I propose the following topic of discussion: If you were doing a healthcare reform bill of your own, and could craft it however you like, how would you do it?

As a starter, and in competition to Obamacare and Boehnercare, I present Bigwoodycare:
-Under this bill, basic health insurance will be compulsory for all citizens.
-All private insurance companies must offer basic insurance (covering only major treatments, similar to what a public option will cover in the US) on a no-profit basis. That is, if they make a profit off their plan one year, they must commensurately reduce premiums the next year. This assures affordable insurance for all.
-Private insurance companies may offer premium plans on top of this basic plan on a for profit basis (i.e. dental coverage, not in the basic plan).
-Health insurance covers the costs of medical treatment and hospitalization of the insured. But, the insured does pay part of treatment costs. This is from an annual deductible ranging from $300 to $2500 (chosen by the insured, premiums adjusted accordingly), as well as 10% of all treatment expenses, capped at $700.
-The basic health insurance plan premium may only be up to 8% of a person's income. If it is more, then the state will provide a subsidy for the remainder.
-All adults 25+ pay the same insurance rate (shared burden amongst young and old). 19-24 pay a slightly reduced rate, 18 and under pay a significantly reduced rate.
-Tort liability is capped at its current level. For individual hospitals, their tort liability cap will be reduced in line with reductions in treatment costs, so long as their success metrics remain the same or improve.

So there you have it. It doesn't even have a public-run plan. Yes, I borrowed generously from other systems.

No kidding you borrowed a lot, this part is the Swiss system

But, hey, that just makes it better, since you can say it's been tested.

I definitely like this idea. There are things I'd rather see on top of those, but honestly, the nation is not me and I think that these are things the US could agree on relatively easily.

It's one way to operate payment reform, though I'm concerned about the difference between "basic" and "premium." We are going to suffer mandate creep, where basic increasingly covers more and more services, and I'm not confident about America's ability to control it. It looks like it will reduce administrative costs quite a bit, but it will still have the general inequity issues that everyone complains about (just a basic and assured level of protection under it).


Most importantly, I'm not convinced it will control costs. A large chunk of US health care cost prices seem to be dependent on providers that are incredibly inefficient and have substantial pricing important. If you read one of the articles that I posted in the other read, a number of countries also control prices for providers as well to combat this problem...but even in the US, if we were to have this, we still have pretty inefficient healthcare providers in general that often make lots of medical errors.


I'm willing to accept a wide range of payment solutions, perhaps even including single payer, as long as we take the provider problem seriously. I think we can still operate on a private insurance market pretty efficiently, but it's not big enough issue compared to fixing the hospitals and the doctors offices. Or so it seems to me. And on that, I have no easy solutions.

Basic care is fixed. It only changes if there is some massive change in care methods. See the Swiss implementation.




Yes, this is a simple model. Although my tort reform solution, giving incentives to hospitals to control waste spending, helps towards this goal.


Part of the problem with private insurance in this country is the lack of regulation has let things run rampant. Denial of coverage is too easy. I picked a system shown to work, with better outcomes for a lower price. Its not perfect, but its a starting point for a debate.

I'm not trying to diss your idea, man

I'm only saying it addresses one aspect of the problem, and that is the payment reform. Which, while important, gets a bit overblown, IMO. We have a serious health care problem in general, and merely changing the payment system isn't going to change that very much. Tort reform MAY help, but even if it does, I'm not convinced it's going to be very big, and I'm CERTAIN that it's not going to cover the difference between US healthcare and OECD healthcare in general.

And not all of it is hospitals being monopolies, but also hospitals and providers being straight-up inefficient. There is really no one in America that can say "This is good healthcare, this is bad healthcare." We have medical journals, but there are thousands of articles published every year, so doctors aren't up to date on best practices. Radiologists that practice in isolation aren't as good as ones that have constant review and can miss tumors up to 20% of the time. Doctors don't cooperate on patients that have multiple chronic conditions, so they don't work together and end up working at cross-ends.

One of the major narratives I've read is that while the rest of the economy has had major innovation in production techniques over the past several decades, US healthcare has been much less innovative.



Now, in terms of practical politics, I'm willing to accept a lot in payment reform, because while I consider single payer to be unnecessary and bad, I don't consider it to be overwhelmingly important. I just want the other end of the trade, too, which is promoting innovation in health care.

