I was one of Treasurer Judy Baar Topinka's children's issue advisors during her last campaign against Blago. I agreed to be Romney's guy here in Champaign after I heard he enacted a non-government plan for health care in Massacusetts. You can search this site for details that I have posted over the last couple of years. I think we will have a debate about this in the fall and I think both sides are going to propose something. This is an outline of the plan and the rationale for each statement. Let's start with philosophy.
PHILOSOPHY
1. The Republican plan should be a non-government plan. Government adds cost to almost everything it runs. Government regulations, vested pensions, union influence, lawyer domination, poor economic return.
2. We should not be putting our insurance industry out of business and substitute it with a Blago type philosophy that suggests that the State of Illinois will fund government worker's pensions when he darn well decides to fund them. Replacing the insurance works with bureacrats does not make sence.
3. The least regressive and most equitable mechanism to collect premiums for a health system is through our income tax system. Now a Bill Clinton type will scream that this makes it a government plan. It doesn't.- No more so than requiring a dead beat father to pay his child support payment through the State's Attorney's Uniform Recipricol Support System.
4. A health care system cannot be developed in one election cycle and must be phased in gradually. The advice we always give our kids is to study each subject in school because it keeps your options open. Long t erm plans are better than short term election promises.
5. We need to get doctors and hospitals out of the insurance business, away from the Health Facilities Planning Boards and other vehicles for political bribery, reduce the enormous cost of defensive medicine, and do it without socializing medicine.
THE PLAN
1. Because there is an election, some form of mandatory insurance is going to be required in the adult system. (22-65)
2. The Republican Plan should start with a non-government program to provide 0-21 universal health care to children.
3. The Plan will start by building clinics in every school district.
4. Doctors will be encouraged to deliver services here through various incentives such as reasonable and customary practices, limited tort immunity, charitable foundation participation, volunteer participation and through the discounted sale of their bundled fee claims to insurance companies who then can fight for reimbursement from the collection mechanism we select.
5. This system can then be expanded as the participant ages because 21 years olds become 22, then 23. At some point we can accelerate the system as it develops.
I'll kick this to the front, as it came up yesterday, and there's very little else I want to discuss today.
I'll start with one question:
"Because there is an election, some form of mandatory insurance is going to be required in the adult system. (22-65)"
Why mandatory? I can understand the argument for mandatory auto insurance - because a car accident often impacts someone else's health and/or property. But why does health insurance need to be mandatory? If someone is capable of making a choice, why should they not be allowed to choose to not have health insurance?
John,
You propose a system where medical premiums are collected through the income tax, and then the doctors "fight" for reasonable reimbursement rates with the governmnent. While your description is a little bare bones, it appears to be identical to the current government system except that it is mandatory. The government already controls its reimbursement rate with no particular evidence of a salutary effect on costs.
The upward pressure on costs, I believe, is a direct response to third party payors and government efforts to restrict competition. Witness futile efforts to build new clinics in this town. Imagine what it would cost to have house insurance that operated like medical insurance. Adjusters and the government would be inovlved when you broke a window, replaced a roof, fixed a furnace or chased a squirrel out of the attic. We wouldn't fix that problem by requiring everyone to to buy house insurance. What am I missing?
John
IP asks: But why does health insurance need to be mandatory? If someone is capable of making a choice, why should they not be allowed to choose to not have health insurance?
Because so far Americans are unwilling to turn people away and tell them that they should go die. Because of that, you will NEVER have a true free market in health care. We don't let people go without all care in this country, which means that the rest of the taxpayers will end up picking up the tab for people who refuse to pay their share, just as right now the taxpayers foot the bill for the expensive emergency care people need after they've let their health slide downhill due to lack of access to preventive and maintenance care.
Elsewhere this is regarded as common sense.
"Because so far Americans are unwilling to turn people away and tell them that they should go die. Because of that, you will NEVER have a true free market in health care. We don't let people go without all care in this country, which means that the rest of the taxpayers will end up picking up the tab for people who refuse to pay their share, just as right now the taxpayers foot the bill for the expensive emergency care people need after they've let their health slide downhill due to lack of access to preventive and maintenance care.
Elsewhere this is regarded as common sense."
