ObamaCare is on the ropes, and no one can say at this time whether the Democrats in the House and Senate will ship it to the President without Republican support. If so, Republicans might be handed a gift that will keep on giving. Or perhaps as Mark Steyn predicts, every issue in future elections would be about the level of government service as Americans become less self reliant and voters want more and more from the government.
Most agree that the current medical care distribution system is flawed. And there is fierce opposition to ObamaCare's "Public Option," i.e., government run medical service. However, there are alternatives to ObamaCare on the table. The other day we discussed Bob Inglis's plan. Link. The topic today is the "Patient Choice Act of 2009," a plan introduced last May by four Republicans -- Senators Tom Coburn, M.D. (R-OK) and Richard Burr (R-NC) and Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA.
The key component of the plan would be state insurance exchanges which would allow consumers to shop for and compare insurance plans. And the key word is "optional." Participation by states would be optional. Participation by insurance companies would be optional, and participation by customers would be optional.
In states which choose to participate, no customer could be excluded because of age, health or pre-existing conditions. "Plans participating in the exchange must offer at least the same minimum health benefits made available to Members of Congress," according to the summary PDF.
The exchanges must have a mechanism to avoid excessive premiums. And to protect uninsurable individuals, the exchanges would have to include independent risk adjustment, pools or reinsurance.
To help the customers pay the premiums the tax code would be changed to redirect the tax benefit from the employer to the customer as well as give a tax credit to the customer which could only be used for insurance premiums or medical expenses. Any excess could be rolled over at the end of the year. And the HSA contribution limits would be raised.
Go to Senator Coburn's Health Care Reform page for links to the bill, FAQs, a short summary, a long summary, a section by section summary, and just about anything one would want to know about it.
Aside: After having read through enough PDFs to make my eyes cross, I wonder how many Americans might be tempted to simply say "to hell with it," and go along with the ObamaCare government run program rather than have to read and choose from among several insurance policies. Well, there's a selling point for Dr. Coburn's proposal. States which put in place a smart exchange program will make the choice as easy as selecting a cell phone carrier.
Hey, it just might work.
Related: Bob Inglis's plan; David Goldhill's plan; Bobby Jindal's plan and John Mackey's plan.
Of course, if it's left up to the states, you can be pretty sure that Texas would not be one of them. Even if Texas did set up an exchange, very few if any of the insurance companies would be likely to join in. Even at that, it wouldn't address the fundamental problem, which is that the fee-for-service model under which we compensate medical care is fundamentally flawed. I suggest reading this article from "The New Yorker" about medicine in McAllen and the Valley: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Posted by: SWalkerTTU | August 22, 2009 at 01:26 AM
Lots of legislation comes through with neat little titles, most of which are rather ironic in that they have little to do with the subject of the bill. This one is a little better than average, but to call it the "Patient Choice Act" is a little disingenuous, since the patient getting a choice relies on the choices of state legislatures (controlled by special interests) and insurance companies (the special interests in control) before patient choice ever comes into the equation.
Posted by: SWalkerTTU | August 22, 2009 at 01:52 AM
Swalkerttu, the New Yorker article doesn't add anything useful to the discussion. Surely everyone knows by now that the current health care delivery system has some flaws. Unfortunately, there is no perfect solution.
As for an exchange in Texas, the state already has one. It's called the Texas Health Insurance Pool.
Posted by: Geo | August 22, 2009 at 06:38 AM
Sounds to me like just another menu of insurance companies and their rates, which is already available to anyone on the web.
It seems that the ones mostly in opposition to a government health care plan are those who have Medicare, which is a government run health care plan. I have also noticed quite a number of town hall meeting protestors who have said they have health care benefits subsidized by the government, but they don't want to have to pay higher taxes for others to have that benefit.
I think the bottom line is fear of chaning anything, even though people know we need changes.
Posted by: Lou | August 22, 2009 at 11:32 PM
Lou, the difference from the present would be the prohibition of denials for preexisting conditions plus the larger pool to spread the risk.
The people on Medicare are afraid that the funds to pay for some treatment they might need down the road will be redirected to pay for other aspects of the larger government program.
You are right, there does seem to be a fear of change, especially in this case when there's no confidence that the change will be for the better.
Posted by: Geo | August 23, 2009 at 06:21 AM
It depends what you wantTop bnfeeit coverIntermediate bnfeeit coverBasic coverWho it is to cover, single, couples, single parent, family. And if you want optional extras, such pregnancy and birth etc, and if you want to pay a excess fee or not. I am Medibank private member, with just Blue ribbon extra's and no hospital cover.
Posted by: Jessica | May 18, 2012 at 02:13 PM