Free Market Alternatives to Obamacare

cincychick35

As promised, here are some Free Market Alternatives to Obamacare and a Single Payer system.  I apologize for the cut and paste but I believe this WSJ article on Whole Foods provides some great examples (http://online.wsj.com/news/articles/SB10001424052970204251404574342170072865070) and is also very similar to H.R 3121 as introduced by the House Republicans, The American Health Care Reform Act (AHCRA) (http://communities.washingtontimes.com/neighborhood/allen-west-out-foxhole/2013/dec/9/president-and-media-ignore-conservative-alternativ/)

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.

snp605

Skimming through that I have to say that I agree with most of it. I have talked to a friend in the insurance industry and she has told me that due to insurance regulations, the idea of crossing state lines is nearly impossible. You have to be licensed by the state to sell insurance and I believe it went along the lines that every person involved with the customers at the insurance companies would have to get licensed in all 50 states and most states require those licenses to be updated yearly.

The last one is my favorite though. We have those stupid things on our tax forms asking us to contribute to the election funds, etc. Let people who say they want to help out and don't mind paying for others put their money where their mouth is and pay up.

chibiyui

Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

I definitely disagree with the bolded above. It's a combination of I think that allows for insurance companies to create loop holes, and also because I think there are some things everyone should have access too (the controversial one would be birth control and other pregnancy related services)

snp605 said:

Skimming through that I have to say that I agree with most of it. I have talked to a friend in the insurance industry and she has told me that due to insurance regulations, the idea of crossing state lines is nearly impossible. You have to be licensed by the state to sell insurance and I believe it went along the lines that every person involved with the customers at the insurance companies would have to get licensed in all 50 states and most states require those licenses to be updated yearly.

The last one is my favorite though. We have those stupid things on our tax forms asking us to contribute to the election funds, etc. Let people who say they want to help out and don't mind paying for others put their money where their mouth is and pay up.

As long as things like medicare and C.H.I.P are still funded, I don't have an issue with additional funds being procured through tax-donations. I would have an issue if this was the only way said services could raise money.

cincychick35

chibiyui said:

Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

I definitely disagree with the bolded above. It's a combination of I think that allows for insurance companies to create loop holes, and also because I think there are some things everyone should have access too (the controversial one would be birth control and other pregnancy related services)

snp605 said:

Skimming through that I have to say that I agree with most of it. I have talked to a friend in the insurance industry and she has told me that due to insurance regulations, the idea of crossing state lines is nearly impossible. You have to be licensed by the state to sell insurance and I believe it went along the lines that every person involved with the customers at the insurance companies would have to get licensed in all 50 states and most states require those licenses to be updated yearly.

The last one is my favorite though. We have those stupid things on our tax forms asking us to contribute to the election funds, etc. Let people who say they want to help out and don't mind paying for others put their money where their mouth is and pay up.

As long as things like medicare and C.H.I.P are still funded, I don't have an issue with additional funds being procured through tax-donations. I would have an issue if this was the only way said services could raise money.

A Free Market alternative means an insurance company could create several different plans to choose from in which an individual person, not the government, could decide what services they want covered.  A woman who is not of child bearing years would not need a plan that covers birth control or maternity care.

sandsonik

cincychick35 said:

 

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.

 

What legal obstacles are there to the creation of high deductible plans?  I don't really get that one, because high deductible plans are quite common, even in my heavily regulated state.

I have one.  It seems to me it makes for pretty poor health care, because nothing is covered.  There is a test I know I need - but I can't afford it.  The plan will help keep me from bankruptcy if I'm ever hospitalized but it doesn't help me much in the way of regular doctor visits and tests which might avoid hospitalization.  And there are very few companies like Whole Foods that pay 100% of anyone's premiums.

I have a question about this next part too: "Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care."

Are you saying that no one should be able to sue a doctor? No one else gets that kind of special treatment.  What is a person's recourse if a really negligent doctor hurts them and makes it impossible for them to support themselves?

 

And really it's all a moot point without two of the basic tenets of ObamaCare  - that companies can't deny people with pre-existing conditions and can't drop people when they get sick.   If those provisions don't remain, there's not much point in talking about free market alternatives that will insure everyone.

snp605

with regard to the high deductible plans: They tend to be quite a bit cheaper, with your cost savings theoretically you should have enough extra to pay for the test yourself. I mean if you can afford a monthly premium that is say two or three times per month what you are paying now then theoretically you should easily be able to pay for whatever test you need that falls beneath your deductible. Under the ACA your "high deductible" can't really be more than about $5000 per year. Also having to pay out of pocket makes you more of a consumer. Do you need a $15 tylenol or can it wait 15 minutes until you get home? Would you opt for a generic drug instead of the brand name? Would you negotiate your own cash discount for medical services? (people without insurance do this all of the time and most providers have *some* sort of discount for cash on the spot. These are ways medical COSTS can be at least stalled if not brought down. Simply having health insurance that writes a check so you don't have to does nothing to address actual cost issues.

