Sunday, April 09, 2006

A Democratic Party solution to the Health Insurance Problem

The Democratic Party should submit legislation to create an "At-Cost Non-Subsidized Public Health Insurance Program" to be managed by the Social Security Administration.

My proposal would be to have separately priced coverage for the following classes of coverage:
  1. Preventative Care
  2. Walk-In Clinic Care
  3. Outpatient Illness & Injury Care
  4. Emergency Illness & Injury Care
  5. Chronic Illness & Injury Care
  6. Major Illness & Inpatient Hospital Care
  7. Long-Term & End-of-Life Care
  8. Catastrophic Care

Each class of coverage would be priced "At-Cost" with the Social Security administration negotiating discounts with doctors, clinics, hospitals and drug companies for the required products and services and passing the savings along to the public.

Any drug required by or prescribed for any of the classes of coverage should be available at a negotiated "Best-Available-Discount" price from any pharmacy or directly from the clinic or hospital.

Actuarial tables should be calculated for each class of coverage and price schedules should be set up just like regular term life insurance where the price is lower the earlier you start your policy.

By providing the coverage At-Cost with no government subsidy, the cost to the government would be just the plan management overhead which should be the same 0.6% as the existing Social Security administrative cost.

All employers with 15 or more employees would be required to offer the policy to their employees and to deduct the premiums (Before Taxes) and forward the premiums to the Social Security Administration along with the existing Social Security Taxes. If the employer offers employer subsidized health insurance the employer should offer the same amount of subsidy (in which case the employer should be able to allocate it's subsidy as it chooses).

Medicare and Medicaid would use the plans services where appropriate and would pay the same amount into the plan as any employer or citizen would for the same class of coverage.

State Workman's Compensation Insurance departments could use the plans to provide the care needed for injured workers on the same terms as medicare and medicaid.

States which provide health insurance to families in AFDC or WIC could also use the plans on the same terms as medicare and medicaid.

Any unemployed or self employed individual and anyone working for an employer with fewer than 15 workers could purchase any or all of the plans at cost. Coverage would not terminate at 12-18 months after leaving an employer like Cobra Insurance does.

Coverage would move with the individual from job to job or between jobs as long as the individual or employer continues to pay the premiums.

If an individual is healthy, a portion of the unused premiums should be transferred to a Health Savings account to be used to cover deductibles or costs in excess of the covered amounts. The remainder of the unused premiums should go to a fund to cover care for uninsured patients with no means to pay.

Plan Coverage Overview:

1) Preventative Care
  • Age 0-15, 40-80
  • 100% Covered, $20 co-pay
  • Periodic Checkups and Physical Exams
  • Vaccinations
  • Prenatal and Well Baby Care
  • Childhood Ilnesses:
    • Mumps
    • Measels
    • Rubella
    • Whooping Cough, etc.
  • Adult Cancer Screening:
    • Prostate Exams
    • Colonoscopy Exams
    • Breast Exams – Mammograms
    • Pelvic Exams – Pap Smears
2) Walk-In Clinic Care
  • Age 0-80, 80% Covered, $20 co-pay
  • Clinic Doctors Visits
  • Initial Diagnosis
  • Injury:
    • Bandages
    • Stiches
  • Illnesses & Infections:
    • Colds
    • Flu
    • Rashes
    • Minor Illnesses
    • Minor Wounds
  • Common (low cost) Tests:
    • Annual Eye Exams
    • Annual Hearing Exams
    • Annual Dental Exams
    • Blood Gasses
    • CBC
    • Blood Sugar
    • Urine Tests
  • Treatments and Procedures:
    • Fillings
    • Teeth Cleanings
  • Common (low cost) Medications:
    • Antibiotics
    • Flu Shots
    • Asthma Inhalers
    • Antihistamines
    • Steroid Creams
    • Birth Control
  • Medical Equipment:
    • Basic Eyeglasses
    • Basic Hearing Aids
3) Outpatient Illness & Injury Care
  • Age 0-80, 75% Covered, $50 co-pay until $500/yr deductable
  • Specialist Doctors Visits
  • Specialist Diagnosis
  • Injury:
    • Wound Care
    • Physical Therapy
  • Illnesses & Infections:
    • Diarrhea
    • Infected Wounds
  • Common (moderate cost) Tests:
    • Stool Sample
    • Biopsy
    • X-Rays, MRI, Cat Scan
    • Blood Gasses, Sugar, Electrolytes, CBC
    • Urine Tests
    • EKG

4) Emergency Illness & Injury Care
  • Age 0-80, 60% Covered, $100 co-pay
  • Ambulance Services
  • Emergency Tests:
    • X-Rays, MRI, Cat Scan
    • Blood Type, Gasses, Sugar, Electrolytes, CBC
    • Urine Tests
    • Toxicology Screening
    • EEG
    • EKG
  • Treatments and Procedures:
    • Fluids & Electrolytes
    • Whole Blood Transfusions
    • Intubation
    • Emergency Surgery
    • Setting broken Bones, Casts
    • Burn Treatment, Debredment
5) Chronic Illness & Injury Care
  • Age 40-80, 75% Covered, $500/yr deductable
  • Covered Conditions:
    • Heart Disease
    • Kidney Disease
    • Diabeties Asthma
    • HIV
    • TB
    • Chronic Pain
    • Arthritis
    • Mental Illness
  • Tests:
    • EKG, Echo Cardograms
    • Urine Sugar, Electrolites & Ketones
    • Blood Sugar & Electrolites
    • Breathing Volume and Flow
    • Viral Load
  • Treatments and Procedures:
    • Stress Tests
    • Dialysis
    • Breathing Treatments
  • Medications:
    • Oxygen, Blood Thinners, Beta Blockers, Cholesterol Reducers
    • Diuretics, Water Pills
    • Insulin, Glucose Tablets
    • Theosophil, Albuterol
    • Anti-Retrovirals
    • TB medications
    • Non-Narcotic Pain Medication
    • Anti-Psychotics, SSRIs, Lithium
  • Medical Equipment:
    • Oxygen Tanks & Masks
    • Blood Sugar Testers
    • Nebulizers
    • Wheel Chairs
6) Major Illness & Inpatient Hospital Care
  • Age 0-80, 75% Covered, $1000/yr deductable
  • Covered Conditions:
    • Cancer
    • Emphysema
    • Pneumonia
    • Severe Arthritis
    • Glaucoma
  • Tests:
    • All medically necissary tests
  • Treatments and Procedures:
    • Radiation Treatment
    • Chemotherapy
    • Surgery
    • Joint Replacement
    • Corneal Implants
  • Medications:
  • Medical Equipment:
7) Long-Term & End-of-Life Care
  • Age 60+, 100% Covered, $2500/yr deductable
  • In-Home Visiting Nurse Service
  • Home Health Aids
  • Hospice Care
  • Feeding Tubes
  • Narcotic Pain Medication
8) Catastrophic Illness & Injury Care
  • Age 0-80, 80% Covered, $5000/yr deductable
  • Intensive Care
  • Transplant Surgery
  • Major Reconstructive Surgury
  • High-Cost Life-Critical Medication

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