You're confounding health insurance with health care. They're not the same thing.
I think everyone should have access to health care. If they're sick and need treatment, they should get it, regardless of whether they have insurance or not. If they need or want some health care service but have no insurance, they just have to pay for it themselves.
I think almost everyone should have health insurance. I think everyone should be able to purchase it if they want it, and would favor allowing even more choices and portability than are allowed now. But I don't think everyone needs health insurance. I certainly don't think that a capable adult should be required to purchase it if they feel like they don't need it. Who are we to tell them otherwise?
Health insurance is not the same thing as health care. Just as auto insurance is not the same as an automobile. Or homeowner's insurance is not the same thing as a house.
Elsewhere, this is regarded as common sense.
Well, as usual, the idea of health care and health insurance for all is a good idea in the abstract, but the big question is: how will this be paid for? This is particularly important in light of Medicare and Social Security going broke in the next 20 to 30 years.
I'm actually OK with taxpayers subsidizing health insurance (note the difference between health insurance and health care) for lower income people and families.
I'd rather it be through private insurance companies deregulated to provide greater choices, portability, affordability than through the state, but that's because I think private coverage is generally better than that provided by the state. And private coverage, of course, doesn't screw doctors and hospitals by paying 180 days late, if at all, or by only paying a fraction of what the service costs.
1. Because there is an election, some form of mandatory insurance is going to be required in the adult system. (22-65)
That is absolutely disgusting. Surely you jest.
Let me first respond to Gordy on why I think it will end up mandatory on the adult side. It is almost like uninsured motorist coverage. Drivers that are insured have to pay a price for those that are uninsured, so even if someone has a bad driving record, the State requires them to get insurance coverage through companies that do business in the State of Illinois. This is essentially what happened in Mass. Although not perfect, it is certainly better than the current system.
Mandatory insurance for cars hasn't made the rates go down that I've seen. It's still makes it extremely difficult for the poor to afford it leaving them having to use less convenient and costly government transportation systems. The Massachussetts system was Hillary Care in its current form... big government healthcare programs, forcing everybody else to pay whether they could really afford it or not or fine them so they have even less money... with the big lie that it'll make it cheaper for all as opposed to help the profit margins of insurance companies. It does nothing to reduce the actual costs of health care itself and does nothing to make health insurance more affordable.
We already have a system that helps subsidize the health care costs and coverage of the poor by even those who do not have private health insurance... they pay taxes into those programs. MassCare/HillaryCare 2.0 don't change that... just make it worse.
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Glock21 Op/Ed
Now let me respond to my friend John Bramfield. This plan only involves Universal Health Care for Children (0-21) It is nothing like what we have today because essentially you have one stardard insurance policy that covers everything. There are some reinbursement difference depending upon whether the services are delivered at the clinics attached to the school. The question you are trying to ask is how are the providers paid?
Imagine if you will that all the "claims" under that standard policy from hospitals or doctors are proposed receivables. Imagine if you will that all premiums that are collected from parents and all premiums collected from other citizens are paid into something we will call a trust fund.
The insurance companies of this State will bid for the budle of claims of from the providers on a discounted "auction basis" To avoid collusion, at least in the children's system, there will be no HMO. The insurance company will make its money by reselling these claims to the trust fund.
You are correct that this is bare bones because the plan is about 10 pages long. To answer your question about coverage let me say this: The rationale for covering everything is because we spend more money (in the children's system) arguing about the different types of policies and whether it covers a, b, or c, than we pay to cover everything. We assure ourselves that doctors and hospitals get fairly reimbursed by paying them "usual and customary" fees and charges for that type of service. If there is a dispute about that amount, the insurance companies will be fighting the trust fund in the same manner that insurance companies fight each other today, which is a system of arbitration. The insurance companies in purchasing the claims will take into account that they will only be paid the usual and customary. You will notice that the providers will be paid immediately and that the cost of delay will be thrown on a large insurance company who is better able to fight the trust fund than the poor doctor.
