Tuesday, May 16, 2017

Healthcare Conundrum II

If Congress is smart enough to break apart the Obamacare Replacement laws, it will open Medicaid to all citizens who have “preexisting conditions”.  But this needs to be defined and renamed.  Whatever we call it should define situations where previously healthy citizens have a serious accident or have the onset of a serious illness. We want to protect citizens from the catastrophic costs now associated with hospitalization today.

Hospitals already have the ability to find funding for indigent patients and they have the incentive to do this, so they can apply to Medicaid in behalf of its indigent patients.

Hospitals should have the right to refuse treatment and should refer indigent patients to designated indigent care facilities.

Hospitals should publish their charges, so that patients will know what the charges will be, even if Medicaid is paying the bill.  Patients should always receive a copy of Medicaid payments and should flag fraud billings.

Preventive healthcare should not be covered. Routine office visits should not be covered.  Cosmetic surgery should not be covered unless it is part of the “repair”.  Community health facilities might be needed for the poor and should be provided by charity.

Covered expenses should be limited to catastrophic expenses the medically necessary rescue and repair.

There also needs to be a mechanism to move previously Medicaid qualified citizens off of Medicaid after their catastrophic expenses are over and they are again considered “healthy” and can rejoin the “privately insured”.

The first Bill should address “insurance for the healthy” and include self-insurance mechanisms like “health savings accounts”. It should have insurance rules like sales across state lines to increase competition. It should not require that insurance companies include “preexisting conditions”.

The second Bill should modify Medicaid to include catastrophic patients along with the poor.

The third Bill should be the complete repeal of Obamacare that is required in order to pass the first two Bills

This is basically what Rand Paul recommended as Congress was struggling with and couldn’t get a vote scheduled.

The end result would be that the “healthy” might opt for self-insurance rather than “private insurance”, because their path to Medicaid would eliminate the risk of personal bankruptcy. That’s fine.  “Private insurance” may become totally irrelevant.

The Next Phase of this fix should be tasking the federal government to go after healthcare costs aggressively and cut these costs in half.

That means the end of malpractice insurance and the repeal of all laws and predatory practices that have increased the cost of healthcare.  At that point, “private insurance” may be able to resurrect itself to handle “preexisting conditions”.

The final phase should be to remove the federal government subsidies completely from healthcare and return to free market pricing.

The concept that insurance is for “unforeseen” events and is basically a cash-flow mechanism would be restored.

The healthcare cost problem was caused by federal government overfunding of healthcare. This should be recognized, exposed and fixed by the federal government that screwed this up in the first place.

Norb Leahy, Dunwoody GA Tea Party Leader

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