I'd be okay with a system with a public and private options that basically run as non-profit institutes. One important feature would be its ability to cut costs with providers, since ultimately that IS what brings down costs. And also what could hold down costs too vis-à-vis a single payer would be offering different kinds of premiums (still providing at LEAST basic levels of care), but also providing an incentive and a form of rationing against non-important health care visits. However, I would still maintain and think that achieving better price setting would be done with a single payer, and at the very least be helped out by a not-for-profit robust public option choice, preferably one with Medicare + 5% payments. BUT, the advantages of a single payer would be, not only do you remove the transaction cost of the insurance companies, and their profit-motive, denial of care and bureaucratic waste, but you also remove a huge part of bureaucratic part on the end of hospitals and doctors, in the form of endless amount of time dealing with insurance companies both with the doctor and in the payment section of hospitals. Thus, you'd likely see an increase in productivity and availability of doctors, increasing their ability to see patients (less waiting times, for example). I do like the idea though of charging people some kind of entrance fee for some compensation in regards as a barrier/self-rationing of care. However, I would in practice envisage a single-payer system able to hold costs of providers down better than insurance companies, and thus this is something I favor.

I think Bigwoody's plan is a decent enough starting point and is not half bad. However, I would include a public option available to cover all people who are not covered by any private insurance. I don't believe in forcing them to accept all people (pre-existing conditions and such things) and as a result the only real thing to do would be to provide a public option to cover all who are not insured by private insurance, much as flood insurance down here in Houston is a public insurance, because it would simply not be profitable to have private insurance covering everything some things need to also have public insurance as an option.

What if the reason the people don't have insurance is because they didn't want insurance in the first place? Some people are like that, you know.

I would like to add to it, especially: Computerized Medical Records. Really, it would clear up a helluva lot of inefficiencies within a hospital, save doctors time otherwise tied up in dealing with the hassle of paper records, etc.

Very important.

And they shouldn't be like that... maybe if they seclude themselves to some area and take nothing from society it's fine, but if they expect to be treated at a hospital then they should at least have insurance, provided they can afford insurance (homeless and such would not be able to afford it, of course). Simply because if someone can afford insurance but they don't have it and then they need a major surgery and head to the emergency room then they will cost all other people who go to the hospital because the hospital cuts them a break and passes along a lot of the costs to other people, if the person would have been insured then his costs would not have gone to the other patients.

Some people just rarely ever get sick. They would rather risk coming down with a major illness (which isn't exactly a 50/50 chance, either) than have to pay $600/month for insurance that they will possibly never need. It makes sense financially, actually.

Meh, care insurance is mandated, I don't see why health insurance shouldn't be mandated. Just because you don't think you'll get sick doesn't make it so, everyone can get sick and as a result everyone should be insured.

Car insurance is mandated so that if a person is at fault for the accident, the person who wasn't at fault doesn't have to pay for the other person's mistake if the person at fault doesn't have money to pay. My father always used to say "you can't get blood out of a turnip", meaning there's no point in suing someone if they don't have the cash to pay the suit.

And plus, if you haven't gone to the doctor's in six years, then that's upwards of $21,000 you saved. So what's their incentive? Even if they have to see the doctor once a year, they still end up saving $20,000 easily. (Going at $300/month for health insurance, which is insanely cheap.) Now, if there were insurance for, say, $40/month that covered the major stuff, then maybe they might be willing to get it. But otherwise, they save money not getting any insurance at all.

another argument for mandating insuirance even for people who wouldn't orginarily get it is so that if they get hit by a car, taken to hospital, and given emergency treatments, the hospital still gets paid, rather than having to pursue them for money they don't have. In the process, we lower the cost of medical treatment for everyone, because the hospital no longer has to find a way of writing off the money it can't recover.

Ok... so if that person who saved 20 thousand dollars suddenly gets cancer he could surely pay for all the treatments himself and not need insurance, right? I mean, surely he didn't spend that 20 thousand dollars that he "saved" for other things, who would do that?


Thanks, that is what I was trying to argue as well.

Oh, so if they didn't have the money for the hospital visit, then what makes you think they had money for the insurance? And besides, according to Obama, the doctors are just in it for the money, why, then, are you so worried about the doctor being paid?

Those people always come begging for help when something goes wrong.

The same reason why I have the money to pay my mortgage but not to buy a house all in one go.



when did Obama say "the doctors are just in it for the money"? If this is according to him, no doubnt you have a source of him saying this or words to this effect.

I explained fairly clearly why this is a good thing for medical costs in general. The money a hospital cannot recover from the uninsured patient, it will pass on to other patients in the form of higher costs.

Why mandate that a private insurance company cannot make a profit off their product? There's then no incentive to compete with the other insurance providers, since it's really less hassle to make their plan less attractive than their competitors. That's what will make the basic insurance unattractive: no one will want to put the effort into it. And no one will want to make it efficient. And there will be no incentive for the insurance provider to keep the doctors honest:

Who cares, just pay it. It's not going to be on our heads. If we come out behind, we'll raise premiums next year. Maybe people will stop using our plan so we don't have to put up with this !@#$.

