First I have to say the flip side of the coin is worse, but
to begin we now have proof without a doubt that the ACA was an unmitigated disaster.
If this was supposed to be a way for people to afford healthcare or insurance
for healthcare then why does it take these tax subsidies to make it close to
affordable. Yes folks riddle me this question, because it doesn’t make sense to
me.
Originally this was to be affordable hence the name, but
what happened between now and then that we are in the middle of a shutdown
debacle so people can afford their premiums because they are so high they need
tax subsidies to be affordable. I don’t know, I probably missed something or I
hope I missed something, but this is ridiculous.
Yet for how bad this is or became the Republicans are just
sitting on their incompetent asses and have no clue what to do. So they are
stuck having to do something with these subsidies or God only does what is
going to happen next year. Realistically they have to approve some version of
them or people will be in a world of hurt. So both parties let this problem become
larger year over year because neither can govern.
Both parties cannot pass a budget, cannot talk to each
other, cannot think, cannot come up with anything resembling a decent proposal,
elected a Speaker who is so morbidly incompetent or so morbidly up the President’s
ass nothing can get done.
This duopoly needs to pass this stupid CR with some relief
on the ACA premiums, then get to work and I mean real work, not talk and come
up with a better plan. And I don’t care which party, but something concrete
that works. And do this while finally passing an actual budget not two years of
continuing resolutions.
I know the Democrats keep saying we need universal
healthcare, well tell me how because we have $38 trillion in debt to pay,
social security and Medicare struggling and need a solution and again no one
can pass the budget. We cannot figure out problems so yes you think we can have
universal healthcare, then come up with the plan. Right now I see no path
towards that without busting the budget even more.
So off the top of my head, and I mean the top of my head as
I watch the Mavericks lay a colossal egg on the basketball court this evening.
And there are a multitude of problems with this plan, but
for now it is a start and neither party has anything else to offer especially
the Republicans. And yes I am a believer in the free market, but these are drastic
times.
First we need to find a way to encourage people to have
primary health care providers. And if your primary healthcare provider is one
of the doc in a box varieties then so be it, but one central location to start
managing your healthcare. Maybe require all PCPs to only charge the exact same
price for initial visits say $25.00 and this visit needs no insurance
validation. This is the price you pay to go to the same doctor regularly. And
so this $25 visit includes an initial diagnosis and any necessary
prescriptions. Basically everyone pays $25 to see the doctor of their choice as
long as they become their primary provider for things like infections, colds,
flu, covid tests, initial exams where there may be a follow up needed such as
testing, yet not including an annual physical, to determine what might be wrong
or to refer to a specialist.
The primary care doctor is responsible for an annual
physical and they can charge up to $50 plus tests. This is where insurance can
come in ie through your employer or your own private insurance and that
insurance company can pay for the visit if they create that type of policy.
Insurance then covers, based on plan, all testing ordered by
primary care doctor for many conditions from diabetes to autoimmune diseases
for example. I am sure the experts can flesh out what conditions could be included.
And with all that I speak about beyond the PCP general visit there can be a
reasonable co-pay by the patient.
And now here is where I need help, but insurance companies
would be limited in their premiums and their plans. Each company would follow a
certain series of guidelines and they would have some control of pricing, but
costs would need to be negotiated by the insurance company. So Company A can
offer a full complete coverage for x amount, a high deductible plan for y
amount, and a long term care plan for z amount and that is what they can do. And
these plans have to meet certain guidelines of care and yes there are price
controls, yep the free market is limited so to speak with these types of plans.
It is up to the insurance company to find ways for
hospitals, specialists etc to reign in their costs.
Secondary items like plastic surgery that is not medically
needed can be excluded from coverage if the insurance company so desires. And other
types of elective procedures can be excluded. Again here is where experts need
to get involved to flesh out what is elective and what is needed. I think
people certainly would understand skin grafts for burn victims should be covered.
Insurance companies can set some pricing let’s say for the
employer plans based on number of employees, yet still cannot exceed the
government guidelines for all employer plans based on any number of people.
Insurance companies to be competitive will need to find ways
to enhance services for the limited dollars to attract customers. And there is
a good chance some won’t be making excessive billions year over year like they
do now.
And yes the government can create guidelines for what is
full care or care with high deductibles and the long term care plans are for
people who are generally healthy now, but are starting to become older. These
plans allow older people to transition this plan into a Medicare enhancement
plan when they reach 65 or let the participants start paying a small extra
premium when younger and I mean small to cover illnesses such as dementia care
for when they are older. It is going to be on the individual to decide if they
want to start paying extra premiums in advance of things that might happen. And
if a patient becomes incapacitated then the premiums are stagnant for the rest
of the patient’s life.
So basically insurance companies offer three general types
of plans with some tweaking as needed for the market, everyone and I am not
sure how to push this, but everyone designates someone as their PCP, and this
can be changed over time as needed, but there is a designation.
Doctors can charge patients basic amounts for all general
care, I haven’t mentioned this yet, but a whole list of drugs would be a generic
pricing for everyone, that list again determined by experts, and specialized drugs
covered by one of the three insurance plans.
So you are taking the cost of going to the doctor and basic
prescriptions out of insurance coverage completely and placing restrictions on
these costs. The PCP would still gather insurance information, but they can
start to streamline staff hopefully since they would only need to contact
insurance company when they are referring or running tests that aren’t the
physical exam tests such as x rays in house or sending to a company that does
radiology.
Secondary labs would also have scheduled pricing for the
various tests so all insurance companies are paying the same.
Specialists would have a bit more flexibility in pricing for
their work, yet it would come with some caveats such as regular routine work
within the specialty would have prescribed costs for example, the cost of let’s
say walking boots or casts at an orthopedic clinic or group.
And with cost controls patients should have choices on where
to go. That way if one doctor does a better job and people hear about it then
they could go to that doctor barring availability of course. This way good doctors
and responsive doctors can do well.
I haven’t talked about emergency room visits. Now this is
covered by the three types of plans, however if you go to the emergency room
for a routine visit then the insurance company can limit how much they pay. If
there is a limited amount of doctors in an area then for example rural hospitals
can create clinics that can be designated as PCPs, but the hospital can limit
clinic hours to the same hours as individual PCPs and going to the emergency
room in the same hospital as the clinic after hours because you got a cold
would still be more costly.
And there could be certain costs for some border line problems
again experts are needed here yet for example does a broken leg that is just
broken ie no bone protruding constitute an emergency. I do not know, but this
can be worked out in the legislation. Or could a secondary charge be added
since more tests may be needed, but those costs become split between the
patient and the insurance carrier.
This isn’t much different from the current situation except
for the general visits to a PCP. By taking the insurance completely out of
simple visits and allowing PCPs to know their patients hopefully better care
can be administered which helps in the long term health of the patient which should
slow down more extensive care later on.
Is this the answer, I do not know, is it a start, maybe, but
I can tell you just sitting here late on a Friday night this puts more decisions
in the hands of doctors, controls the cost of insurance premiums which should
force these companies and patients to find realistic care instead of abusing
the system and we are already at least one step in the right direction.
And is much further along than anything the Democrats or
Republicans are talking about or planning while they are yelling at each other
in the media.
Fund the subsidies, open the government and get to work, or
hopefully if this morass is still going on in two months people will realize we
just need to change. The government itself is still great, it is the people we
keep putting into office that is failing us. Let’s not wait until November 2026
to realize what we know now. Or otherwise we will wait until 2028 and each time
we wait it only gets harder to fix.
And if you don’t like my plan, fine, put a better one on
paper because if you complain about it without offering alternatives etc.. then
you are part of the current problem, and nowhere near the solution.
