Thursday, March 9, 2017

Alternatives to Obamacare (Part 2: A 12-Point Plan to Replace)

Abstract / Summary

      POINTS #1-5: CHANGES TO OBAMACARE: Repeal the individual and employer mandate, and other mandates. Repeal Obamacare in its totality, and replace it on the same day. Repeal the provision of Obamacare that lets people stay on their parents' insurance plans until they turn 26. Allow total state control over Medicaid and Medicare, advocating significant means-tested tax credits that are refundable for those living in poverty.
     POINTS #6-7: INCREASED ACCESSIBILITY OF INSURANCE: Expand health savings accounts. Make health insurance portable by addressing employer- and location-based discrepancies in coverage. Legalize the interstate sale and purchase of non-group and small-group health insurance. Account for the resulting need to increase policyholders' price leverage by allowing people to join into group insurance pools, including on the basis of profession or trade. De-link employment from insurance by keeping all types of health insurance taxes low, and dismantle health firms' privileges in order to curb cronyism.
      POINTS #8-12: INCREASED AFFORDABILITY OF CARE: Liberalize drug importation by reducing tariffs and patent protections. Repeal taxes on the sales and profits of medical devices to increase affordability and diminish the apparent necessity of tort reform. Repeal the Obamacare provision that prohibits denial of care on the basis of pre-existing conditions. Address the resulting pre-existing conditions coverage gap by encouraging state solutions, incentivizing free care through non-refundable tax credits, and allowing the implementation of professional consequences for breaking promises to never deny care on the basis of inability to pay.

The 12 Points

      1. REPEAL THE MANDATES: Stop playing political games, solve the issue already, and repeal all of the Obamacare mandates. Repeal the individual insurance purchase mandate, the employer-sponsored insurance purchase mandate, the minimum coverage standard mandate, and the benefit mandate in-full. Also address community regulations and the manner in which health insurance plans are categorized.
      2. FULL REPEAL, & REPLACE SAME-DAY: Repeal each of the even key provisions of the Patient Protection and Affordable Care Act. Repeal the entirety of Obamacare, and on the same day, replace the rest of Obamacare with Points #2-12.
      3. REPEAL THE 26-YEAR-OLDS PROVISION: Repeal the provision of Obamacare that requires health insurers offering family coverage to allow young people to stay on their parents' health insurance plans until they turn 26. Oppose Paul Ryan's proposed tax credits that benefit the elderly and married people, providing tax credits on a different basis.
      4. STATE MEDICAID SELF-DIRECTION: Oppose extending the expansion of Medicaid; but choose block-granting Medicaid to the states over reforming Medicaid at the national level. Allow states to reinstate Title 1 of Obamacare, and / or any other provision of the A.C.A. they wish. Allow and urge states to self-direct their own health policy and health plans. Urge states to explore private and non-profit solutions, as well as community-, worker-, and consumer-oriented solutions.
      5. STATE CONTROL AND TAX CREDITS: Allow states to choose whether to replace their Obamacare subsidies to extend Medicaid with state-level tax credits. Urge states to consider means-tested tax credits – deductions for health insurance premium expenses, as well as care-related expenses - refundable up to $5,000 annually for people who are living below the poverty level, regardless of whether they work, earn income, or are required to pay taxes, and regardless of their age or marital status. Federal and state poverty levels should also be raised significantly, so that refundable tax deductions may reach the lower middle class as well as the poor.
      6. EXPAND HEALTH SAVINGS ACCOUNTS: Make contributions to health savings accounts completely tax-free, and remove limits on the amount of money which can be donated to H.S.A.s. Make health savings accounts inheritable, accessible to families, and able to be rolled-over to family members. Make it possible for H.S.A.s to follow people throughout their lives, even from state to state and job to job; and allow people with H.S.A.s to enroll in lower-deductible plans.
      7. LEGALIZE INTERSTATE INSURANCE: Make health insurance portable for people who move to new states, lose their job, travel for a living, and are unemployed and non-employed. Legalize the interstate purchase and sale of small-group and non-group non-employer-sponsored health insurance, as well as small-workplace employer-sponsored insurance. Account for the resulting need to increase policyholders' price leverage by allowing people to join into group insurance pools, including on the basis of profession or trade. De-link / de-couple employment from insurance not by beginning to tax employer-sponsored insurance, but instead through lowering taxes on non-employer-sponsored insurance through means-tested refundable individual tax credits for health care and insurance expenses. Additionally, dismantle taxpayer-funded privileges and supports for health care and insurance companies, and restore the Enumerated Powers, in order to remove the temptation to pass mandates that let companies get away with high prices.
      8. LIBERALIZE DRUG IMPORTATION: Remove tariffs on, and barriers to, the importation of pharmaceutical drugs; lower importation fees will mean lower drug prices for patients. Give the Food and Drug Administration thirty days to approve Rx drugs that have been approved in other industrialized countries. Reduce the duration of time for which medication and medical device patents are enforced; this will help swiftly end prohibition on cheap knock-offs that may be safe alternatives to expensive name-brands. Oppose any and all measures which would aim to establish price transparency through compulsory means; instead, urge insurers to be more transparent about their prices and rates, and allow states to enact price transparency laws.
      9. REPEAL MEDICAL DEVICE TAXES: Repeal taxes on income, sales, etc.; replacing them with Land Value Taxation, in order to reduce tax burdens on ordinary people, including health care workers and patients. Most importantly, on hospitals that are trying to affordably purchase medical devices. Repeal taxes on the sales of medical devices and equipment, and repeal taxes on profits therefrom, in order to decrease prices. When hospitals can afford up-to-date equipment, they can diagnose diseases earlier. Oppose efforts to enact tort reform (medical malpractice reform); do not limit juries' abilities to award damages for non-medical traumas through legislative means. Instead, repeal medical device taxes, in order to help hospitals avoid medical negligence lawsuits brought on grounds that a practitioner's lack of up-to-date equipment impaired or hindered a proper diagnosis.
      10. REPEAL PRE-EXISTING CONDITIONS: Sick people primarily need care, not insurance coverage. Repeal the “consumer protections” provisions of Obamacare that prohibit health insurance companies from denying coverage on the basis of pre-existing conditions, and prohibits insurers from “overcharging” policyholders. Allow states to consider providing uninsured sick people with an 18- or 24-month transition period in which they can obtain coverage, or to consider prohibiting denial of coverage of afflictions which a health insurance customer does not already have. Don't prohibit denial of coverage; instead, increase sick people's ability to access care affordably by enacting Points #11 and #12.
      11. INCENTIVIZE FREE CARE: Health care workers don't show up at work because they look forward to denying people care; they want to do their job, and they want to help people. Allow doctors and nurses to decide whether to donate care for free, and enact non-refundable tax credits for health care workers who decide to donate care. Government doesn't get to tax or regulate a hospital if it doesn't generate any revenue. Let hospitals choose whether to operate on not-for-profit bases by refraining from charging people for, and profiting from, care. Do not subject non-profit hospitals to the same taxes and regulations that come with the territory of for-profit health care models.
      12: ADDRESS HIPPOCRATIC OATHS: If health care were free, then health insurance would be unnecessary. Make the health insurance industry obsolete, and health insurance coverage unnecessary, by allowing doctors and nurses to choose whether to submit to their Hippocratic Oaths. Urge health care network to implement guidelines that require the termination of health care workers who voluntarily vow not to withhold care on the grounds of inability to pay, but who then break their oaths by turning away people in need of treatment.

Written between March 7th and 9th, 2017

Edited March 10th, 2017

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