How about THIS health care reform idea?

Harvard economist Martin Feldstein proposes a different approach to health care reform. Under his plan, the government would just ensure that everyone has catastrophic health care insurance that would kick in when you spend 15% of your income on medical expenses. Below that, you would pay, either for the times you go to the doctor or for an extra insurance policy. This would be much cheaper than the proposed pay-for-everything plan. I’ll let him explain it:

A good system should not try to pay all health-care bills. That would lead to excessive demand, wasteful use of expensive technology and, inevitably, rationing in which health-care decisions are taken away from patients and their physicians. Countries that provide health care to all are forced to deny some treatments and diagnostic tests that most Americans have come to expect.

Here’s a better alternative. Let’s scrap the $220 billion annual health insurance tax subsidy, which is often used to buy the wrong kind of insurance, and use those budget dollars to provide insurance that protects American families from health costs that exceed 15 percent of their income.

Specifically, the government would give each individual or family a voucher that would permit taxpayers to buy a policy from a private insurer that would pay all allowable health costs in excess of 15 percent of the family’s income. A typical American family with income of $50,000 would be eligible for a voucher worth about $3,500, the actuarial cost of a policy that would pay all of that family’s health bills in excess of $7,500 a year.

The family could give this $3,500 voucher to any insurance company or health maintenance organization, including the provider of the individual’s current employer-based insurance plan. Some families would choose the simple option of paying out of pocket for the care up to that 15 percent threshold. Others would want to reduce the maximum potential out-of-pocket cost to less than 15 percent of income and would pay a premium to the insurance company to expand their coverage. Some families might want to use the voucher to pay for membership in a health maintenance organization. Each option would provide a discipline on demand that would help to limit the rise in health-care costs.

My calculations, based on the government’s Medical Expenditure Panel Survey, indicate that the budget cost of providing these insurance vouchers could be more than fully financed by ending the exclusion of employer health insurance payments from income and payroll taxes. The net budget savings could be used to subsidize critical types of preventive care. And unlike the proposals before Congress, this approach could leave Medicare and Medicaid as they are today.

What would you think of THIS plan?

And let me add another point for discussion: Would you rather just have what we have now for health care, or do we need some kind of reform? And if we have to have a health care reform measure, what kind would you prefer?

Trimming the deficit via health care reform?

The latest health care proposal is touted as saving the government money:

A health-care reform bill drafted by the Senate Finance Committee would expand health coverage to nearly 30 million Americans who currently lack insurance and would meet President Obama’s goal of reducing the federal budget deficit by 2019, the nonpartisan Congressional Budget Office said Wednesday.

The bill would cost $829 billion over the next decade, but would more than offset that cost by slicing hundreds of billions from government health programs such as Medicare and by imposing a 40 percent excise tax on high-cost insurance policies starting in 2013.

All told, the package would slice $81 billion from projected budget deficits over the next 10 years, the CBO said, and continue to reduce deficits well into the future.

It would also expand coverage to 94 percent of Americans by 2019, the CBO said, up from the current 83 percent.

I’m curious what they are cutting out of Medicare. If it’s just paying less for services, that will mean even fewer doctors will take Medicare patients than do now. And this is an even bigger tax on the “cadillac plans” that many Americans enjoy and soon won’t have than was announced earlier. And for all of this, the percentage of Americans now having health care insurance will go up only 11%? Still, Congress seems giddy to have come up with a plan that will actually cut the deficit, so this might be what we end up with, though details of the legislation have yet to be spelled out.

The caps on chromosomes

It’s Nobel Prize season, a time to salute good scholarship and, even more, to marvel at the structures built into nature that the winners have discovered. This year’s Nobel prize for medicine goes to three scientists who discovered how chromosomes stay together and keep their integrity even after the cells split. It seems the strands of genetic material have little caps on their ends:

Elizabeth H. Blackburn of the University of California at San Francisco, Carol W. Greider of Johns Hopkins University in Baltimore and Jack W. Szostak of Harvard Medical School in Boston were awarded the $1.4 million 2009 Nobel Prize in Physiology or Medicine. It was the first time two women shared the prize. . . .

The scientists won for a series of experiments they conducted in the 1970s and 1980s that showed that the long, intricate molecules known as chromosomes, which carry genes inside every cell, have protective structures on their ends — often likened to the plastic tips on shoelaces — called telomeres, which are replenished with an enzyme dubbed telomerase.

The work “solved a major problem in biology” and has led to groundbreaking insights into the aging process and potentially to new treatments for cancer and many other health problems, the Nobel Assembly said.

“This is a fundamental biological mechanism,” said Rune Toftgard of the Karolinska Institute.

In time and after multitudes of cell divisions, those caps degrade, leading to the degeneration of the cells, as we aging folks are experiencing. Knowing about these caps mean that some of those effects might conceivably be reversed, and knocking off the caps might help us defeat the uncontrolled cell division that is cancer.

But those caps are absolutely necessary for life and reproduction. I suppose an atheist materialist would have to say, “Isn’t it lucky that chromosomes randomly generated those little caps?”

But surely this is an example of irreducible complexity. Those little caps couldn’t have evolved, because to have evolution, you must have reproduction. These are necessary for reproduction, which means they have must have first appeared fully-formed.

Do you have “Cadillac” health insurance?

To help fund the proposed health reform measures, lawmakers are thinking about imposing a stiff tax–up to 35%–on so-called “Cadillac” health insurance plans. Those are defined as individual plans valued at $8,000 per year, or family plans valued at $21,000.

They typically have low deductibles, cover vision, and dental. Such plans are usually just described as “good benefits,” or “I’m really pleased with the health insurance that our company offers.” Such “Cadillac” plans are not just for high-paid executives. They are common in union contracts.

Wouldn’t taxing these good insurance benefits mean that fewer companies would offer them? Wouldn’t this result in people having poorer health care than they currently have? Doesn’t that work against the stated purpose of health care reform? How can taxing excellent plans be justified? Don’t lawmakers understand that the prospect of having worse health care than they did before the reform is what makes people leery about their tampering?

Health care reform as a barrier to abortions?

I posted about this possibility before, but now pro-abortion folks are getting nervous about health care reform. The Atlantic blog reports that the laws against taxpayer money going for abortion may well mean that if health care reform gets passed, insurance companies would have to stop covering abortions:

Some of the supporters of health care reform have rediscovered worries about crowding out.  That’s because it now looks as if the bill may not allow Federal subsidies to be used to buy insurance that covers abortions.  Suddenly, a big chunk of the left sounds like a bunch of Republicans, warning about what happens to insurance markets when the government gets involved:

Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.

Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.

The question looms as a test of President Obama’s campaign pledge to support abortion rights but seek middle ground with those who do not. Mr. Obama has promised for months that the health care overhaul would not provide federal money to pay for elective abortions, but White House officials have declined to spell out what he means.

Wouldn’t that be a good outcome?

UPDATE: Senators are fighting strengthening the anti-abortion provisions, but, as I understand it, so far the ban against federal funding would stand. See also this.

A cleaned-up Health Care Reform proposal?

So would you support this bill?

The chairman of the Senate Finance Committee said Monday that he will propose an overhaul of the nation’s health-care system that addresses a host of GOP concerns, including blocking illegal immigrants from gaining access to subsidized insurance, urging limits on medical malpractice lawsuits and banning federal subsidies for abortion.

But see a new worry raised in this same story below. . . .


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