Glock 21- As you have observed I reallly am no advocate of adult health care. In fact, my greatest fear is that we will enact some expansion of government though adult health care. I am just saying that either democratic candidate will propose some program that makes people think they are getting something for nothing. We all know that this cost is spread back to us. To avoid losing this election, some stop gap measure in the adult system will have to be proposed. If we don't, then we lose this election and cannot get the real benefit of a non-government universal health care plan for children that will be slowly implemented and then displace the mandatory insurance provisions plan which we have been forced to implement on the adult side.
Glock 21- I have heard you talk a lot in the past about the excess profits of big companies and big insurance companies. You are probably aware of the fact that all company profits, by law, have to be distributed each year to its shareholder. If you have any of these type of investments you will report them to the IRS on Schedule A/B. Interest is on A and Dividends are on B. If you get pensions from your employer or hold IRA's, or have 401 K's in which you invest, you will note that your investment in all these are profits distributed in the form of profits. The interest that you are paid by your investment in CD's and government obligations are your profit. During the Jimmy Carter years you made excess "profits" because interest was near 20%. You may believe that it is unfair that corporate presidents are overpaid and I would agree with you. I think that there are a lot of abuses in the system for which Blago is a living example. I would have no problem fixing the corruption, but the problem has nothing to do with the economic system or the law of supply and demand.
eh? So you're not for adult health care, but you're supporting mandating it? You're against more gov't in healthcare, but you're supporting it to win the election? If this isn't what you just said, I'm really confused. If this is just what you just said, I'm really confused.
I have no problems with companies making massive profits. I hope to own a chunk of one that does the same someday... or be an absurdly paid CEO of one. That'd be great! Conspicuous consumption looks like it'd be fun, and benefit the economy! What I don't see is insurance companies needing any government help in that regard to further pad their profits. Perhaps I'd see it differently if I already owned stocks in them, but I don't... and I hope my political convictions wouldn't be so easily for sale. My problem here is with the government overstepping its bounds, which is bad enough, but doing so in yet another way to make the situation even worse. Making some people rich (especially me) is the least of my worries.
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Glock21 Op/Ed
We can only hope and pray that John E Baloney is as successful pushing this nonsense as he was in pushing Judy Bar-Topinka.
This is a plan worth fighting against for sure.
Typical political chatter about health care for people age 0 to 65 when the financial crisis upon us is Medicare funding for those 66+. Its not the HOT topic for any canidate, GOP or DEM or even this blog. Why---Because the crisis is in the next election cycle. However medicare is going broke and fast. If you really want to discuss a current problem and suggest solutions (I'm not counting Akibar's "tell them that they should go die") discuss MEDICARE. You think the "Baby Boomers" starting to hit Social Security this year was big news, wait until 2012 when they start to become are mandatory medicare recipients.
Mandatory insurance for cars hasn't made the rates go down that I've seen. It's still makes it extremely difficult for the poor to afford it leaving them having to use less convenient and costly government transportation systems. The Massachussetts system was Hillary Care in its current form... big government healthcare programs, forcing everybody else to pay whether they could really afford it or not or fine them so they have even less money... with the big lie that it'll make it cheaper for all as opposed to help the profit margins of insurance companies. It does nothing to reduce the actual costs of health care itself and does nothing to make health insurance more affordable.
I agree with your general point, but it's a poor example. Government transportation systems in congested urban areas are far more convenient and less costly than not having them. Imagine what Kansei, Tokyo, London or New York would look like without an awesome public transportation system. Imagine what Chicago would look like with one.
Whoever gets in R or D will campaign on the issue of health care for everyone. D's will submit a plan that will be a government sponsored plan that creates more government. We cannot afford that. I was Topinka's county coordinator as you recall. You are a great example of why Topinka would never come out with a Universal Health Care Plan for Children- If McCain came out and said just what I did, that he really didn't care about health care for adults (what I really said was Children First), there would be people like you that would try to twist that. What I said was that some lesser form of non-government adult care was likely to to propoosed. I said it was likely to take the form of that in Mass. -I was very precise. You see, I really believe we need to start with kids in a non-government fashion. Search my statements-I am very consistent on this point. The issue here is basically a government vs a non-government system.
IP says:
"You're confounding health insurance with health care. They're not the same thing.
