Obama's 2008 health care plan with several (minor) changes

Feel free to correct me if I'm wrong, and maybe it may be beneficial to actually link to his 2008 campaign plan, but Obama's plan essentially guaranteed a few things:

1. People could not be discriminated for preexisting conditions.

2. There would be no mandate, except for children.

3. There would be financial assistance for the poor.

4. There would be a public option.

Of course, the criticism from now Secretary of State Hillary Clinton and Paul Krugman was that if you do not mandate health insurance while giving a guarantee for preexisting conditions, no healthy person would sign up for health insurance until they got sick. Thus, only sick people would sign up, healthy people would no longer want health insurance both for the lack of incentive and now the increased costs because the pool now includes sick people who can get coverage, and thus health insurance companies would just fold.

This was a compelling argument at the time, and it was one I accepted and thus supported now SoS Clinton.

Now, I think I was wrong and here's why:

In 2008, we did not know the outcome of what is now derisively regarded as RomneyCare by some on the right and the left. I posted a survey here (I'll concede only 5 people responded thus far) for both residents from shall-issue states with no mandate and Massachusetts. The only somewhat negative response was from one of our friends in MA. Everybody else described positive experiences, and as a former New Jersey resident I believe them.

In hindsight, I think I now realize why the supposedly market-based plan in Massachusetts, the one that would cure our health care crisis via a capitalistic mechanism failed. It failed because it was an unfunded mandate or in other words an unfunded quota. It now takes longer to see a primary care doctor in Massachusetts than it does in Canada (the country known, somewhat accurately - I am a Canadian citizen, for long wait times). Why is this? Because Canada funds, via its single-payer system, its mandate for universal health insurance. Massachustts simply legislates universal health insurance, washes its hands, and takes a step back.

So if the Massachusetts plan has had some glaring weaknesses, why repeat it as a national model (now that the public option)? Additionally, it seems as if we are going to add a supposedly nonprofit co-operative that will get some starter money from the government and then be on its own. Funny, but that sounds a lot like a health insurance version of Fannie Mae to me.

I'm not bashing Paul Krugman or Hillary Clinton. They (and I) had a valid concern that a guarantee of coverage without a mandate would result in a total market failure. However, I now believe that those concerns, and the concern of potentially an uninsured having a catastrophic event and then being without care and possibly a burden on the state, can be addressed without totally discarding then Senator Obama's proposal on health care.

What if we took then Senator Obama's plan and made about 17 minor changes:

1. Guarantee coverage for preexisting conditions, but only after 13 months of continuous coverage or the date of the reform's enactment, whichever is earlier. This will of course be in line with all of the guaranteed issue states current laws and would remove any incentive for healthy people to game the system. It is not reasonable to find out you just got cancer or your arteries are clogged and just wait idly by for the 13 months, all while you now have to pay the health insurance premiums.

2. Create a government insurance program that doctors and hospitals have the option to pay into that will cover all bad debt by legal residents or visa holders and by all people, regardless of legal status, receiving emergency care or in labor. Make all government guaranteed debt not dischargable through bankruptcy, except if the debt exceeds $75,000, the individual is now over 67 (Medicare age), or the individual has been adjudged disabled for a period of over 13 months by Social Security.

3. Expand the protections under EMTALA to now guarantee any medical treatment for any legal resident or visa holder without regard to ability to pay. Doctors, but not hospitals, that elect not to use government debt insurance will be excluded from this guarantee. Hospitals, since they practically cannot determine immigration status, cannot turn away any illegal immigrant that arrived in labor or to the emergency room. These protections would effectively make this country officially a universal health care country.

4. Increase funding to staff the Social Security disability office so they can adjudicate claims of disability and appeals within 3 business days after evidence is provided by doctors. For those unaware, and correct me if I'm wrong on this, Medicare is also included for individuals on Social Security disability. If Cash for Clunkers can process claims timely, why can't Social Security?

5. Create a short-term disability insurance program through Social Security that can be processed within 1 business day. If you cannot work for 3 months, because you have been hospitalized and are recovering from surgery, you should get some sort of living stipend. Also, include Medicare coverage for these individuals for the approved duration of disability time.

