What Obama should have said in his 09-09-09 speech to the joint session of Congress was “I will send Congress a draft bill incorporating all the key elements of my healthcare reform plan including implementation details.” What he did was reiterate a collection of proposals from previous speeches on the subject leaving the details, to much laughter, for Congress.
He is playing a high-risk game staking his presidency and perhaps, in the 2010 elections, control of at least the House of Representative on passage of a reform bill. Should it fail, he can’t really blame the Republicans since the Democrats have clear majorities in both houses of Congress plus the White House. His safest bet would be appointment of a blue ribbon commission to prepare reform legislation with an up or down, no amendment vote of Congress.
What should a commission bill include? How about the following:
1. Funding for any reform or future revision must meet accounting standards, be actuarially sound and use appropriate criteria for forecasts of costs. That is, the sources of funding – private or government – must be transparent, reasonable and not add to the national debt.
2. To reduce the inevitable benefit creep that has caused solvency problems for Social Security and Medicare, require a super majority of Congress (perhaps two thirds) to add/delete/increase/decrease any healthcare benefit mandate.
3. Individuals, not the government or employers, should be responsible to pay for their own medical costs. They may do this by purchasing insurance directly or through associations using tax deductions and personal funds depending on the amount and patient choice.
4. Send medical bills to the patient who must review and forward within thirty days to the insurance provider who must pay the bill to the limit of the policy within sixty days. This provides a user audit and appreciation of the costs of care.
5. Standardize and simplify claim forms and bills. Attaching a bill to a one page basic information form should be the only requirement to submit a claim.
6. Require some level of co-pay for every use of the healthcare system to discourage over use and serve as a reminder that healthcare is not free.
7. Define healthcare expenses to include physical and mental primary care, specialists, hospitalization and prescription drugs.
8. Make healthcare insurance mandatory with a minimum coverage at least for major medical including high cost care resulting from accidents, major surgery and chronic illness such as diabetes, MS and Parkinson’s. Basic preventative care such as breast, prostrate, colon and skin screening should also be required. The government can subsidize the cost for the truly indigent.
9. Use tax-free health savings accounts to pay for less expensive or not covered services such as dental, elective procedures and co-pays.
10. Coverage for alternative healthcare (Chiropractic, Naturopathic etc.) or more comprehensive allopathic medicine should be offered at extra cost.
11. Medical malpractice claims should be settled through arbitration with right of appeal to an appeals court. Awards will be limited to actual loss plus legal fees except that loser pays all legal costs.
12. Insurance companies may sell their policies in all states and territories. State insurance commissioners could recommend national standards.
