajama wearing blogger and not a full-time political pundit, I plan to continue to re-visit the subject of health insurance reform in more lengthy posts but not today! 8-)

But briefly:

(1) I support a voucher program to help the low income to buy health insurance. That is a very direct way to help these folks. Thus, that aspect of the bill should stand.

(2) My perspective can be summed up simply that more government regulation is not necessarily better.

The goal of helping make health insurance more accessible is a good goal but some of the mechanisms in the new bill involve regulations that have the potential to derail attainment of the goal.

More posts to follow as those regulatory issues and potential side-effects can't be summed up in one or two sentences.