Healthcare: Fixing the ACA

Problems with the Affordable Care Act

The ACA was never designed to provide “affordable healthcare” but “affordable health insurance”. Medical care hasn’t been affordable for anyone in a long time, nor have CMS/Medicare/Medicaid payments covered the cost of practitioners’ time. The reality is if you go to your doctor and tell them you want to pay cash – they will work something out with you. I know docs who will take $5K up front each year – to cover all care for individuals/families. These individuals then purchase catastrophic care to cover emergencies. Unfortunately most people can’t do this. So they’re stuck between paying for insurance they can’t afford, and they still can’t see a doctor because they can’t afford the high out-of-pocket deductibles.

Single Payer System

As a result of these rising cost, I started looking seriously at single payer system. I’m not fond of single payer after time on Tricare & the Veteran’s Administration. However, a possible single payer solution might look like social security. Everyone who works pays into to a standard fund pre-tax; either their employer takes it out, or if you’re a small business you pay it out.

Under this system Centers for Medicare/Medicaid Services (CMMS) manages the single payer account. The single payer account covers individuals who are not eligible for coverage by Medicare/Medicaid.Medicare/Medicaid continues to operate and function as a separate programs, for those eligible for those services. Providers, Hospital groups and Affordable Care Organizations (ACOs) file claims as they do now and CMMS applies pre-tax payment from the single payer account to providers for services rendered.

Under this single payer account all prescription drugs would be covered 100%. Additionally, no services or prescriptions can be denied under this program. Providers may choose not to offer certain services, and patients can choose to use providers that offer the services they need.

Congress must participate as well. Congress will not be allowed to pull funds from this account in a “rob Peter to pay Paul” scheme. Should Congress w/draw any funds from the account, they forfeit all access to health care for the remainder of their lives for both them and their dependents.  Congress will continue to pay into the system even though they are no longer eligible for services.

Catastrophic Care Insurance

I’ve also considered that a participation requirement to purchase “catastrophic care” is also needed. Similar to car insurance or home insurance.  Premiums operate on a sliding scale. Catastrophic care would cover the unforeseen events, of a catastrophic nature, such as an accident, or cancer and would be supplemental back up to ensure care is covered for the duration of the event and recovery. If you don’t use the catastrophic care, the premium is then rolled into a health savings account that could be use for any health related issue.

  • $100/year for families with incomes under $40,000/year;
  • $250/year for families with incomes between $40,000-$60,000/year;
  • $500/year for families with incomes btw $60000- $80,000/year;
  • $750/year for families w/ incomes between $80,000 – $95,000/year;
  • $1000/year for families with incomes between $95,000 -$115,000/year;
  • $1500/year for families w/ incomes between $115,000 – $125,000/year;
  • $2000/year for families with incomes between $125,000 – $150,00/year;
  • $2,500/year for families w/ incomes between $250,000 – $275,000/year;
  • $3,000/year for families w/incomes between $250,000-$300,000/year;
  • $4,000/year for families w/incomes between $400,000- $450,000/year;
  • $4,500/ year for families w/incomes between $450,000 – $500,000/year;
  • $5,500/year for families w/incomes between $500,000- $550,000;
  • $10,000/year for families w/incomes between $1M-$1.5M;
  • $1500/year for families w/ incomes between $1.5M- $2M;
  • $20,000/year for families w/incomes between $2M-$2.5M.

You get the idea.

Optional Health Insurance

Additionally, everyone has the opportunity to buy additional insurance if they so choose. Sliding scale premiums apply to the additional insurance as well, based off the additional services purchased. Additional insurance might cover:

  • chiropractic care,
  • compounded prescription coverage,
  • massage therapy,
  • accupuncture
  • and other alternative treatments

While not ideal, single payer, coupled with catastrophic care insurance ensures everyone has access to a minimum standard of care.

Healthcare Industry’s Participation

Furthermore, the single payer system requires health insurance companies, the pharmaceutical industry, and BIG hospital systems to pay into the system as well. Additionally these companies publish a pricing sheet that is accessible for all consumers and list the following:

  • the payouts to providers for medical services,
  • drug prices,
  • the cost of services.

This provides transparency across the system, and both patients and providers can work together to identify the best way to meet the patients’ needs.

Incentivizing Care

Finally, providers who are diligent in their care, and reduce the costs associated with disease, should be rewarded for improving their patients’ health. Just keeping the patient status quo, isn’t helpful for the individual or the system. It also increases cost over the lifetime of the patient. The goal in healthcare should be keeping patients healthy for the duration of their lives. Healthcare shouldn’t be about keeping a continuous stream of patients and revenues, which is how healthcare and health insurance currently operates.

This is just one option for solving the deliver of healthcare in the United States; there is no silver bullet that will make everyone happy. But we need to fix the current system. Total revocation of the ACA is untenable, as it will impact so many people, nor can the ACA continue on as it currently stands. Congress needs to get off its ass, listen to all constituents across the isles, and start collaborating and cooperating to find a solution that will work. We, the people need to vote them all out of office, if they continue to kick the can and collect their extravagant paychecks, with their Cadillac BCBS government health insurance plans.

Gretchen