I think everyone should have access to health care. If they're sick and need treatment, they should get it, regardless of whether they have insurance or not. If they need or want some health care service but have no insurance, they just have to pay for it themselves."
It's a trick of language. Matters not a bit. Reason being, the health care service in question is desperate care when someone is in serious trouble, and even in the US people are not denied that. If they can't pay, the taxpayers pay for it.
If you are not willing to deny someone service at the emergency room when they come in and are dying, then you can never have a free market of health care services. Insurance is one means to try attempting it, but it doesn't matter. If your 30 year old fit and hale "I'll never die because I make Good Decisions Always" naive young buck guy refuses health insurance to buy a 50 inch TV, or whatever, then gets diagnosed with cancer tomorrow, he gets care, paid in or not. The rest of society realizes that this isn't fair, so during the "pause, okay, let's all decide what rules will bind us and set up the floor" period, decide to require buy in to health insurance.
Of course, if you're going to "require people to go out of their way to purchase insurance" then the easier less bureaucratic way is just tax people for it, which is why that's what most of the first world does.
I repeat, too, elsewhere this is a matter of common sense.
I took a Health Care policy seminar (8 weeks) with Professor Rich at the U of I. It was an Olli class. I said exactly what you said, why do we have a government sponsored health plan for 66 and over, when a lot of old people (like myself age 63) can afford it. My point was that since we have an obligation to supply every child with a free public and approriate education, we have an absolute duty to provide free public and approriate health care. The only argument on that is who should bear the cost. My point was that parents, if they can afford it, should bear a significant portion of that cost. If they cannot, the taxpayers end up paying for it anyway and in the process we waste a lot of money and time. Thus I argue that the most equitable way to pay that cost is through a mechanism that can take into account whether or not there is a parent there and what that parent's income is. Most lower income people that have kids do not pay a significant amount of tax anyway. Most lower income people who are really poor get an earned income and child tax credit. The income tax, when used as a tool to collect premimums for a Universal Health Care system for children is the least regressive method of proceeding.
In my Olli class I suggested that the ideal situation would be to leave the adult system alone and develop the 0-21 system first in a non-government method (as I just suggested). What I suggested happen then, after the child care system was developed was that we compare the government plan (Medicare) to the Universal Health Care Plan for Children and see which was better before we started on the adult system. But this is unlikely to happen.
We would like ideal operating conditions for every patient that we treat, but many times the patient dies before we get there. If the Republicans do not win this election, a real Universal Health Care plan for children will never be developed. This plan would save us a lot of money both in the short term and the long term. The very simple plan of Romney in Mass. saved a lot of money-
The cost savings in mandatory heath insurance comes about because people use the emergency room less and seek treatment at an earlier point in time. Mandatory health insurance, when it is geared to income and parents with chlldren, is a less regressive method of spreading the cost. Linking health care to the schools means that parents lose less time taking their kids to the doctors. Linking this care to the schools means that the very inefficient method we deliver mandated special education services can be improved. This makes diversion for drug, alcohol, and mental heath more effective which decreases costs in the long run. If a doctor delivers services for a municpal corporation such as a school, these institutions have limited tort immunity which will reduce the cost of malpractice insurance. If we provide nearly all health services we can be assured of immunizations. We can send kids home when they are really sick and not send them home when they are just faking it. Or we can continue this fragmented system where Mom's and Dads when faced with paying the rent or having a kid looked at will not have to make that choice.
Its socialism shoved down the throat...by the REPUBLICAN PARTY? My words to John E. Maloney are not acceptable in this blog. Use your imagination.
http://www.ocregister.com/opinion/nanny-state-town-1899452-government-new
"Let me first respond to Gordy on why I think it will end up mandatory on the adult side. It is almost like uninsured motorist coverage. Drivers that are insured have to pay a price for those that are uninsured, so even if someone has a bad driving record, the State requires them to get insurance coverage through companies that do business in the State of Illinois. This is essentially what happened in Mass. Although not perfect, it is certainly better than the current system."
You didn't answer my question. Car insurance is mandatory because car accidents often damage someone else's health and/or property. Not so with medical bills.
Why does insurance need to be mandatory? If the only reason is to force those who think they don't need it (or need less of it) to subsidize those who do (or need more of it) then that's a pretty crappy reason.
