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March 16, 2017

6

The Healthcare Debates – Problems – Solutions

Debate 1:        Is access to quality healthcare a right or a privilege

Debate 2:        Should health insurance be a purchase mandate for all citizens

Debate 3:        Should pre-existing conditions be covered under new insurance coverage

Debate 4:        Should insurance companies have death panels that may deny coverage for expensive catastrophic procedures


Problems

Insurance companies do not provide healthcare.  They are middle-men that drive-up healthcare cost due to mandated reserve funds, salaries for employees, executives, as well as profit seeking investors.  Their main profit protection is the screening of customers and limiting high risk patients access to insurance coverage.

An additional problem is the denial of a single payer system, where the Government collects premiums or taxes and pays healthcare providers directly (cutting out the middle-man) is a socialist ideology that arguably increases bureaucracy and inefficiency.

A single payer system will increase the unemployment rate due to the cutting of millions of insurance workers.  Yet, a system that does not screen and eliminate preexisting illnesses, require less insurance professionals.

Can healthcare providers have the right to deny various levels of care to patients due to their inability to pay or access insurance?

Healthcare cost are skyrocketing due to technological advances and research and development that often extend the life of citizens that are not productive taxpayers (elderly, infirmed medi-care recipients).  Additionally, as American diets worsen, the demand for healthcare creates upward pressure on healthcare cost.

Obamacare squeezes profits from insurance companies so they are opting out of participating in markets with such small profits.  Insurance companies mandate to cover ALL Americans regardless of pre-existing conditions takes unpredictable bites out of their profitability.  This is leaving less and less insurance options for citizens, in addition to States opting out due to political reasons.  This reduction in competitive options and increased cost to insurance companies, increases the cost of healthcare (even at a slower rate of prior healthcare inflation).

 

Solutions

COVERAGE LAYERS – Healthcare should be divided into 3 different layers of coverage.

WHITE LAYER: Preventative maintenance- Annual health screening, On-line vitals tracking (BMI, PB, LDL cholesterol levels) and nutritionist/dietitian/physical therapist & trainer consultations. Emergency services Urgent care services.

All of these services should be free to the public regardless of any coverage or contribution. These services shall be paid for by the government with tax dollars collected from all citizens.

BLUE LAYER: Acute care provisions of ongoing medical infirmities with a limit on medical treatment requirements and expenses.

RED LAYER: More expensive catastrophic and long term care.

 

FUNDING PER LAYER

White Layer: provided to all citizens regardless of income, contribution or socio/economic status. Tax dollars covers these procedures.

Blue Layer: A health tax will be added to all consumable and food items per their nutritional value.  Healthy foods with lower sugars, sodium and trans-fatty acid concentration are taxed less than processed foods, cigarettes, alcohol and other consumables that are known to increase health risk.

These tax collected dollars shall be referenced as the “General Health Fund.” These funds are funneled to insurance companies to fund their operations as they focus on efficient dissemination of healthcare to the public.

Red Layer: coverage is strictly privatized as insurance companies may offer the public these elective insurance policies.  If patients do not elect to purchase this coverage, hospitals shall then have the opportunity to deny care to those with Red Layer chronic and long term illnesses if coverage is not in-force.  Insurer’s denial for preexisting conditions are prohibited.  Yet insurance companies may enact a waiting period, which delays coverage for medical treatment. For example, waiting periods may range from 3 months to 2 years. Where patience may have to have coverage in-place for a stated amount of time prior to the insurance companies obligation to pay for any medical expenses.

STRUCTURE

Healthcare providers and Insurance companies shall merge or become joint partners.  The insurer will act as the accounting and finance departments of the medical facilities (like current structures of Kaiser Permanente & Molina Healthcare).  Each entity will work internally to create increasingly efficient healthcare delivery.

ENROLLMENT

Citizens will have the opportunity to enroll (or switch annually) to any healthcare provider in their area.  Each provider will have a list of enrollees referenced as a “Healthcare Group.”

Healthcare providers will receive a portion of the General Health Fund” according to the size of their Healthcare Group.  This quarterly payment to healthcare providers will be according to the number of enrollees at the beginning of each year, referenced as the quarterly “Static Fund.”

In order to increase the percentage of the General Health Fund  received by a particular Healthcare Group, they must encourage their enrollees to use as much White Layer funds as possible.  This billing will be tracked by the insurance company even though the payments are reimbursed by the government and not paid by the General Health Fund.  The higher the percentage of the groups White Layer spending relative to Blue Layer spending, the more “Healthcare Bonus Funds” received by the Healthcare Group at the end of the year.  Thus, rewarding Groups for positive health outcomes.