It's really not the government's job to protect every single person from every peril that might befall them. I could get hit by a hit and run driver or a judgment proof drunk driver to where I couldn't work for a year. My medical bills might be covered but I would go bankrupt from my basic living expenses. Is there legislation to make sure that doesn't happen to me? I could get shot in a random drive by and end up permanently disabled, is there legislation to make sure I don't go bankrupt from that? Where exactly is the line drawn between what is ok to have happen to you that is bad and what isn't?

As a practical matter bankruptcy isn't the end of the world. People throw that word around like it's leprosy. Thanks to the recession I know quite a few people who went through it and while it wasn't fun, it's not the end of the world. Most kept their houses, their cars, etc. No one plastered a Scarlet B on their door and some have even 2 or 3 years later been able to sell and purchase new homes and get other types of financing. No one kidnapped their kids or showed up in the middle of the night and stripped their belongings from the basement. As a practical matter in most cases funds such as your retirement IRA,  pension etc are completely untouchable through bankruptcy so it's not like it burned the candle out on your end years.

With regard to tort reform,(I'm not so sure that this would really control costs that much FTR since I don't believe most doctors pass cost savings on to their patients) many of the proposed ideas don't say that you can't sue your doctor. They simply limit what you can recover. There are far too many people who think that because something bad happened to them and there is a doctor/insurance company with a deep pocket that this is their lottery ticket to never having to worry about anything again. Absolutely someone should be compensated and made as close to whole as possible. However, there are compensatory damages and punitive damages. I've long believed in most cases once you are compensated the punitive damages should go to a victims fund or other such entity that helps restore people who have not been able to be compensated by virtue of a lawsuit.

cincychick35

To add to SNP's comments.  High Deductible plans are designed for younger, healthier people.  

High Deductible plans and Health Savings Accounts go hand in hand:

A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan. It is the fastest growing type of health insurance plan in the country. The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds paired with either HDHPs or standard health plans. HSA funds may currently be used to pay for qualified medical expenses at any time without federal tax liability or penalty. However, beginning in early 2011 OTC (over the counter) medications cannot be paid with HSA dollars without a doctor's prescription.[3] Withdrawals for non-medical expenses are treated very similarly to those in an individual retirement account (IRA) in that they may provide tax advantages if taken after retirement age, and they incur penalties if taken earlier. These accounts are a component of consumer-driven health care.

Proponents of HSAs believe that they are an important reform that will help reduce the growth of health care costs and increase the efficiency of the health care system. According to proponents, HSAs encourage saving for future health care expenses, allow the patient to receive needed care without a gatekeeper to determine what benefits are allowed and make consumers more responsible for their own health care choices through the required High-Deductible Health Plan.

vlagrl29

DH and I have a high deductible plan because it is more affordable for sure!  We also have an HSA account so we can deduct medical expenses on our taxes every year.  We don't see the point paying out the ass in health premiums when we rarely go to the doc.

sandsonik

snp605 said:

They tend to be quite a bit cheaper, with your cost savings theoretically you should have enough extra to pay for the test yourself. I mean if you can afford a monthly premium that is say two or three times per month what you are paying now then theoretically you should easily be able to pay for whatever test you need that falls beneath your deductible.

Nice theory, but it doesn't work in reality. It would take me a long time to save $5,000.  Actually, I've never saved $5,000 in my life, so I wouldn't know!.  I'm making a lot, lot less than I was a few years ago so I'm doing my best just to remain insured. If neither my husband or I go to the doctor for a few years,  I might have the money I need for my problem, but I don't think that's the intention of health insurance - to intentionally ignore your health problem to save money.

 

I want to know where these labs and medical facilities are who will will work at a discount. In fact the opposite seems to be true.  I get a lower negotiated rate through my insurance than I could possibly expect to get on my own.  If I didn't have insurance, the standard rate for every procedure is much, much higher.