"Reason being, the health care service in question is desperate care when someone is in serious trouble, and even in the US people are not denied that. If they can't pay, the taxpayers pay for it. "
No, they don't. Often such cases end up as medical bankruptcies. Taxpayers don't pay for it - often hospitals collect some of the costs, eat some of it, and pass some of it on to other consumers.
"Of course, if you're going to "require people to go out of their way to purchase insurance" then the easier less bureaucratic way is just tax people for it, which is why that's what most of the first world does."
The rest of the first world also used American medical technology and research to fuel their health care systems.
But, that said, I don't really care what the rest of the first world does. Most of the rest of the first world also has much higher tax burdens, lower growth rates and higher unemployment, yet there's no special compulsion to follow their lead in tax policy (at least among most of us). And, as I've said before, America is different. Our government is not set up to make health care decisions for an individual or to ration health care based on the latest political criteria - it's too unaccountable.
IP asks "You didn't answer my question. Car insurance is mandatory because car accidents often damage someone else's health and/or property. Not so with medical bills."
It's EXACTLY the same as the car insurance question. When a guy with no health insurance gets sick (VERY sick, because they've not gotten any preventive care and have let things get desperate), he shows up at the emergency room, and YOU end up footing his bill.
So, this is "damaging your property." Your money. Not to mention the public cost of having sick people or halfway medicated people wandering around (disease resistant infectious agents, spread of disease) - TB is a big one.
Again, you can not have a free market for health care unless you are willing to turn people away from the emergency room, or kick them out of the hospital, telling them we're sorry, but you have to go away and die. You will not receive care.
So far, Americans are unwilling to do that.
akibare... I'm not sure where you can go to the hospital and not be forced to pay your bill afterwards. Even most bankruptcies don't completely absolve people of their debt as much repayment agreements. Up until recently I hadn't had any health coverage for quite some time. I had to pay my bills. The hospitals, the debt collectors, and eventually the court will nail you if you don't.
Did it hurt Gordy by me going to the hospital without insurance? Did it cost him a dime? Did it cost taxpayers any cash whatsoever other than me?
Nobody is arguing for hospitals to turn people away, just asking that they pay their bill afterwards.
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Glock21 Op/Ed
Why are Medicare benefits forced on people 65 and older?
There are two answers. It relieves the burden of medical costs on the elderly (how the program was sold to the voters). It provides government subsidization of the insurance, drug and medical industries. Both answers are correct.
It appears both the GOP and the DEM want to extend health care to other age groups not to benefit any group (how it is being sold) but as payback for all the campaign dollars and lobbist's support provided by those industries to our political representatives.
akibare... I'm not sure where you can go to the hospital and not be forced to pay your bill afterwards. Even most bankruptcies don't completely absolve people of their debt as much repayment agreements. Up until recently I hadn't had any health coverage for quite some time. I had to pay my bills. The hospitals, the debt collectors, and eventually the court will nail you if you don't.
Did it hurt Gordy by me going to the hospital without insurance? Did it cost him a dime? Did it cost taxpayers any cash whatsoever other than me?
Nobody is arguing for hospitals to turn people away, just asking that they pay their bill afterwards.
I think akibare is referring to the frequent case of someone going to the emergency room and being unable or unwilling to pay their bill.
A few years ago, citizens of Champaign County met in a series of town hall meetings, called big.small.all., to address the important issues facing our residents. Of all the issues discussed, access to affordable healthcare was always at the top of the list. As a candidate for State Representative, I had the opportunity to meet with insurance representative doctors, nurses, hospitals, and community advocates. Without exception, they all said that the best way to provide affordable healthcare was to insure everybody. With a clear mandate from the voters, and the expertise of the insurance and healthcare community as my guide, during my campaign I announced a plan to bring universal healthcare to the people of Illinois.
I was not elected and Healthcare costs are still skyrocketing. The United States is first in healthcare expenditures, yet only ranks 37th (maybe worse now) in overall quality. We are the only industrialized nation that does not provide healthcare for all its citizens and, as a result, our life expectancy is shorter, infant mortality is higher, and our child immunization rate is lower than countries with universal healthcare. Catastrophic health problems are just waiting to destroy the financial well being of thousands of normal individuals who simply have to pay other bills besides health insurance.