The above should decrease the demand for healthcare due to built-in preventative measures.  Couple this plan with my Pay it Forward, Free college plan, especially in the medical field, we’d increase the number of healthcare professionals with the passion for service.  The laws of supply and demand will drive down the cost of healthcare to a manageable level as Americans live healthier lives.

According to the CDC, 45% of all serious health issues are caused by patient lifestyle choices.  Encouraging healthier U.S. cultural lifestyles, over the profiteering interests of corporations, may be a preemptive measure that has positive ramifications to the true pursuit of happiness.

            QUESTIONS, CRITIQUES, CONCERNS?

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6 Comments Post a comment
  1. Laura J Thompson
    Apr 1 2017

    One of the “pros” is supposedly, that the ACA lowers overall healthcare costs, but to who? If businesses are paying the federal government penalty payments, rather than providing insurance to its employees, then that increases the costs to employees who must come-out-of-pocket, to purchase healthcare insurance. The greatest advantage to the ACA is that insurance companies cannot deny coverage to those with pre-existing conditions, however, this is coupled with the disadvantage of many insurance companies are opting out of the government mandated insurance plans. Thus, far, the idea that children can stay on their parents’ health insurance plans up to age 26, is beneficial, so long as their premiums do not escalate, or if their parents lose their healthcare coverage from their employer, and are forced to find affordable coverage. If they cannot find affordable coverage, then this benefit becomes a burden.

    ACA was supposed to “lower the budget deficit by $143 billion by 2022”, however, since young healthy people did not opt-in, most healthcare costs are being paid for those with long-term illnesses, and pre-existing conditions. These costs are skyrocketing, and many analysts agree that by 2022, these healthcare costs will increase the national deficient. Former President Obama, touted, “If you like your plan, you can keep your plan”. This statement was premature and turned out to be untrue, because many insurance companies canceled policies, and for those who lost their insurance the replacement costs were “high”.

    Then there is the negative of paying a penalty to the IRS for those who did not have coverage throughout the year. This penalty is no more than a tax, and it is questionable as to the IRS being a part of healthcare, at all. The penalty for those who do not have coverage should be the debt they incur if they require medical treatment and must pay out-of-pocket, and that is all. This provision to the ACA is reflective of a dictatorship more so than a government looking out for its citizens. Per the Washington Post Fact Checker, “Tax Breaks vs. Tax Hikes”, four million people chose to “pay the tax” rather than pay for coverage. The government should view this as people not wishing to have their arms-twisted into making a purchase that they did not chose for themselves. Health insurance, particularly, for the young and healthy, is not where they want to spend their money. Rising healthcare costs not only affected the immediate expenditures of families, but their tax payments. In 2013, “families could only deduct medical expenses that exceed 10 percent of income,” whereas prior to 2013, they could deduct expenses that exceeded 7.5 percent of income.

    Given the information we have on the Affordable Care Act, and how it is increasingly becoming unaffordable, the tier-system of Red, White, and Blue-layered funding also has its pros and cons.

    “White Layer: provided to all citizens regardless of income, contribution or socio/economic status. Tax dollars covers these procedures.”

    The “white layer” should cover all citizens, also those within the Blue and Red layer, particularly because tax dollars can cover all citizens if the government would stream-line excessive spending on non-essentials, stop bailing out companies who found themselves in the red, i.e., General Motors and Wall Street, and given minimally to countries that need assistance. Assistance can be given in other ways than money, i.e., medical supplies and food. We have all balked at the “Golden Parachute” when the government decided to be a generous Uncle Sam, and the monies that are sent overseas when there are communities in America where people are sleeping on the streets. Healthcare (and education) can be covered on the government’s dime.

    As for the Blue Layer as a healthcare proposal, this is not fair to someone who buys, candy, for instance. Why should there be an additional tax added to those who like processed meats (Spam) and candy. Enough is taken away from us that we enjoy. Additional taxes, once again, are out of the question. People spend enough in tax to the point where our country should have a surplus of monies. When President Bill Clinton was in office, he left with a “surplus”. There are monies that the federal government needs to make adequate use of, and appoint certain dollars towards healthcare.

    The blue layer further states that, “These funds are funneled to insurance companies to fund their operations as they focus on efficient dissemination of healthcare to the public.” Sorry…insurance companies look to their bottom dollar which usually causes the executives to increase their wages, more so than on “efficient dissemination of healthcare”. Who is going to watch-dog the insurance companies when the monies are used efficiently?

