The anti John Edwards solution:
Approximately 25% of health care costs are "Defensive Medicine" and Malpractice Insurance. In fact a Doctor can lose his Malpractice insurance if he is sued multiple times even if he wins all of the suits. How do we reform it? Some people want to limit the judgments, I don't, if the Doctor is guilty make him pay. I want "Loser Pays". In other words if the Doctor is sued for Malpractice and wins, the plaintiff and the plaintiffs' counsel have to pay all court costs and legal fees associated with the case. They would also have to reimburse the Doctor for preparation time and time spent in court at his current rate or a rate deemed commiserate with his abilities by the court. A lawyer would be reticent about a pursuing malpractice suit unless there was undeniable evidence of wrong doing.
John Edwards became a multi-millionaire from suing doctors for children born with cerebral palsy. It has been shown that a lack of oxygen during birth does not cause cerebral palsy, that didn't stop John, he just had to convince a jury that it "might" cause cerebral palsy...
Interstate Insurance--
??? What does this mean BigMan?
Currently you may only purchase health insurance from those companies licensed to operate within your state. These licenses are denied for such arbitrary things as a company not offering a plan that includes coverage for Sex Change operations or a plan for single men that doesn't include a yearly gynecological check up. If you could purchase your plan from any company licensed to do business in any state in the US, competition would cause the costs to go down. You would be able to get a plan that only covers the items that YOU want.
HSA or Health Savings Plans--
Most people now have the option of contributing to an HSA now. This is an account in which you may deposit pre-tax income in to be used to pay medical bills only. These accounts currently have two limitations that make them unattractive. The first is you may only contribute up to $5,000.00 to a plan.The second is that any unspent money in the account at the end of the calendar year is forfeited to the Federal Govt. Here is what I propose:
- No limit to the amount you my contribute yearly to the account.
- Allow the money to rollover year to year.
- The ability to invest the money in your account as you would a 401k.
- Allow employers to contribute or "match" it.
What would this do? With an HSA like I describe, you may begin contributing to it as soon as you have employment or are able to. It is portable, it would also build over time so that it could be used in the event of a catastrophic health emergency. If it was never used it would be available to cover health expenses during your retirement when they are more expensive. This HSA would also allow you to have a high deductible health insurance policy. Therefore you would only need a "Health insurance policy" not a "Health care policy". Your health insurance could do what insurance is supposed to do, indemnify you for catastrophic, unexpected costs. The best analogy I have heard is Auto Insurance. You pay to fix your and possibly another vehicle in case of an accident, your insurance doesn't pay for your fuel, oil changes, and other repairs (although repair insurance is now available). Another benefit to only having catastrophic coverage is that when you spend your money, you can select the level of care and the physician you want. you are not restricted by your insurance company to the list of participating Doctors. This would drive competition up and costs down.. What are the two fastest growing segments of health care that are not covered by most policies? Lasik eye surgery and plastic surgery. The quality of these procedures has gone up and the costs have dropped dramatically in the last 10-15 years. When you spend your money, you are more careful that when you spend someone else's money..
End the Artificial shortage of Doctors--
??? What do you mean "Artificial shortage of Doctors" BigMan??
The AMA along with Medical schools determine how many people are accepted to medical school regardless of their qualifications and they also determine how many doctors of each specialty that can be licensed.. Why? If an individual wants to be a physician, and meets the minimum qualifications required, then let them in. Better yet, let's have more schools.. The ABA (American Bar Association) doesn't limit the number of lawyers (unfortunately). Why should we have a limit of doctors.The process will weed itself out. The good ones will have all the business they want and the bad ones won't have any business...
Portability--
Unfortunately, most folks insurance is connected to their employment. There is a reason for this, and it is the same reason that we have most of the issues we have in the health care system today.. The US Govt. interfered with the free market. Employer provided Health Insurance was created during WWII because the US Govt. imposed wage and price controls. Employers, always looking for ways in which to attract the best possible employees, compensated for the fact that they could not increase wages. They used other benefits to sweeten the pot, one of which was Health Insurance. One wartime employer even started it's own Health system for it's employees. This system required a small nominal payment for each visit to the company clinic (a co-pay). This company was Kaiser Ship Building. Their "Company Clinic" was so successful that it is one of the only things that survives the industrial giant that started as an Aluminum smelter and then built more "Liberty" ships than any other ship yard in WWII. We know it as the HMO Kaiser Permanente.
Because of this meddling by the US Govt. and lobbying efforts by Insurance and Industry; this Benefit is Tax Deductible for the employer and a non-taxable benefit for the employee. We should disengage the employers' control of the plan altogether. If an employer wishes to contribute to my HSA or health benefits, they may do so, but the package is MINE. When I leave that employer my package goes with me. My employer doesn't select or cover my auto insurance, why should they select and cover my health insurance?
