Guest Post by Scott Adams
We the People of the United States elected a populist president to go to Washington DC and make the changes the people want. Sounds good on paper.
Unless the people don’t know what they want.
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That’s the situation with health care. The public doesn’t have any majority opinion on what a comprehensive plan should look like. The topic is too complicated and the public is too uninformed. We sent President Trump into battle unarmed. If We the People find a way to tell our president what we want, I have confidence he can help us get it. But if we don’t know what we want, our populist president has nothing to sell. That’s our situation today. We elected the world’s greatest salesman and gave him no product to sell to Congress.
Don’t say “repeal Obamacare.” That’s not a health care plan. That’s just a step.
What we need is a “people’s plan” for health care that does not originate from congress or lobbyists or the healthcare industry. We need 1-3 sensible plans created by the public, and presented to our populist president for selling to Congress. No other path is likely to succeed.
To get the ball rolling, I created the hashtag #PeoplesPlanHealth to capture the various ideas coming from the public. If any of those plans emerge as popular (based on retweets, likes, etc.) I have offered to help turn what is likely to be a complicated idea into something simple and persuasive. Once we have a plan with popular support, and persuasive packaging, I will make sure it gets to the right people in the White House. One way or another. (Twitter is probably enough.)
Here’s my Periscope in which I talk about this in more detail.
Scott is correct: The POTUS could sell a plan – if there was a plan.
It’s hard to believe that the Republicans had SEVEN fucking years to draft their own market driven solution. Instead they did nothing, have no ideas, offer nothing except to ‘hack’ away at the current ACA – what a weak teat solution. It’s an embarrassment to be a conservative.
The obvious thing is that health insurance / hospitals / pharma – are ass raping us big time. The reason people buy health insurance, is not for health, rather it’s anti-bankruptcy insurance. The insurance companies know this.
The Swamp doesn’t want to disturb the status-quo. Nothing will get done.
Why do we need a Federal mandated healthcare plan?
It isn’t about actual healthcare services anyway, it is about who pays for it and how they do it.
Just get the Federal government out of it and let the States do as they will if they deem it wise to do anything about it at all.
You need a Federally mandated health-care plan so that YOU pay 100% of the costs for a cigarette smoking, HIV-positive diabetic with end-stage vodka induced dementia & neuropathy. You’ll also pay for her mother, as she has not saved a dime.
My recent five day stay in intensive care prompted an invoice for $117,000. Upon contact with my insurance company, the hospital immediately cut the bill by $102,000. After some additional, incomprehensible charges, it appears that insurance paid about $14,000 and I’m to pay about $6,000. It would probably take 50 hours of my time to be able to comprehend 70% of the billing.
Denninger’s right – the fake part of the bill – the $102,000 that was immediately written off – should be illegal, because that’s the Sword of Damocles they hang over your head to force people to spend $19,000 / year for insurance that usually pays out precious little. BTW, if you’re not paying $15-20,000 for family insurance coverage, it’s because someone else (your employer) is “paying” part of your insurance cost for you.
The fakery must go.
See, in a rational world Iska, you know, one with the rule of law – that is called fraud. But, in a US where the only thing holding up the economy is the big cons of the day – Finance, Fraudcare, Education and Insurance, it is just business as usual.
I say that we just let the system collapse on its own. There is no .gov solution to this. Because, there is no “solution” at all. Any more than there is a solution to the retail apocalypse going on right now, or the housing “shortage”, read – no one can afford the shit…..The only solution is to stop printing money, allow the market to sort itself out, and then hopefully at the other end “we” are smart enough to NEVER allow the crooks and wolves to invade the hen house again.
Think about this: Eliminate insurance. Immediately people will have $$$ – that they can spend / invest and thus make a booming economy. So much so, it would be easier to have government catastrophic health care.
If you’re only going to get a percentage of what you charge, it makes sense to charge as much as possible to begin with.
Establishing standardized pricing would eliminate much of this, all billing and payments done at predetermined and non discountable rates based on real actual costs and margins involved instead of inflating charges in hopes of getting adequate payment after dismissing most of them.
That is what MediCare does. I worked for one of the largest PPO providers in the country, that was not part of the big three :
which were Aetna, United Healthcare and CIgna — at the time .
Medicare pricing is standardized for each listed procedure. We charged a percentage of Medicare in our PPO contracts, 75%, 200%, 375%, whatever. BUT THE PRICE LIST WAS STANDARDIZED, and revised periodically ( this memory is from a decade ago, and longer )
Here’s the thing, a cardiac surgeon in Wasilla has different costs than one in upper Manhattan. So the standardized Medicare price list was adjusted — zip code by zip code — for every ZIP in the USA. Only the first three digits were used, so there were potentially about 1000 geographical adjustments to the published, standardized MediCare price list. For some reason I always remembered, even to this day, that some of Kansas is 666 first three digits. Sweet. ( http://www.eachtown.com/ZIP/6/ )
I am retired now, and am daily forgetting my 20 years in the Health Care industry. But here is what I said in a concise statement : MediCare has standardized pricing for procedures ( based on diagnostic codes ) that are geographically adjusted.
Having said all of this, I will now return to my work on getting enough senior dementia — to forget the 4 decades that I spent in Scott Adams’ cubicle-world , 20 of them in HealthCare !
SnowieGeorgie
Name me ONE other service where NO ONE will give you the price UP FRONT. It’s BS and everyone knows it. Make all the hospitals post their prices online for comparison, let the free market drive prices down instead of medical monopolies and extortion driving the prices up.
Ok Scott, here’s my plan one more time.