    The Red Layer sounds un-Democratic and un-American, for those who do not have coverage, because under this plan, “hospitals shall then have the opportunity to deny care to those with Red Layer chronic and long term illnesses.” This is not fair. What about those who have terminal, chronic and long-term illnesses but cannot afford coverage? Who will control the most important element for this type of coverage – the Pricing? Insurance companies have what is known as competitive pricing, however, where are the margins. There are several cases of people who have long-term illnesses and found policies at estimates of $800 per month, which escalated to $1500 per month. If insurance companies raise their prices randomly, who is to pick up the costs when the insureds cannot pay? Therefore, the best of all the above-plans, is the “White Layer,” which should be expanded to include all citizens. Tax dollars should be used to cover healthcare for all Americans. Tax dollars should be set aside; the way monies are set aside to fund Social Security – they should be kept in a fund for the sole purpose of healthcare.

  2. Greg Layman
    Apr 2 2017

    Hello Professor Harris,
    The health care situation is both a problem and a solution. As it is now, there seems no way it can sustain itself currently as the affordable care act. With President Trump determined to end it, the government needs to make clear who’s side it is on, the insurance companies, the health providers or that of the people. So first of all health care should be a right and not a privilege. If health care providers cannot care for the sick and injured, people will die and the protesters will not stop and people will do things like in the movie Mr. Q.
    Mandated health insurance should be purchased by all based on a sliding scale and their ability to pay. I agree with the concept of layers in coverage and really need to use the first layer to pride preventive care to the masses. People living unhealthy lifestyle also need to face consequences if they are educated on their unhealthy behaviors and continue to do their bodies harm.
    People should also not be the only ones facing consequences for unhealthy habits. As mentioned in your blue layer funding, a health tax should be broad and far reaching toward greedy corporations that sell proven unhealthy products. Example would be tier taxes with the most taxed being alcohol and tobacco products, fast food and high soda companies. All of which contribute to many diseases such a addiction, diabetes and obesity.
    For some people sadly it may be too late to prevent conditions that came about due to their life style, and at those that have a pre-existing conditions that they had no control over. These situation are no excuse for insurance companies to deny coverage. Equal treatment, education and care is what makes America the Great county that it is and shall not discriminate based on health.
    Healthcare is a resource and if healthcare is not regulated in some way by the government then the demand will eventually out weigh the supply and we will all suffer in some way. As a right by law then the law creates a responsibility to those it has given the right. By signing up for care and living healthier lifestyles, then the trends of corporate America know that people need healthy products and provide them.
    The medical field should be the biggest beneficiaries of a new and improve healthcare system and in turn if given a free medical education then it should be given on the condition the as a health profession you give back to low income community for a period of time to pay back what was given to you. Thanks…Greg Layman

  3. Rich
    Apr 9 2017

    The primary problem of focus in the subject is accessibility to funds to cover the medical expenses rendered to individuals. Various strategies are available, evident in our health care coverage systems and those of other countries. The article “The healthcare Debates-Problems-Solutions”, presents proposals for healthcare subsidies.
    The article refers to “coverage layers” as a method to manage the costs associated with providing healthcare services. There are three layers, white, blue, and red. The first two are subsidized by the government through taxes. The third layer is subsidized through the citizen, either through a private pay insurance plan or “out-of-pocket”.
    The proposed layers are similar to current insurance plans available through the Affordable Care Act, i.e. Obamacare. They are available to individuals with partial or full government subsidy if under the maximum income level. Their focus is on preventative maintenance, but has provisions for acute and catastrophic care.
    The problem with the Affordable Care Act, which will also manifest in the proposed “layers” system, it the presence of high utilizers of healthcare services. These persons often possess chronic to severe conditions that require high expenditures in the management/treatment of their ailment. Financial resources for these conditions should be provided by premiums of utilizers at the low to nil levels of healthcare services. Premiums solely from the high utilizers will not be sufficient for their expenses. This is the model in the insurance industry, whether it automotive, life, malpractice, etc. Thus far, this model has NOT materialized in the implementation of the Affordable Care Act. And, it may not occur in the proposed “layers” plan.
    Healthy individuals (i.e., low to nil utilizers) are inclined to opt out of health insurance plans, which is the primary cause of strain in the Affordable Care Act. This occurrence has been the primary cause of the plans demise in many areas throughout the United States. This may eventually ensue in the overall collapse of the plan.
    The possible resolution to the health care coverage conundrum is the deviation from the prevalent insurance model-low risk individuals manage high risk individuals’ costs. One alternative is socialized medicine. Individuals under such system, in such countries as Canada and the United Kingdom, have personally expressed satisfaction to me during conversations. In contrast, the costs, which are covered through high taxation, is harsh to the countries’ citizens. Other alternative health care coverage systems are available. Perhaps, mergers and/or adopting portions of several systems may be the required approach in the United States.

