ATTENTION : KAMALA HARRIS

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August 02, 2019

ATTENTION : KAMALA HARRIS

by Frank Thomas

ADDENDUM II. August 2, 2019

I applaud your attempt to put forward a Medicare Option Plan that includes the insurers. Joe Biden is doing the same thing when he says significantly improve the Affordable Healthcare Plan, called Obamacare.

BUT, as I note in detail in describing the Dutch universal non-optional Basic Plan that an variation to that plan, like your and Biden’s options WILL NOT WORK unless following conditions are met:

The much needed scale of standardization in our complex national healthcare system will not be achieved without Medicare first defining one standard embracive coverage package that applies to all applicants and insurers. A transparent standard benefits package that insures comprehensive coverage - and profoundly simplifies the system. Insurers must accept that coverage package. They and providers (e.g., hospitals) deal with a single set of rules and billing procedures. A big plus with such a system in the Netherlands is that insurers and hospitals act largely as non-profit entities. This will be difficult in the states where healthcare for maximum corporate insurer profits is deeply imbedded. Even non-profit insurer firms in the U.S. have exorbitant salaries.
The individual monthly insurance premium and annual deductible costs should also be standard nationwide (or at least regionally). In the Netherlands, the premium and deductible costs for an individual 18 or older under the Basic Universal Plan are at reasonably affordable levels of $136 monthly and $435 annually, respectfully. And that’s for excellent coverage with no co-pays or playing the profit maximizing games of setting limits or exclusions under the standard Basic Plan for all.
The government should subsidize the premium cost up to, say, 70% (as does the Netherlands) depending on gross income levels below $35,000 per year. This could be funded by a small federal tax of +- 0.015% on everyone’s annually reported adjusted gross income.
Medicare should NOT accept insurers whose executive salaries are sky high – a perversely greedy condition that pervades every inch of our healthcare system (but NOT in Europe).
Insurers cannot retroactively revoke insurance based on errors in applying for the Medicare Option plan. Obama’s Affordable Care Act had an individual mandate - as does the Netherlands’ Basic Plan - that no-one can be rejected for plan coverage in any way, including a history of prior sickness. Not surprisingly, Trump’s administration has established numerous loopholes that undermine the insurance protections of Obamacare.
Our U.S. current private healthcare insurance system is primarily employment based and covers two-thirds of the population. Many people are happy with this but it comes with limits and exclusions regarding coverage and co-pays. And, most importantly, there is no standardization. So the premium and deductible out-of pocket costs still end up being extremely high vs. European plans. This problem and the insurer/provider being in business for maximum profit must be resolved in a clever way if a quality, affordable U.S. Medicare Option plan is ever to work successfully.

The potential purchasing and administrative cost economies where insurance firms play a role with central government oversight and control of a standard quality, pricing, coverage package are enormous – as proven by the Dutch, Swiss, and German systems. And unlike our Medicare Advantage health plans – where private insurers overbill Medicare in the hundreds of millions annually for sick patients who are not so sick or have reported medical conditions that cannot be proven - the profoundly simple, transparent EU healthcare systems don’t have such problems.

Perhaps you and Joe Biden could merge the best of each other’s ideas and the brains of experts to significantly reform an Obamacare Option. This would include re-installing the provisions Trump’s Administration has taken away. Actions that constrain access to Obamacare and make it more expensive.

For a Medicare Option alternative, we should adopt in a constructive way the standard plan conditions and operating rules noted above that work so well in providing better coverage at a much lower cost in Canada and European countries with populations of 10 million to 70 million. Greatly reducing plan complexity, increasing plan standardization, scale purchasing of drugs and medicines, and equipment will deliver massive cost efficiencies and better healthcare coverage.

If we can’t take this first step as a precursor for a much, much broader public acceptance of a universal basic plan centrally controlled by Medicare, then we will likely remain a 3^rd world country when it comes to comprehensive, quality basic healthcare at an affordable cost for the average American.

Frank Thomas

August 2, 2019

The Netherlands

Posted at 08:10 AM in Frank Thomas, Health Care, Medicare, Medicare for All | Permalink

Comments

by Frank Thomas

ADDENDUM II. August 2, 2019

BUT, as I note in detail in describing the Dutch universal non-optional Basic Plan that an variation to that plan, like your and Biden’s options WILL NOT WORK unless following conditions are met:

The much needed scale of standardization in our complex national healthcare system will not be achieved without Medicare first defining one standard embracive coverage package that applies to all applicants and insurers. A transparent standard benefits package that insures comprehensive coverage - and profoundly simplifies the system. Insurers must accept that coverage package. They and providers (e.g., hospitals) deal with a single set of rules and billing procedures. A big plus with such a system in the Netherlands is that insurers and hospitals act largely as non-profit entities. This will be difficult in the states where healthcare for maximum corporate insurer profits is deeply imbedded. Even non-profit insurer firms in the U.S. have exorbitant salaries.
The individual monthly insurance premium and annual deductible costs should also be standard nationwide (or at least regionally). In the Netherlands, the premium and deductible costs for an individual 18 or older under the Basic Universal Plan are at reasonably affordable levels of $136 monthly and $435 annually, respectfully. And that’s for excellent coverage with no co-pays or playing the profit maximizing games of setting limits or exclusions under the standard Basic Plan for all.
The government should subsidize the premium cost up to, say, 70% (as does the Netherlands) depending on gross income levels below $35,000 per year. This could be funded by a small federal tax of +- 0.015% on everyone’s annually reported adjusted gross income.
Medicare should NOT accept insurers whose executive salaries are sky high – a perversely greedy condition that pervades every inch of our healthcare system (but NOT in Europe).
Insurers cannot retroactively revoke insurance based on errors in applying for the Medicare Option plan. Obama’s Affordable Care Act had an individual mandate - as does the Netherlands’ Basic Plan - that no-one can be rejected for plan coverage in any way, including a history of prior sickness. Not surprisingly, Trump’s administration has established numerous loopholes that undermine the insurance protections of Obamacare.
Our U.S. current private healthcare insurance system is primarily employment based and covers two-thirds of the population. Many people are happy with this but it comes with limits and exclusions regarding coverage and co-pays. And, most importantly, there is no standardization. So the premium and deductible out-of pocket costs still end up being extremely high vs. European plans. This problem and the insurer/provider being in business for maximum profit must be resolved in a clever way if a quality, affordable U.S. Medicare Option plan is ever to work successfully.