Eliminate all other forms of insurance. Private, Medicare, Medicaid, VA (except for injured vets). Provide government sponsored catastrophic health insurance based on income and not medical condition, for all MEDICALLY NECESSARY services, including prescriptions, for ALL US citizens. Premiums based on AGI minus FPL. Out of Pocket Costs based on AGI, after which government picks up the bills. Individual Premium..5%. Couple..6%. Three..7% with a maximum premium of 10%. And a max premium of $20K. Out of Pocket expense of 4% of AGI with a max OOP of $16K. No more deductibles and copays. Example: A couple with an Adjusted Gross Income of $60K reduced by the Federal Poverty level of $16K would pay 6% on $44K or $2640 for a premium and have a maximum OOP of $2400 for the year.
A mandatory physical and lab work would be required annually to detect any problems early. Cost is part of OOP. Shouldn’t cost more than a couple of hundred per person. You can get a complete adult blood panel at a Quest lab in Arizona for $85. OOP spending will foster competition for daily maintenance. Transparent pricing for all services. You could even allow a tax credit health saving account for OOP costs. A panel of doctors will create the standard physical requirement and lab work that will provide that early detection. An independent panel of physicians would determine what is medically necessary and the courts would prevent government denial. Won’t require physicians to do most physicals. Clinics, PA’s can do most of that work. Failure to get work done will result in a 10% premium surcharge. Failure to correct destructive behavior(obesity, alcohol and drug abuse, smoking, etc.) will result in a 10% premium surcharge. Repeated failure results in loss of coverage. Eliminate EMTALA for all US citizens.
The power of the government will help to control costs on their part through negotiations with service providers(like they do for Medicare now) and pharmaceutical companies.
This would eliminate all concerns about age, preexisting conditions, bankruptcy and all the other problems with existing insurances. Takes out the profit of insurances.
The IRS would provide a certified letter as to your annual AGI and next annual premium and OOP. CMS can be the collector of premiums.
Everyone would have skin in game. An individual who earns $12k would pay no premium, but would have an OOP of $480 and at least some would have to be spent for the annual work.
As to costs. Aside from premiums collected, there would be no more tax write offs for premiums in private insurance. All employers could be assessed a charge of 1-2%%(based on company size since many will no longer be providing health insurance) of payroll(no more medicare FICA tax). No more medicaid payments to states. Would free up existing state contribution for other services. And if need be, a 1% national sales tax.
Health care providers have a monopoly because they provide life saving services and can charge just about anything they want when your life is on the line. And that, along with insurance middlemen are what is driving costs up. Some regulation is needed while still giving medical providers a reasonable income based on their value to society, which is more than a health insurance salesman.
So if I read this correctly Dave,you agree w/both Hillary and Barack that insurance should be mandatory.
Phuc you Dave!
If a person doesn’t carry insurance or have cash,no treatment.
Hey dumbfuk did you read anywhere in my post that I said insurance was mandatory? You have a right to pay your own fucking bill and to die.
sure looks to me like you’re talking single payer–
Is there something wrong with single payer? Does it sure look like single payer is mandatory? Single payer isn’t government run health care. People have a right to be stupid and turn down cheaper insurance for no insurance at all. At least a single payer will cut the overhead and cut out the middle man. Do you have an alternative to offer? Is there any criticism of my plan other than you don’t like government involvement? There are reasons we are called the United States. One of them is there are some things that states can’t do alone. This is one of them, like it or not. Health providers have you over a barrel because they offer a service you can’t live without. Insurers are just skimming off of that fact. They have no fucking intention of controlling costs because they want their share. The medical industry need regulation and some control. And government needs to regulate destructive behavior of the people insured. American exceptionalism isn’t fucking up your health at the expense of others.
Six down votes and not a single farking critique or alternative.
On the one hand you have lying swine politicians who do not have the guts or integrity to tell people that comprehensive health plans cost up the wazoo.
On the other hand you have citizens,especially women and moms,who want comprehensive,all inclusive care from pre natal to the last artificially prolonged breath for the cost of a high dollar deductible catastrophic policy.
Is this reconcilable w/o force of law?
Iska ,I just got out of the hospital myself.When they ask how I was going to pay I said Lipoh was going to pay.They ask who he was I said family.I just love sticking to the Man.
Damn it Jim…..I’m just a country doctor….so said Bones . Perhaps some of our solutions are found in an era gone by ?
The only way we’ll ever bring down costs for healthcare is to rid Washington of the Healthcare Lobby,Open across the board competition for every facet of healthcare. This includes hospitals,MRI companies,doctors,pharmacies etc.
If an MRI in my area can be reduced from an average of $1,100.00 to $380.00 due to competition then it can be done in all facets of our healthcare .
healthcare should be non-profit. salaries ok. buildings ok. equipment ok. excess profits should go to lower costs to clients.
dividends to stockholders, go to jail.
no one should profit from peoples misery.
Repeal, don’t replace. Let the free market economy work. Get Government out of Healthcare
Womb to tomb medical care , sounds great , how much does it cost ???
First it must be non profit then we can address costs to support it. Insurence companies , medical professionals , pharmaceutical mfg and hospital conglomerates have colluded to create the mess that is health care in America today . Government has done nothing to repair or replace what we now have , in fact our government has only made it worse .
The major overhaul that was supposed to be the AHA was nothing less than orginized theft in an attempt to keep the price gouging of the American people for the benefit of the Washington Circle Jerk . Wall Street to K-Street to Capitol Street .
The health care system can and should supply top notch health care to all American citizens . Those of us who have been paying the freight for decades know , we have paid for that Cadallic Plan for us we just are not getting it , especially now .
I have a major surgery coming up that is a must do following a life saving organ transplant 4 years ago before Obama Care . This one is to be much tougher , the transplant was nearly $300 grand and the meds and follow up Care to date are easily another $100 grand .
I am sure we can do better