  4. Usiel
    Apr 10 2017

    Health Care

    Should paying higher taxes entitle us to get free health care? Some countries have high taxes just to cover health care for everybody but in the United States we spent a lot more in the health care industry. Splitting up the healthcare into layers is a great idea, having a layer for health young people who are young and most likely don’t need a premium health plan but every layer should always include emergencies of all kinds. Layer for elderly people who will have many problems and will eventually be visiting the doctor very frequently, and possibly to keep their costs low to use tax money to keep their costs low. Great idea to have certain foods is taxed much higher than other foods. Having foods that are linked to certain health problems like, cigarettes, junk food, GMO foods etc. Those foods will have a higher tax that will go to the health care industry for people who need it the most.
    For people who have serious or more health problem young or old should never be denied health coverage. I understand their insurance having to be a little higher but not every family could pay a high premium for every kid or young adult with health issues. I feel like the government should have some kind of tax deduction from certain foods that will get taxed higher and that extra money can go towards better health care for people with very bad health conditions.
    Its very tuff to offer a solution, I looked up online and found out some countries tax the people and offer free health care. Yes their taxes were high but interesting enough the United Sates wastes about 18% on health care from taxes and other countries are at 9%. Their could maybe be a non government agency that the government can pay to think of health care solutions there’s many companies out their who are very strong and smart who could have greater ideas than the government. Also another solution could be is taxing bad foods more and healthy foods can get taxed very little, eventually that can lead people to buy more healthy foods.

  5. Karina C
    May 16 2017

    Health care in America has never had any real balance. Although Obamacare tried to help those in the lower class to have insurance it still screwed over everyone else. To implement a law that mandates every one to have coverage or else you would be penalized from the IRS is ridiculous. That’s just another way for the governments pockets to get bigger. How is this helpful to anyone? So the government regulates the people but doesn’t regulate the insurance companies. Yes, I understand that there are technological advances in medicine but who really gets to experience that? Not the average person, if anything its the upper class , rich who have the advantage. And yet, we have to pay for it? Insurance companies at will, will raise rates every six months with an excuse of the “advancement in medicine.” Your idea on coverage layers seems like a good starting point to help with this crisis. However, your red layer is similar to what we deal with today. It’s up to the insurance company to offer it to you and if you don’t take it then the hospital can decide whether to help you or not. You never know what situations life can bring or what can happen to your health down the line. How expensive will this red layer be? Who will regulate the cost? The waiting period seems too long as well. Some people find out they have cancer and two months later they are dead. Whose to say you can wait 6 months to a year? Finding a balanced health care structure will definitely take some time but something needs to get done. Not only should we view the medical field but we should also consider these pharmaceutical companies. They are apart of our healthcare system as well. That’s really where to government should help and step in. The price of medicine also harms us. If you can’t afford it then you will end up in hospitals constantly. If medicine can become more affordable then less people will most likely not end up in hospitals as much.
    I do agree that education for those in the medical field should be free or at a lower cost. I have a few friends that are doctors and they are barely making ends meet due to high student loans. Some still require financial support from their parents. Yes, in due time they will be able to benefit from their hard work but this will take several years. I don’t believe a stressful doctor is a good thing. Happy doctor, happy life (for you)!

  6. Marylin Salguero
    Jun 1 2017

    The health care debate is an ongoing argument. Especially now, that the Obama administration enforced health care for everyone. By implementing the Obama care. Obama care enforces everyone to have some type of health coverage and if you don’t you get a fine at the end of the year. This fine will increase if you don’t have health coverage. Many don’t want to pay this fine so are forced to get a health coverage no matter what their income is. I strongly believe that health care in the United states has never had a balance. Having healthcare is a right not a privilege. If taxes were a little higher, it could be a benefit to the U.S. Some people can’t afford health coverage, if we are already paying so much in taxes, why can’t we get health benefits from tax dollars? Splitting layers and different cost to these different types of layers is a great idea. First, because young people who are healthy don’t need to visit the doctor as much. Older people who are prone to get sick do have to go often to the doctors. Then we have people who smoke. There should be different premium rates. For example I pay so much in health coverage for myself weekly. I’ve never have had the need to go to the doctors (luckily ) How is it that a healthy person rates are so high compared to someone that does have health issues and needs to go often to the doctors? I feel like insurance companies who are in the middle take advantage of this because were paying them and our health benefits. It is very hard for the U.S to try to find a balance that we can all benefit from.

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