If you took the top 5 "essential elements" in the current Senate Healthcare bill, and the top 5 from the GOP, and actually tried to form a compromise bill, what would it look like? Would you have a workable plan? Would the "hybrid" -bi partisan approach be better or worse?
The big gap here is in the refundable tax credit of $2,300 under the GOP plan and the individial mandate required under the Democrat’s plan. The 2nd costliest countries in terms of health care spend about 5K, so we have a bit of a gap. You could perhaps get preventable care for everyone with that amount, but not quite full coverage for $2,300 (i..e no coverage for chronic diseases or other long term care).
If the sides compromised and broadened the tax “Cadillac” plans, and combined it with Medicare reform one could increase the rebate to fund the individual mandate at $5K or higher depending on how comprehensive the plans had to be.
Top 5 Ideas in the Republican’s Bill (Paul Ryan of Wisconsin)
- Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family. Each year, five chronic diseases (heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes) cause two/thirds of American deaths; treatment of these largely preventable diseases makes up 75 percent of total health care expenditures. Critical investments in public health and disease prevention will go a long way in restraining health care costs and improving the quality of Americans’ lives.
- Create a State Health Insurance Exchanges to give Americans a one-stop marketplace to compare different health insurance policies and select the one that meets their unique needs.
- Investment in IT infrastructure to create transparency in health-care price and quality data, so this critical information is readily available before someone needs health services.
- Create state-based high risk pools will make affordable care available to those with pre-existing conditions. In addition to the tax credit, Medicaid will provide supplemental payments to low-income recipients so they too can obtain the health coverage of their choice and no longer be consigned to the stigmatized, sclerotic care that Medicaid has come to represent.
- Medicare: Secure Medicare for current beneficiaries, while making common-sense reforms to save this critical program. It preserves the existing Medicare program for Americans currently 55 or older so they can receive the benefits they planned for throughout their working lives.For those under 55—as they become Medicare-eligible—it creates a Medicare payment, initially averaging $11,000, to be used to purchase a Medicare certified plan. The payment is adjusted to reflect medical inflation, and pegged to income, with low-income individuals receiving greater support. The plan also provides risk adjustment, so those with greater medical needs receive a higher payment.
Top 5 Ideas in the Democrat’s Bill
- Tax on all “high cost” employer based insurance plans to discourage over consumption from “Cadillac” plans. No Union expemptions. Ideally, individual plans and employer plans should be taxed the same way.
- Individual Mandate for health care. An individual mandate for at least preventative care potentially can save money. The Democrats mandate that Americans to carry or obtain qualifying health insurance coverage or possibly face a surtax for non-compliance. One possible modification-prevent gaming of the plan by applying higher rates to those that only subscribe to health plans when they are sick. Provide further a subsidies to low- and middle-income Americans to help buy insurance
- Prohibiting health insurers from refusing coverage based on patients medical histories.
- A central health insurance exchange where the public can compare policies and rates
- Reductions in projected spending on Medicare of $400 billion over a ten-year period
No question a lot of time has been spent on this issue and it seems intractable. But if we took the top 5 ideas from both sides could it work? What do you think??