Well for those people who really can't afford private insurance there should be a public insurance option available where they would only need to pay a certain percentage of their income. This way if they are truly poor they will have an affordable insurance option available. Doesn't Medicaid cover many of the ultra-poor similarly?

Not everyone can even afford a house. Hell, people who have one probably couldn't afford it in the first place. (Hence our current recession and the bank bailouts.) What are, say, bums supposed to do? They can't afford insurance; they can't even afford a clean cardboard box to sleep in at night. How about the people living in the projects/ghetto, are they just supposed to magically find two grand to pay for insurance?



I do actually have a source:

http://www.youtube.com/watch?v=SG56B2et4M8
http://www.youtube.com/watch?v=ZhNeGYYPgIE

Aren't those implying that doctors are so greedy that they would rather have your tonsils or leg amputated because it saves them money, thus saying that they are only in it for the money?

And let's use my brother as an example. He recently underwent a CT scan for his back because he was having massive back problems. None of us can afford insurance and, in fact, can't use credit cards due to bankruptcy. You know what he did? He called the hospital and they offered to let him pay over time. Golly jee, who would have ever thought that a hospital would let you pay over time??

No, sir, a public option to kill America financially even more would not be wise.

1) the analogy I was making was that payments in installments are easier to find than lump sums.
2) it's a good point about poor people, if only there were a government provided healthcare safety net

I don't know of many hospitals or doctors who won't let you set up a payment plan with them to pay off medical bills. I've done it before.

If taxes are not increased accordingly then I do agree, but seeing as many nations with public options have not been bankrupted by them I don't see why the U.S. would necessarily need to be financially killed by a public option. Knowing America though I can see where you are coming from... it is unfortunate that you guys can't seem to ever have a surplus or at least a balanced budget.

Besides the major health costs are already paid by the government via medicare and medicaid. Having a public option to cover people with pre-existing conditions on top of the very poor and the old won't cause too much more costs for the government.

1. Yes, you are right. Fortunately, [most] hospitals are more than willing to accept installments if you can't afford lump sums.
2. As long as the government option doesn't turn into a monster (which is is today, ironically), then go for it. Unfortunately, almost every project, including simple projects such as road construction, almost never end up being a 'small' cost.

and if and when you declare bankruptcy to get out from under the payments, they take a loss and pass it on to everyone else.

True. I'm just rectifying your payment plan with the fact you can get payment plans.

So what is being instituted is basically a payment plan that you cannot escape with the shield of bankruptcy. The government is just allowed to be more ruthless than someone you actually owe money to.

I'm just killing time until someone responds to my real post.

Compulsory health insurance. I wouldn't it. Goes against my principles. Not health care, but the fact that something should be compulsory. Just ain't right.

Are you against breathing RV? You shock me.

Don't compare biological processes to politics. There ain't no comparison. Health care ain't cheap you know. You got to spead a lot of money on it. Granted I would if I had the money since I enjoy living, but forcing people to determine where to put there money? That's just all sorts of wrong there. This is about freedom

Very well then. You are against taxes? That...actually doesn't really shock me. No offense.

Since you asked, here's my idea to fix the problems with the U.S. healthcare system.

I'll keep it under 1900 pages

1) Eliminate any government provisions (mandated services for basic coverage, restrictions in cross-state marketing, etc) that interfere with the free market. Fixes cost issues caused by government mandates

2) Make personal health care expenditures for insurance 100% tax deductible. Breaks the cycle that has made 3rd party healthcare payment so common in the country

3) Allow up to $5000/year to be saved tax free in a medical savings account, rolling over year after year - most such accounts now are use it or lose it. Builds portability and savings while people are younger and healthy

4) Encourage the use of such accounts (#3) for all health care expenditures combined with high deductible insurance. Puts individual consumers back in charge of their spending decisions and promotes self rationing and yes, healthy living -- no other plan out there I've seen does this.

5) To further encourage savings/self rationing, at the end of each year, allow each year 20% of the saved balance from that year's contributions in a medical savings account to be withdrawn and used for any reason completely tax free. Further encourages savings & self rationing

6) Create a "liability table" that caps non-monetary damages for any liability. Participation is voluntary, but those who participate can expect reduced rates from medical service providers. For example, lets say the table defines "loss of life" as a maximum award of $30 million in the case of 100% negligence (such as the doctor performs surgery drunk). If the doctor in such a case is found to be 50% negligent then the max award for non-monetary damages is 50% * $30M or $15M. This should reduce costs

7) Reform medicare/medicaid and other government provided services to follow the model above -- that is, government will put money into an MSA and pay some premium for private insurance catastrophic coverage for those who can't afford health care. Reduces cost of government services

8) Expand #7 to cover those with preexisting conditions and other issues so that the government option is the option of last resort. There should be some means testing/buy-in based on ability to pay. This improves universality of coverage.

