Saturday, November 2, 2013

A synergistic solution to health care problems

September was a bad month for the Republicans (Congressional Republicans shut down the government and tried to stop paying about 30% of the government's bills).  They looked like nutjobs who couldn't be trusted to run a car wash let alone the government.

And October was a bad month for Obama and the Democrats.  The Obamacare rollout has been a disaster.  The website is apparently terrible, and millions are losing their insurance despite repeated promises by Obama that if you wanted to keep your existing insurance you could.  

At the heart of liberalism is a trust in government.  Obama's trustworthiness is justifiably dismal, and government's trustworthiness is even lower - the government looks like it just isn't up to the size and complexity of Obamacare, which has been the conservative charge against government for decades - nameless bureaucrats with little interest in the people they serve mindlessly enforcing rules impersonally and destructively on a helpless public.

Two things that stand out loud and clear from September is that Republicans really, really hate Obamacare, and Democrats really, really like it - or at least the Dems really want it to work.

I may be one of the only people in the country that never had a strong opinion about Obamacare.  I had to agree with the Dems that the old health care system was fundamentally flawed because it didn't cover everybody, had limits on insurance payouts resulting in bankruptcy for middle class people inflicted with catastrophic medical emergencies, and denied coverage to people with pre-existing conditions (which would eventually be almost everyone as they grew older).  These were very serious problems that had to be addressed and Obamacare addressed them.  But is it functional?

On the other hand, I have to agree with the Reps that trying to take one sixth of the economy under the control of the federal government just may be more than the government is capable of handling.  

The problem with the Reps is they don't really have an alternative.  Oh, I understand there are a bunch of Reps with various ideas, but there is no easy to explain workable Republican alternative that is being championed by the party to move forward - either to fix Obamacare or to replace it with a conservative alternative that addresses coverage for everybody, prevents medical bankruptcies, and cares for people with pre-existing conditions.

I have a suggestion for the Reps to present as an improvement/replacement.  It is unlikely that anyone will champion it, but I have always liked it.

The conservative economist from Harvard, Martin Feldstein, has what could be called the 15% solution.  

The government gives every family or independent person a voucher that pays for all health care costs above 15% of their annual income.  If any want to have more coverage, they pay for more.  

This takes away bankruptcy by medical catastrophe.  It takes away previous medical history exclusions. It eliminates rationing. This takes away caps on payouts. It eliminates bureaucrats deciding which health procedures to allow.  This introduces buying savvy in the purchase of care and thus reduces the overall cost of healthcare in the country.  It keeps the insurance companies in business. It creates competition in the insurance industry to compete for clients. It's a conservative solution.

If people have problems paying the first 15% they will have a government issued credit card, at a low rate, enough to cover the bureaucratic costs of handling loans, with no profits and no exorbitant salaries.  

Everyone gets the voucher and credit card which could be used only for insurance.  Bold, easy to explain, covers everyone.  Feldstein says that costs of the vouchers is in line with existing government expenditures, so there is no increase in government costs.

Plus, surprise surprise, it would be a synergy of liberal and conservative ideas - liberal Obamacare based on caring and compassion, and conservative adjustment based on the freedom and power of markets. Both parties could be proud of creating a better health care system for the country. Of course, that would mean they would have to stop hating each other and demonizing each other.  A bridge too far?

I think it could be a good solution to our health care debacle.  Dems could see it as an improvement to Obamacare (replace full coverage for everyone with catastrophic care for everyone).  Reps could see it as a replacement (replace full care for everyone with vouchers and a government issued credit card for everyone - no fines for not participating, no incentives for not participating).
One thing is guaranteed. At this point in time the Reps have put everything into making sure Obamacare doesn't work, and Dems have put everything into making sure Obamacare does work.  

I just want a health care system that covers everyone including those with pre-existing conditions, and prevents medical catastrophe bankruptcies. If Obamacare works, those concerns are more or less handled, if it doesn't, maybe the 15% solution could work.