The State Plan I proposed was a free market approach to healthcare. Based upon the insurance model, everybody pays a little so no one pays a lot. Uninsured and underinsured are grouped together, which spreads risk and lowers premiums. This is NOT socialized medicine, NOR single payer medical care. The state will not be in the business of running hospitals and employing doctors or paying for the uninsured via Medicaid or Emergency Room services. The state’s role under this plan will be to guarantee the insurability of residents and to use its enormous buying power to negotiate very competitive costs for services for each health care region. The only involvement of the State would be to pay the premiums of each regional health insurance provider. Private insurance companies may participate in the program at their discretion. They (the insurance providers) would be responsible for administering the program and reimbursing health care providers. The State would not be involved in any of the horrendous administration costs and the actual administration costs for the medical and insurance companies would almost be non existent because everyone and everything would be covered. This multi-payer system will retain the advantages of a competitive market such as lower prices and improved service. Funding for the plan will be through a combination of employee-employer contributions. Individuals may opt out of this plan by participating in another insurance program of their choice, but that program must provide the same benefits as the State Program.
Similar plans are already in place in other states. Both Vermont and Massachusetts passed comprehensive universal healthcare bills with the support of Democrats, Republicans, the healthcare community, private insurance companies, and the business community. Healthcare expenditures and, by extension, taxpayer costs are expected to decrease, not increase, while improving access to care for everyone. Americans, on average, spend $5700 per person annually on healthcare. By contrast, the Swiss (who rank 2nd in healthcare expenses) spend less than half that per person WHILE COVERING EVERYONE and maintaining one of the best healthcare systems in the world. We can do the same in Illinois.
Savings would ultimately be recognized because the hospitals would have fewer licensed professionals shuffling papers and doing actual health care. While the State would not be obligated for any administrative costs.
The State would be FORCED to make the insurance premium payments, otherwise the insurance providers would simply cancel the insurance and people in the health care regions would be turned away or have to pay out of their pockets. NOTHING would get an representative un-elected any faster than large numbers of voters losing their insurance because the State did not pay. (this is in line with akibare's statement near the top of the blog)
Our current system is deceptive, irresponsible and has failed. It’s time to try something else. FDR said, “It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.”
To that end, I am, and shall always remain;
Rex Bradfield
If you read #5 point, you will see that this plan is the opposite of socialized medicine.
I agree John, I don't believe it is socialized Medicine either. I posted my original thoughts for comments as the the similar items or differing.
No Plan that involves Government doing anything but paying premiums will succeed.
Again quoting FDR
"Business works, Government in Business does not"
One of the most shocking things was that nearly 50% of the LPN's, and RN's are spending their time working on administrative papers, and not doing one lick of health care. The reason is they are familiar with the medical terms and they must be involved to assure the proper procedure is being paid for and that the hospital's legal ass is being covered.
Now that is shameful.
Additionally, all the health care facilities will not publicly state so, but privately admit, they charge about 3-4 times their actual costs when treating emergency room patients. Those cost are directly related to the State of Illinois and their failure to promptly pay Medicaid invoices. Only Cook County Hospital receives payments from the State in 30 days.
Consequently, the smaller hospitals hedge their finances, by charging more. That way if the State waits 3 or 4 times longer to pay the invoices, the Invoices are 3-4 times larger than the expenses and it balances out. Also, the poor use the Emergency room as an outpatient clinic simply because many health care facilities will not accept them on Medicaid.
That too is shameful.
But as is with the present control of the State and as I posted in another blog on the U of I rate freeze, these legislators are not about solving problems, but deceit and deception is the order of the day, with the emphasis being placed on how many votes will it affect if they do this or do that. In the case on this blog, the State political leaders realize they can finance other projects on Medicaid money, because there are NOT enough votes in the health care industry to boot them out and by going to the emergency room those votes who would be voting them out (as akibare said) are receiving treatment. You and I and everyone else who pays insurance premiums are footing the bill for the State.
That is just criminal.
To that end, I am, and shall always remain;
Rex Bradfield