Pre-existing conditions--
I am, as I have stated a Libertarian. I believe that we as a people and Govt. in particular should stay out of business and let them handle their own affairs.. For pre-existing medical conditions I make this one exception. An Insurance company cannot turn you down IF you had been previously insured for at least 1 year prior to your current health issue, or that during the issue in question you had been covered by another individual's policy and lost coverage through no fault of your own. In other words, if you had insurance, got sick, your provider went out of business, or you were a minor or were covered by a spouses insurance and were no longer covered you can't be turned down. I don't want someone that had never had insurance because they didn't wish to pay for it, get sick and try to then get insurance.
The US Govt. already controls 50% of the health care industry and the have made a mess of it. We should be cutting back Medicare and Medicaid not increasing their size and adding every man woman and child to them. Implementing the steps I have outlined most of the "Future" Medicare recipients wouldn't need it. Medical costs would go down and service would go up..
I keep hearing about the statistic that health costs have risen by 300% over that last 20 years. Education costs have gone up by almost 400% during the same time period, I don't hear the leftists screaming about that (because they get most of the money). Furthermore what of the medical advancements of the past 20 years would you like to give up? We have the most advanced system in the world when it comes to technology.. THAT does not come free...
"If you think it's expensive now, wait until it's free" -Unknown
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HSA Update-- New Rules, a step in the right direction..
The new rules also allow you to roll over a distribution from a health care flexible spending account (health FSA) or health reimbursement arrangement (HRA) into your HSA. This is a tax-free maneuver. However, the rollover contribution cannot exceed the smaller of:
The balance in your health FSA or HRA as of Sept. 21, 2006, or
The balance in your health FSA or HRA as of the distribution date.
To qualify, you must completely drain the health FSA or HRA and cease participating in it after the rollover. Only one account-draining rollover is allowed for each health FSA or HRA that you own. So this is not something you can do repeatedly.
Unfortunately, a punitive recapture rule will apply if you make a rollover and then become ineligible to make HSA contributions during the subsequent "testing period." This testing period begins with the month of the rollover, and it ends on the last day of the 12th month following that month. If the recapture rule applies, your entire rollover contribution amount must be included in your taxable income, and you'll get hit with a 10% penalty tax.
Here's an example:
Say that on Sept. 21, 2006, you had a $2,500 balance in your health FSA. At the end of 2007, your FSA balance is $2,000. You tell your employer you won't participate in the FSA for 2008, then you sign up for HDHP coverage for 2008. In January of 2008, you take advantage of the new FSA-to-HSA rollover privilege by rolling over $2,000. The rollover drains your FSA and jump-starts your HSA. So far, so good.
But what if you become ineligible for HSA contributions on July 1, 2008, because you obtain coverage under a more generous health plan? It's not pretty. Since ineligibility occurs during the testing period, you must recapture the entire $2,000 rollover amount by reporting it as income on your 2008 Form 1040. Plus, you'll have to pay a 10% penalty tax of $200.
Bottom line: Once again, we wouldn't blame anyone who thinks this nasty recapture rule makes the health-account-to-HSA rollover idea look too dicey.
New IRA-to-HSA Rollover Privilege
You can also make a tax-free rollover from your IRA into your HSA. This is yet another way to jump-start your HSA.However, the rollover amount cannot exceed your "regular" HSA contribution limit for the year, based on whether you have self-only or family HDHP coverage. So the maximum you can roll over in 2008 is $2,900 if you have self-only coverage or $5,800 if you have family coverage. Afterward, your "regular" deductible HSA contribution limit for the year is reduced by the amount of any IRA-to-HSA rollover. You can generally make only one such rollover during your life.
As you might expect, a devilish recapture rule can bite you in the wallet if you do a rollover and then become ineligible for HSA contributions during the subsequent "testing period." The testing period in this instance begins with the month of the rollover contribution and ends on the last day of the 12th month following that month. If you fall victim to the recapture rule, you must include the entire amount of the rollover contribution in your taxable income and pay a 10% penalty tax.
Here's an example:
Say you have family HDHP coverage for this year. On Oct. 1, 2008, you decide to roll over $5,800 from your IRA into your HSA. This puts a substantial amount of money into your HSA without any cash-flow problems.
But what if you become ineligible for HSA contributions in September of 2009? Since ineligibility occurs during the testing period, you must recapture the entire $5,800 by reporting it as income on your 2009 Form 1040. To add insult to injury, you must also pay a 10% penalty tax of $580. Assuming you have enough cash to make a "regular" deductible HSA contribution for this year, you would be better off taking that course — because it avoids any chance of the nasty recapture rule coming into play later on.
