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A 21st Century Intelligent Healthcare Solution to
Creating a 300 Million Payer System

Introduction

A 21st Century Intelligent Healthcare Solution to health and healthcare transformation requires establishing a vision and a process for change that wins over the hearts and minds of Americans with a message that this is a problem that can be solved with American ingenuity and entrepreneurship in a uniquely American way. This is a values issue where lives and the health of citizens are in danger. Family security and financial stability are at risk. Americans must demand a change from a world that does not work to a world that does work. Today we have the worst of all worlds. We have a costly government healthcare system that locks citizens into restrictive limited choices, and a private market that is overburdened with state and federal laws and regulations.

Change must include things that are real, tangible, and results oriented for real people with real health, healthcare, and health insurance problems. Solutions must be based on American values of financial freedom, personal responsibility, individual ownership, and choice. There are two camps of thought for our future. We will either move to a Washington-based insurance system or we will develop expanded market-based insurance solutions. Unless the free-market is given more flexibility to meet this problem, citizens will undoubtedly turn to the federal and state governments to “solve the crisis.”

But at least many of the proposals more-or-less acknowledge the importance of addressing the tax code. A more thorough analysis of what they’re trying to reform would have been nice though.

For starters, how about listing some attributes of the employer tax exclusion:

1. The tax incentive to overconsume is fairly high for those in the higher tax brackets, because the size of the tax benefit happens to be an accident of the employee’s tax bracket.
2. The tax exclusion is regressive, providing next to nothing for low-income employees, again because the tax break is tied to the employee’s tax bracket.
3. The tax exclusion discriminates against individuals who pay for identical (e.g. COBRA) or nearly identical (e.g. HIPAA or continuation) coverage themselves.
4. The tax exclusion differentiates between group coverage and individually-rated insurance.
5. The benefit of the tax exclusion is based on the size of the insurance premium (not a flat amount, in other words).
6. In addition to 4, the tax exclusion is open-ended and extends to any size insurance premium.

To me, attributes 1-3 are inexcusable. 4-6 are defensible, or at least arguable to the extent that defenders would likely stymie any attempt to reform the tax code.

Unfortunately, it’s true as Stan says. With 12 years in charge of Congress and 6 in charge of everything, the Republicans did nothing (apart from smothering Medicare drug coverage in a bunch of corporate welfare) and by their actions showed that they don’t give a rats arse about the uninsured, or the fundamental problems in the system.

Many of us who won;t make any “free-marketeer” idea lists aren’t delighted with what the Democrats are doing, But at least they’re doing something.

And much as I love Michael Cannon, his book has 3 whole lines about the problems of spending past the deductible. Which is somewhat representative of the overall level of ideas about systemic change from this list.

But have fun complaining guys. The more sensible ones among you will move over to a topic Republicans care about (moose hunting?) by the time they get their next shot at government–which might come rather sooner than the country or the world needs–given how well they did last time.