 

snp605

well my family premium via our employer plan was last over $1600 per month so I would take me less than 5 months to get to the deductible amount by not paying premiums. My husband on a lark ran the Obamacare model on our family in early December and we qualify for a subsidy for the Bronze plan which would bring our premium down to $953 with really high co-pays and deductibles.   The fact that you don't have the desire to save that money would indicate that it isn't really the priority to you that it might be to someone else. The reality is that hospitals and such would also work on a payment plan with you. My husband's ACL surgery hit us at a really bad time and he had to pay upfront for his cadaver part as well as his deductible It was several thousand dollars between the two. We simply called the business manager at the surgical care center he was going to and set up a payment plan prior to his surgery.  My pediatrician offers a minimum 35% discount if you pay cash/check at the time of the appointment. A local chain of urgent care type centers has a flat $85 rate for cash/check paying visitors. Whereas the rack rate for a visit that the inital rate for insurers is $150 and is then discounted to where you pay your co-pay of say $25 and your insurance pays $60 or so. There's not a huge difference other than the $800 individual premium you paid that month. A friend of mine had not maternity on her insurance a few years ago and her doc set a fee, she paid a monthly payment during her pregnancy. After the birth she worked out a negotiated bill with the hospital (and found several billing errors that she shouldn't have been charged that insurance would have just paid without question). She made a monthly payment to them and her credit was not negatively affected either. Had she had complications with the birth then her insurance would have kicked in under the emergency care provisions of her policy because they supercede the maternity exclusions.

Many pharmacies have huge discounted programs (Walmart's $4 program being one of them) that cover the most commonly used prescriptions. My grocery store has a bunch that are either free of $3.95 which include contraceptives, asthma meds, etc.

Check out American Addict for a look at how over-medicalized our system has become. The US is 5% of the world's population yet consumes 50 % of the world's prescriptions and  80% of the world's narcotics. This is not just druggies on the street. These are prescribed for our various ails and ills. 7 out of 10 Americans is taking a prescription medication daily. The #4 cause of death in this country is adverse reaction to prescription medications.

Not all "healthcare" is good healthcare. Just because a doctor recommends it or prescribes it doesn't necessarily mean it's the best course or route for you. Maybe you believe it is but I have a right to believe it isn't and not have to pay for you to get your every sad feeling erased by a couple of prozac.

vlagrl29

I love doctor discounts!  I always ask before I pay the bill.  We didn't have maternity insurance either after DD was born.  We had maternity when I was pregnant with her because I was on COBRA with my old job, but that soon ended. My Health insurance agent told me that the hospital I delivered DD at would do a contract rate with me as long as I carried health insurance of some sort, obviously it had to be paid ahead of time, but it was only $3500 for a 4 night c/section stay assuming there were no complications.  that was our plan for #2 before pregnancy was no longer a pre existing condition.

sandsonik

Why are you lecturing me about prescription drugs?  What makes you think I'm on any?

$1600 a month is more than my mortgage, there's no way I could afford that.  It would take almost every dollar I make.  Like a lot of people after the recession, I'm making 75% of what I used to make, so I'm on the cheapest health plan with the lowest benefits because it's all I can afford now. 

I will try calling the sleep study center and see if they will do payment plans, but I really don't think they'll do that.

Believe me, I'm well aware of what I need for my own health care.  I was diagnosed with severe sleep apnea before and the difference a cpap machine made was amazing.  I lost weight and was able to go off the cpap entirely for 13 years, though my diagnosis was still somewhat borderline.  Unfortunately, I've regained weight.   But it take a sleep study to get the prescription for another cpap machine and both are quite expensive.

 

 

 

vlagrl29

sandsonik said:

Why are you lecturing me about prescription drugs?  What makes you think I'm on any?

$1600 a month is more than my mortgage, there's no way I could afford that.  It would take almost every dollar I make.  Like a lot of people after the recession, I'm making 75% of what I used to make, so I'm on the cheapest health plan with the lowest benefits because it's all I can afford now. 

I will try calling the sleep study center and see if they will do payment plans, but I really don't think they'll do that.

Believe me, I'm well aware of what I need for my own health care.  I was diagnosed with severe sleep apnea before and the difference a cpap machine made was amazing.  I lost weight and was able to go off the cpap entirely for 13 years, though my diagnosis was still somewhat borderline.  Unfortunately, I've regained weight.   But it take a sleep study to get the prescription for another cpap machine and both are quite expensive.

 

 

 

I think they might and it doesn't hurt to ask.  There have been many times when I could not afford a doctor bill and was put on a payment plan with little to no interest.  I agree $1600 is high way robbery for a health premium.  Is there any way you can get on the exchanges.  I hear the plans are affordable if you have a low net income.