Pie-in-the-sky Healthcare

Private insurers could offer $50,000 (85% with a 15% co-pay) annual coverage
from age 21 until Medicare takes over at 65.  Children under 21 would be covered under
special policies available to their parents, but, upon reaching 21, would need to
purchase their own policies.  Their parents (or others) could pay for the
policy, but the newly adult child would own it.

Adult health insurance would be made available only at 5-year increments, at
ages 21, 25, 30, 35, etc., but once purchased, the premium could not be
changed until age 65, unless the premium is not paid or the individual opts
out by written notification.


If the insurance is purchased at age 21, coverage can not be denied for pre-
existing conditions, and the premium rate would be calculated to include all

individuals.  If the individual opts out of health insurance and then attempts to
enroll at one of the later enrollment periods, rates could be adjusted for
pre-existing conditions.

So, if an individual buys the insurance policy at age 21, the insurance company
is obligated for up to $42,500 (85% of $50,000) per year until the policy-
holder reaches 65.

I believe that such an insurance policy would be affordable, since most people
never reach that limit in any year prior to age 65.
  
Now, where does that leave the individual?  If they did have a year where they
had $50,000 in medical bills, they are stuck with a bill for a maximum of $7500.
Call me cruel, but I do NOT believe that supplemental insurance should  be
available to help pay this obligation.

One of the best ways to avoid unnecessary medical procedures and keep
medical costs down is see that the person using the procedure is aware of the
cost, and has to deal with the pain of paying at least part of the cost.

To HELP the individual deal with the pain, state government should offer
low-cost loans to help those who need assistance to pay for the co-pay
portion of the medical costs, based on the need of the individual.  This
program could be self-supporting, and should aggressively attempt to
collect all loans.

Catastrophic coverage (over $50,000/year) could be covered as follows:

                            First                Then            and then
                                                                      donated Medical
                          State Govt       Fed Govt      & Private Charities

Year 1                  $200,000         $100,000        above $350,000                
Year 2                  $100,000         $50,000          above $200,000
Over 2 years             -0-                 -0-               above $50,000
Over 2 years could also be covered by catastrophic private insurance.




Catastrophic coverage would be based per incident, not per lifetime.  Sales 
and/or payroll taxes could be used to fund the state and federal programs, but
the money should be treated and regulated as an insurance program, not
as a honey-pot for general fund spending.  If these taxes were combined with
a maximum income tax rate of 10%, as discussed earlier, there
would not be much impact on an individual's take-home pay.

Finally, what happens to those who either choose not to purchase health insurance, or
those unfortunate enough not to be able to afford it?  First off, they would go to
the emergency room, just as they do now.  Life threatening emergencies would be
treated, just as now.  For those who chose not to purchase health insurance, the
state would attempt to collect for the cost of the service.  The state would pay
for those who could not afford to pay back.

For non-life threatening conditions, hospitals should be legislatively allowed to staff
low cost medical clinics near their emergency rooms.  The non-insured would be
sent to this clinic, staffed as much as possible with physician's assistants, medical
and nursing trainees, and non-union maintenance worker trainees.  Generic drugs
would be required in all instances where they are effective.

Doctors could perform their required free service (1 out of 20) for patients for the
low-cost clinic, helping keep expenses down.  The state could still bill uninsured
patients for services rendered, if they could afford to pay.  They could even be
billed at a lower-than-market rate for donated medical services.

The low-cost medical clinic would in effect create a two-tiered health care system,
as a strong incentive to get individuals to buy health insurance for better care.  The
uninsured would still receive medical care, albeit more of a generic nature and they
may have to wait longer for non-emergency operations.  If they are financially
able to, the state would require them to pay for all, or part, of the medical services
they use.

I know, it sounds impossible...but think about it until the next post.