Part One – The Federal Government’s Involvement
The United States Treasury shall be the default reinsurance
carrier for all American Citizens. The Federal Government shall fund a stop
loss plan on every person equal to $50,000. This means the maximum any individual
is responsible for paying for medical care is set at a $50,000 limit annually. Individuals may purchase an insurance policy
to transfer this risk to an insurance carrier.
For lower income earners the $50,000 limit shall be reduced
based on income. Individuals even at the poverty level will have some level of
shared costs in order to allow for individual responsibility. The Government shall
not pay for anyone’s insurance but rate cap the annual spend on needed care
based on income and considering assets. Able bodied workers can be required to find
gainful employment to have access to these benefits.
This fall back option shall only cover basic care as defined
by the Hippocratic Oath. Drug manufactures and medical facilities will help
fund cost for lower income individuals in order to have access to participation
to the $50,000 reinsurance program.
Part Two – The States Governments Involvement
The individual state shall be tasked with the responsibility
to provide Children’s (including maternity) benefits within the Federal
Structure as they see fit. States will also be encouraged to provided Tier one
care (basic everyday services) as they see fit to reduce impact on vulnerable individuals
(homeless, immigrant, and others). States will also be given authority to
establish any sort of plans and programs as they see fit. For example if
California wants a single payer option they can choose to establish one.
Part Three – The Involvement of Insurance
Two types of insurance programs will be established. The
first is to provide more comprehensive services and access in above to the
basic benefits as assigned in the over $50,000 reinsurance program. For example
access to a nationwide network of specialized hospitals or to elective services
like gender reassignment or abortion.
The second type of insurance program is will focus on the
under $50,000 risk that is borne on individuals to pay annually. This $50,000
risk can be reduced to any amount, for example $5,000 by paying a premium to an
insurance carrier.
Part Four – Elimination of Provider Discounts
All providers of care, including medications, will be required
to charge the same amount for a service or drug to all individuals. Copayments,
networks and any other sort of mechanism that allows for cost shifting shall be
abolished. All fees and costs must be provided upfront to the patient or their representative
except in the case of emergency or urgently needed care.
Part Five – General Welfare Provisions
General welfare pertains to the over health of the population
in terms of limiting the spread of infectious disease (vaccinations) and deficiencies
based on environment (pollution and natural disaster). This section also falls
under the Federal Government’s responsibility as these risks are irrespective
of state boundaries. I have very strong opinions regarding vaccinations
but they are out of scope for this article.
Part Six – The Employers Involvement
Employers will benefit dramatically from reduced costs based
on the $50,000 reinsurance program funded by the government. Employers will be
tasked with collecting payments for the program via a payroll tax. Individuals based on income will also be
required to contribute to the program. Nothing
is free.
Part Seven – The Individuals Part
Much of medical costs can be eliminated by good personal
lifestyle choices. Individuals with poor health have a special responsibility
to work for good health outcomes for the betterment of the health of the
community. In the spirit of brotherhood/sisterhood any individual tapping into
the $50,000 reinsurance program and low income individuals receiving special assistance
will be required to work toward health outcomes as assigned by a community if their
peers (individuals with the same health issue).
Part Eight – The Role of the Association
Like minded individuals shall be given the right to bind together
via free association to bear the burdens of one another based and shared
values, for example a church, social organization, or union.
Part Nine – The Medical, Governmental, and Elite Classes
No governmental, medical, or global organization shall be
allowed to establish any structure to provide special services, programs or entitlements
without first forfeiting lifetime access to the $50,000 reinsurance program
Part Ten – Prescription Drug Reform
Comprehensive drug reform is essential and will be included
in reform efforts. This topic will be covered in depth in a latter release.
Part Eleven – Tort Reform
Tort reform is essential and will be included in reform
efforts. This topic will be covered in depth in a latter release.
Part Twelve – Monopolies
Market reforms are essential and will be included in reform
efforts. This topic will be covered in depth in a latter release.
Part Thirteen – Vision, Dental, & Hearing
TBA
Part Fourteen – Alternative and Holistic Medicine
TBA
Part Fifteen – It’ Getting Complicated is it not, I am sure I
missed something…