Let’s talk health care.  I have not read what other people have proposed on fixing health care in this country.  These are my original thoughts for whatever that’s worth.   You be the judge.

First we must be honest with ourselves and answer some questions. 

Well I am sure that most will say yes, everyone deserves some basic healthcare.  But should it be “free “. Well, nothing is free, someone must pay.  Either society pays (taxpayers) or individuals pay.   Remember, if something is truly free then it has no value.  If it has no value, then no person or business will produce this product or provide this service.   The word “free” is really abused.

The Affordable Health Care Act, what a huge piece of legislation that has really accomplished nothing.  Have healthcare costs gone down? No.  Has healthcare insurance rates dropped? No. Are less people going to emergency rooms as their first stop for healthcare? No.  Is the government enforcing the requirement that everyone purchase healthcare insurance by performing audits on individuals? No.  Why has this failed?  Because it tries to force “for profit” industries into operating and accepting policies that cause them to lose money.  Let’s face it, insurance companies must insure more people that don’t have problems so they can pay for people that do have problems.  Healthcare providers are mostly corporate conglomerates who have shareholders that want dividends for the stock they own.  Dividends require profits.   Doctors spend huge amounts of money for their education and must pay vast sums to keep their offices running.  It really is a wonder that there are people who feel the calling to endure what is required to become a physician.

Can universal care and capitalism breathe the same air?  Very tough question.  First, there must be conversations and non-ideological mindsets that must occur for there to be any hope of developing and implementing a system that utilizes the creativity, efficiency, and competitiveness of capitalism and still provide universal care.  There must be competition in healthcare to drive efficiency.

Currently everyone who needs healthcare in an emergency gets what they need.  I do not hear reports of people dying on the steps of hospitals or in the streets in front of them because they were denied care.  This is not happening.  Does everyone who shows up at hospitals have insurance to pay, no.  Who pays?  Those who have insurance pay or taxpayers pay.  People who have insurance pay higher rates and government programs payed for by taxpayers pay the remaining.  The healthcare industry must deal with mountains of paperwork and justifications for treatment from both the government and insurance companies.  It is a real struggle for hospitals, doctors, and the healthcare industry as a whole to deal with.

Enough whining so let’s get started on solutions:

Healthcare saving accounts (HSA):  These must be expanded and encouraged.  You must not be penalized for having a HSA by being forced into a high deductible insurance plan.  Why penalize people who can save for saving?  They must be expanded.   Even if a business does not offer healthcare they can offer healthcare savings accounts that are portable.  These accounts must be managed by the major insurers of this country not the government.  Like the FDIC with bank accounts, these accounts will have the backing of the U.S. government.  First, the government would have to document qualifications for a company to offer and manage these individual accounts.  Their incentive would be they could invest these funds into approved markets to get a return.  Markets such as U.S. bonds, approved infrastructure bonds, and any other low risk investment that could pay for their administrative costs and provide them a return for providing this service.  The investments must be kept in the domestic markets.  They would receive a fixed amount of return.  Any amount over the fixed amount would be divided among the individuals who have their accounts with that provider.  If a provider was not able to achieve the fixed amount of return then the government would fill the gap for the return shortfall provided the shortfall was not due to gross negligence on the part of the provider.  Example:  Joe goes to work at Big Papas Burgers when he is 16.  When Joe fills out his application and claims his dependents for withholding he also selects a healthcare savings account provider.  He will be issued a card with an account number from that provider.  He must save 5%.  He can save more, bur 5% is the minimum and that is pre-tax money.  Pre-tax money is limited to 15% of gross pay.  Joe can save more after-tax should he have the desire to do so.  Joe later gets a better job.  When Joe does the paperwork for his new job, he uses the same healthcare savings number issued from his previous employer.  This account can be used for healthcare insurance premiums, doctor’s visits, and prescription medication and so on.  This account is transferrable to his heirs but can only be used for health care purposes.  Consumers can shop for the best price for their medical dollars.  If Joe wants to select another healthcare savings account provider, he can, but only one time per year during a pre-defined open enrollment period.   I realize this is very much simplified, but it is the concept that is important.  Just as social security, the 5% minimum must be mandatory.  The difference being you can select the provider and can change if desired.

Low income families and individuals:  Some states have enacted expanded Medicaid programs that allow these families to purchase insurance at reduced prices.  These family members still must enroll in HSA’s and would be required to save 5% before taxes.  This 5% would be used to pay for insurance.  If they could somehow save more before tax money up to the 15% maximum this would be to their benefit.  If not, current programs are in place to help them pay for the balance after their 5%.

For people on Medicare who are receiving social security income as their sole source of income the 5% requirement for them would be waived.  If they received other income above their social security income then they would be required to save 5% pre-tax money.  This could be used for supplemental insurance.  Once again if they could save more, it would benefit them.

Catastrophic Health Issues: There are very few families in this country that do not have at least someone in their family that has had an event like this, be it cancer, rheumatoid arthritis, Alzheimer’s, dementia and on and on.  This is devastating for all the loved ones involved.  The huge amount of personal stress in dealing with the person who is ill, and the financial drain on the family.  I know because I have lived through this.  I lost my wife to cancer so I speak from experience.  I have group insurance through my job and even with that, it was still very much a financial drain.   Let’s use two examples where the status quo this is not really practical.  ( 1 ) Let’s say an older woman’s husband develops Alzheimer’s.  Currently Medicare will not start paying until this couple’s assets are completely consumed.  Now there are ways around all of this but why should a family be forced to make changes in their life while going through the stress of the illness?  What is going to happen to the woman when her husband eventually passes?  She will have to leave her home and live with whom?  ( 2 ) A man recently retired after working over 30 years.  He saved money for his and his wife’s retirement.  She develops dementia and eventually requires constant care in a facility.  She is not eligible for Medicare yet.  Currently he would have to deplete his entire life savings before social security disability would engage to help with his wife, and even then it would only partially pay what is required.  Then, what is he going to live on?  Would he to have to leave his home?  So what do we do so that a family does not have to spend their whole life savings to deal with a catastrophic illness?

We are in an area now where the free markets cannot function.  I know that private insurance policies are available but have you looked at what you get?  Most offer a lump sum payment depending on the illness.  The lump sum is not nearly enough.  Long term care insurance is even more expensive.   I hate to suggest another entitlement but I really see few options.  I would suggest another payroll deduction like social security only this would be dedicated for catastrophic illnesses.  Everyone who is working would pay in 5% of their income matched by 5% from their employer.  There would be no income cap as there is currently with social security.  Would this require supplemental funding?  Yes, for a while, but hopefully it would become self-sufficient the longer it exists.  Maybe the 5% would have to be increased, I don’t know.

Here is what I do know.  We are 20 trillion dollars in debt.  Politicians are doing nothing to get us heading in the right direction.  Why?  Because no matter what they suggest will be unpopular.  Thus, we continue to do nothing.  Guess what, how much longer do you think we can go down this path?  We are headed for a brick wall and when we hit it, society as we know it will no longer exist.  As a society we must all pay more for what we think we deserve as basic health care.  No longer can we ignore this.  If you are an elected official you need to lead before there is nothing left to lead.

These are ideas, maybe not new, but something.  If we never get started on this we will surely never finish.  We must have action and no more complacency.