6. Give Medicare to individuals with conditions that may not prevent an individual to work but if left untreated are determined to have a high probability of death within 13 months. Proposals 4, 5, and 6 possibly may only benefit the insurance companies who now don't have to outlay for expenses now covered by Medicare. But in reality, this paradox already exists for insured individuals who later develop a condition that would qualify them for Social Security disability.

7. Make Medicare eligibility instant for all disability claims from the date of filing and abrogate the 2 year waiting rule. It is simply not fair that those who have done hard drugs and bummed around get Medicaid retroactively because they now have schizophrenia, but those that have worked have to wait two years for eligibility. The 2 year waiting time also prevents needed care for those on disability who may become well and productive if they received this care.

8. On that point on how Medicaid is retroactive, but Medicare has a two year wait time for disability, why is it that those in prison get free healthcare but those on the outside who work and obey the law sometimes are unable to get healthcare? This is not a proposal for reform and not an endorsement of the quality of prison healthcare, but just an observation.

9. Define specifically the contribution requirements that push a disabled individual from Medicare to Medicaid eligibility and remove any gaps that preclude a disabled individual from both Medicare and Medicaid, specifically any rules related to asset levels. However, continue to allow those eligible for both Medicare and Medicaid, because of accrued work experience and low asset level, to keep both Medicare and Medicaid.

10. Levy a tax on private health insurance companies to fund Medicare based upon net income with prior year losses allowed to be carried over indefinitely. Under this proposal, and actually currently because of Medicare eligibility both for disability and also for seniors, health insurance companies get away with not paying a lot of our health insurance costs in America because so much of the costs for health care is absorbed by Medicare and other public safety net programs. In fact, even though we don't have universal health care yet, the government still pays almost 50% of health care costs already. To compare, Switzerland and France only pay about 60% of health care costs and have better health outcomes. This tax would compensate the government for picking up the tab for life threatening and disabling conditions from private insurance.

11. Open Medicare to all legal residents and visa holders eligible to work, but at an extra premium and only if they are currently having withheld in payroll tax at least what a full time worker on minimum wage would pay or have withheld. Employers must contribute what they would contribute for their most expensive private health insurance plan offered, up to the cost of the extra premium. Having employed and thus generally healthy and able-bodied contribute to Medicare can only bode well to assist for the costs incurred by the elderly and the disabled. Those individuals on this plan who are laid off without cause and then collect unemployment would, just like COBRA, be eligible to pay 35% of the extra premium while unemployed, but not have to pay the payroll tax of course, and would still keep their coverage for up to 18 months.

12. Grant Medicaid without cost to all people, single or married - with kids or without kids, who are below the line of poverty and on a sliding scale premium for those above the poverty line but below 300% of the poverty line who have no other insurance program. Also grant Medicaid without cost to anyone laid off without cause on unemployment for the duration they are receiving benefits if they are using no other insurance program.

13. Reinstate VA health care eligibility for all veterans discharged under other than dishonorable conditions. Our veterans deserve health care to be provided by the country they served regardless of how successful they later become in life.

14. Require private insurance companies to offer supplemental coverage that is equivalent to any products they offer for those covered by S-CHIP, Medicare, Medicaid, VA health care, TriCare, or military care in the event that these governmental health care programs cover less than private insurance. Require that prices are individually set on a calculation of potential benefits provided by governmental plans versus potential benefits of the private plan. People on governmental plans deserve the right to buy into the private insurance market at an affordable price without duplicating their governmental insurance.

15. Require any individual with two or more health plans (except for supplemental plans like MediGap plans), including two governmental plans, two private plans, or one governmental and one private plan, to be able to add their entitled benefits together up to the full cost of the procedure. Calculation of benefits from insurance must be additive and not multiplicative since the individual has earned the right to use both non-supplemental plans.

16. Continue to allow the VA to bill private health insurance to recoup costs and expand this principle to all governmental health programs, with the caveat that any extra money recouped must go into a trust fund designed to pay for future medical bills for the veteran community (or for the equivalent insured group). The money recouped belongs to the veterans (or to the equivalent beneficiaries), not to a government bureaucracy.

17. Allow all children to be able to enroll in S-CHIP on a sliding scale premium based upon the income level of the guardian(s). Every child deserves to get health care regardless of their guardian(s) stated wealth.

Let me know what you think.