My idea has been to provide people with basic health insurance that covers all major medical issues, based on income. Some people can afford it, and they do not need a government handout. Those who do not have insurance are sol if they need medical treatment.

Exclude persons who drink, smoke, do drugs, or are inactive for reasons other than medical conditions. Employed persons get priority.

You're no fun.

I guess I would need to be stuck with private care then, no way I'm going to not drink alcohol every now and then.

As a matter of fact I am against excessive taxation.

excessive? What about Income taxes in general? I would think that you are entirely against them as they are oppressive and evil and socialistic.

They still have to buy it. This is my plan and I decree it to be so.


Those people who rarely get sick should pay their share. If they DO get sick, they're covered! If they don't, it helps cover those who do. In fact, people choosing not to get insurance, then getting sick and having those paying in cover THEM is part of how we are in this mess.

What would YOUR healthcare reform look like?

A small income tax perhaps, for the maintenance of an army. Although most of the defending ought to be done by militias independent of the government. Point is the government has no business in health care. Furthermore it has no right to force people to get it. Freedom of choice buddy.

They aren't a large enough to group to be relevant.

I know I'm going to get a sh*tstorm thrown at me for saying this but I believe that Healthcare should be ran by the free enterprise system and regulated by the market.

The idea is have healthcare in the yellow pages like car insurance, you look for the best deal offered. It breeds competition, gives the companies incentives to offer better plans and services than the other guy and fight to keep costs lower than the other guy. Capitalism at its finest.

But some butthurt Communist will say "Waaah what about the poor people?" Ok there is charity and state ran clinics. I seriously doubt if you have health problems and you go to the hospital they're not going to let you lay there and die. You won't get quality treatment but you'll be treated none of the less.

You mean exactly like it is right now? The setup that really doesn't work at all and provides a horrible quality of care and thousands of medical bankruptcies?

great idea

Do you know who pays for the poor people's hospital care?

If you have health insurance, you do.

Yeah I know who does. Tax payers.

But I'm not about to impliment that everyone goes on the same plan. Either way you slice it the very poor are always going to be left out regardless if it is a Capitalist or Socialist society. The facts of life are that you can't help everyone.

13 million of the uninsured have incomes of 50k+.

14+ million more qualify for Medicare or Medicaid, but aren't enrolled in them.

40% of the uninsured are between the ages of 19 and 29.

I repeat my previous statement. $50,000 isn't as high as it sounds, particularly if you are trying to get a policy for a family of 4. People who qualify for programs but aren't enrolled don't necessarily not WANT the program, but just don't know how to enroll/are too lazy. And 20-somethings don't usually have a lot of purchasing power to begin with.

If it were a family of 4 with a combined income of 50k, it wouldn't be "13 million without insurance have personal incomes of 50k+". It would be, 13 million without insurance are in families with combined incomes of 50k+. There is a vast difference.

As to enrollment knowledge/laziness, this is a hypothetical. There is a very real chance a large percentage of those don't want to take on 5-10k extra a year for the health insurance, and the bill in its current form is simply going to offer another option, and appoint a table of bureaucrats who will punish the individual with fines/jail time if they continue on their current path.

And if 20-somethings don't have the purchasing power to afford a 5k private plan, how are they going to have the purchasing power to afford a 5k public plan?

So be it, just don't expect my vote.



Let's have universal car insurance then as well. Hell, let's just abolish income completely and have the state decide what everyone should be paid! Oh wait, that sounds like a Communism.. Seriously, paying MY fair share? I am paying MY fair share when I go to the damn hospital. The problem is that you think that I should be forced to pay for everyone's problem. I pay my fair share when I pay taxes, I pay my fair share when I go to the movies, I pay my fair share when I go on vacation. Are you seriously suggesting that I should be forced to pay for everyone's taxes, everyone's movie tickets, and everyone's vacation? What about the poor people who can't afford car insurance, should I have to pay for that as well? What about the poor who can't afford life insurance? Where do we stop? This is a capitalism, not a !@#$@#$ communism. Communism failed and capitalism didn't. The only reason our capitalism is failing is because it's no longer a free capitalism, it's being $%&@ed up by the state.



My health reform? I would abolish it. It's not constitutional at all. I would probably make it easier for individual states to have health care systems, but the federal government is constitutionally wrong by making such a policy. This senator is right, though, there is no place in the constitution where it says that the government has the right to regulate health care or even regulate education. Actually, I highly doubt that anyone who made the constitution wanted government-regulated education in the first place.

So you want huge tax breaks? Ok, that's a $900 billion tax break right there ($1.05 trillion if this law is passed), another several hundred billion for education... we could actually pay off the nation's debt in two decades or less if we dumped this massive government spending programs!

So, you get to kiss your rights goodbye if you're not with the majority opinion these days?