I read through Senator Dianne Feinstein’s opening remarks on ACB’s confirmation hearings hoping to get more t-shirt ideas, but what I found instead was: I’m worried the healthcare law I passed is unconstitutional, and people will die as a result.
I differ from Senator Feinstein in this worry, because I am a user of our post-ACA medical system and can attest: It’s still broken.
My concern, therefore, is not whether a failed attempt at reform will stand up to court scrutiny, but whether we can get Congress to go back to the drawing board and come up with better solutions. Here are some possibilities to consider.
Pricing Transparency
It’s laughable to speak of managing health care costs when consumers are unable to know what their costs will be. We now have the technology necessary for care providers to publish their raw costing data, and for private app developers to then gather that data into usable information. Pricing transparency should include:
- List price for all procedures. Every medical procedure has a numerical code. You should be able to select the code and see what your provider bills.
- Negotiated rates for all providers. Every insurance company either pays the list price or pays a discounted “negotiated” price for “in-network” procedures. It’s impossible to know the real value of a given insurance plan until you see how your bill will vary depending on which plan your purchase.
Pricing Fairness
Customers who pay in cash at the time of service should receive the lowest price. This change alone would revolutionize our health care cost system.
Equal Tax Benefits for Part-Time Employees
Currently, the law favors employees who work full time with tax-shielded insurance benefits. Someone who works forty hours a week at a single job gets access to preferential health care benefits that someone who works forty hours a week at two part-time jobs does not.
Change the law to allow all employees, freelancers, contract workers, and business owners to deposit tax-free wages into a permanent, transferable, never-expiring personal healthcare savings fund that can then be used to purchase insurance and pay out-of-pocket expenses, including (when applicable) the right to access the same insurance plans available to their full-time coworkers. The savings fund would be specific to the individual, not the job, and would allow sheltered savings to be applied to any healthcare plan, whether employer-sponsored or not.
–> So for example, if you work three jobs, your tax-shielded savings would go into a personal account combining savings from all three jobs, and then you could choose to use your combined savings to opt-in to an employer-sponsored plan at any of your three employers — or purchase a plan on the open market.
This approach could help fill the gap for freelancers, gig-economy workers, and micro-business start-ups while still maintaining the benefits of a competitive healthcare market.
Legalize Solidarity
Currently there are strict limits on who you are allowed to count as “family” for healthcare purposes. Why not facilitate allowing individuals to help pay for the healthcare expenses of anybody they want to help? If I want to send ten dollars of my healthcare fund to top off my next-door neighbor’s insurance bill, why not? As long as my tax-shielded savings are going to the same exact, government-approved expense that the government would otherwise have to pay for, it’s far more efficient to encourage people to help one another on a local level.
Allow Citizen Opt-in to Existing Single Payer Plans
Your state government already has a single-payer system — it’s the one that your governor and other state employees benefit from. Why not simply open up this plan to all state residents? Individuals can opt to have their premiums deducted as an additional tax withheld from their paycheck, with the balance straightened up annually on the state tax form. Low-income and no-income families can pay on a continuous sliding scale, so that everyone receives the amount of financial assistance they need, with no cut-off moment that leaves families a-dollar-too-rich to be able to afford medical care. Multi-state residents can choose annually which state’s system they want to opt-in to; those relocating, which usually involves a change of employment, can simply transfer over to their new state plan if desired, or transfer onto a different private plan.
- By operating on the state level, state governments have an incentive to pass tax and regulatory incentives to fight unemployment.
- By opting-in specifically to the exact same plan the governor uses, governors have an incentive to make sure the health care the masses receive is fairly priced and offers quality care.
- By allowing all citizens access to a fair and comprehensive healthcare plan, there ceases to be any concern about whether any given employer-offered plan does or does not offer everything the state believes citizens need.
- By creating an opt-in rather than a compulsory plan, market forces will continue to encourage improvements in efficiency and quality of care.
What else?
I’m sure readers (combox is here) can come up with other suggested reforms — there are so many things broken in American health care that we could be decades reforming all the many ways the market is corrupt and non-competitive. And here’s the beauty of it all: It’s possible to have antitrust laws and social welfare laws that don’t create a constitutional crisis.
I would propose that if senators are concerned their laws won’t hold up to court scrutiny, perhaps there are other ways to achieve the proposed, laudable ends of those laws without running afoul of the Bill of Rights.
Photo: Capybaras, by Clodomiro Esteves Junior, via Wikimedia CC 4.0. I didn’t even bother looking for a healthcare related photo — seemed prudent to go straight to cute animals.
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