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Digging Into My Modest Election-Year Proposal For Healthcare Reform: Part 3 — Driving To Affordable Universal Access

This blog is one in a three-part series that digs into my modest proposal for healthcare reform published at this site on May 27, 2024. See that blog here to review my proposal thoroughly: https://www.healthcarelabyrinth.com/a-modest-election-year-proposal-for-healthcare-reform/ .

Much of my proposal is taken from my book, The Healthcare Labyrinth, available at this site and through leading bookseller websites. It is available in print, ebook, and audiobook forms. This blog has information from Chapter 28 of my book — “The Right Healthcare Reform Solution.”

Driving to affordable universal access

“… Let me add that the health and vitality of our people are at least as well worth conserving as their forests, waters, lands, and minerals, and in this great work the national government must bear a most important part.” – Teddy Roosevelt, The New Nationalism Speech, August 31, 1910.

In my “A Modest Election-Year Proposal For Healthcare Reform” blog on May 27, 2024, I stressed that the cornerstones of reform are three key tenets – driving affordable universal access, reforming price, and pivoting to care management (CM) from our obsession with utilization management (UM). This week I cover the need to drive to affordable universal access.

In the May 27, 2024 blog, I told you about the three types of developed-world healthcare systems – socialized medicine, single payer, and private affordable universal access. I indicated that each could both be cost-efficient and have quality outcomes. Today, America has a patchwork system that has neither affordable or universal access. The system leads to high costs, administrative waste, and duplication. I also noted that the United States spends the most on healthcare as a percentage of gross domestic product (GDP) but has the worst outcomes of any developed nation.

Given private delivery’s success in other developed nations, I propose that the United States adopt a system rooted in private affordable universal access. Private plans would run the healthcare system with regulatory direction from the Centers for Medicare and Medicaid Services (CMS) and other state and federal agencies. I think CMS should take the lead in most areas to ensure coordination across what would be a few lines of business.

While a burden on business, I believe we should continue with our employer-sponsored coverage foundation. There are a few reasons: As I noted in Part 1 of this blog series, price reform would help reduce costs for business and end cost-shifting to employer coverage. That would also make coverage more affordable. Employer coverage is also reasonably popular among Americans. Last, ripping employer coverage apart would mean huge upheaval in the system as a whole.

The problem is that there is a solid percentage of Americans – I round it to about 25% to cover both the uninsured and underinsured — that do not have a consistent or strong nexus to employer coverage. They are some elderly and disabled that are uncovered and do not work. Some go in and out of the job market. Some have low incomes and cannot afford premiums and cost-sharing.

As such, I propose that we create one master safety net healthcare program that serves these folks. The system would have sliding scale premium and cost-sharing subsidies. For lower income families, the subsidies could be used either for employer coverage or the safety net program.

I am open to maintaining the Medicare program side by side with this system given the sicker cohort the program serves and its complexity. But a case can also be made that the single social safety net program would be most stable with all remaining non-empoyer populations in it.

The one master social safety net program could be sponsored by the federal government or be a state-federal partnership like Medicaid and some Exchanges. The traditional fee-for-service (FFS) Medicaid and Medicare systems would go away in favor of a private delivery model as we have in Medicaid managed care and Medicare Advantage (MA). If Medicare remained free-standing, I think the traditional system should likely go away anyway.

Most Affordable Care Act (ACA) protections would stay in place, including community rating, pre-existing condition protections, preventive services, and benefit mandates. I propose to modify the generosity of some of the benefit mandates.

In more rural areas, rate-based participation incentives similar to what is in MA today as well as reinsurance and rate corridor programs (like occurred in the Exchanges) would be put in place. Fair risk adjusted rates would also be a cornerstone. If Medicare remained free-standing, additional paticipation incentives could be passed to further increase MA penetration to cover all Americans with good choices.

Employer and individual mandates would exist. Tax credits for small business would also be available.

What would be accomplished if my proposal is adopted?

  • We finally would have affordable universal access that prioritizes coverage. Coverage will eventually reduce costs in the system as people move to less costly healthcare interventions as opposed to crisis inpatient and emergency room services.
  • We would conquer the issue of the uninsured but of the underinsured as well. Combined, these total about eighty-five million Americans or about 25% of the population.
  • We would eliminate tremendous duplication and administrative costs in the healthcare system. Today, this costs billions of dollars per year.
  • My proposals on price reform could be more easily implemented.
  • With better and more stable coverage for all, the shift from utilization to care management could be successful.

Sound familiar? Some of the proposals mirror various historic proposals, including RomneyCare, HillaryCare, and Obamacare. But the proposal has most in common with a proposal by President Richard Nixon back in the 1970s. You could say I cribbed a bit from Nixon here.

Nixon was somewhat of a trailblazer on healthcare, including supporting and ushering in the HMO Act of 1973 as well as Nixon’s universal healthcare access proposal in early 1974. He had proposed a partial remake as well in 1971, which would have mandated employers provide health insurance and started federal affordability subsidies for workers. Nixon resigned during the Watergate scandal in August of that year, killing any chances for his plan to pass.

What I find fascinating about Nixon’s healthcare proposal is his compassion for the less fortunate, which is not unlike that of another Republican president, Teddy Roosevelt, who also proposed universal healthcare access in his 1912 run as the third-party Bull Moose Progressive candidate.

To conclude this blog, I post relevant parts of Nixon’s special message to Congress on February 6, 1974 on his healthcare proposal. The full text is available at a link at the end of the blog. Note the references to high prices and major inflation. Note his discussion on a segment of the population that is disenfranchised from healthcare. Note the concern about the lack of comprehensive coverage and how people are underinsured. Even then, Nixon saw it as a crisis. Here is hoping the time has come for healthcare reform some fifty years later. Here is hoping the healthcare views of the two GOP presidents I quote in this blog rub off on members of my own party.

“One of the most cherished goals of our democracy is to assure every American an equal opportunity to lead a full and productive life.

In the last quarter century, we have made remarkable progress toward that goal, opening the doors to millions of our fellow countrymen who were seeking equal opportunities in education, jobs and voting.

Now it is time that we move forward again in still another critical area: health care.

Without adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial, and social barriers not stand in the way of good health care as it is to eliminate those barriers to a good education and a good job.

Three years ago, I proposed a major health insurance program to the Congress, seeking to guarantee adequate financing of health care on a nationwide basis. That proposal generated widespread discussion and useful debate. But no legislation reached my desk.

Today the need is even more pressing because of the higher costs of medical care. Efforts to control medical costs under the New Economic Policy have been met with encouraging success, sharply reducing the rate of inflation for health care. Nevertheless, the overall cost of health care has still risen by more than 20 percent in the last two and one-half years, so that more and more Americans face staggering bills when they receive medical help today:

–Across the Nation, the average cost of a day of hospital care now exceeds $110.

–The average cost of delivering a baby and providing postnatal care approaches $1,000.

–The average cost of health care for terminal cancer now exceeds $20,000.

For the average family, it is clear that without adequate insurance, even normal care can be a financial burden while a catastrophic illness can mean catastrophic debt.

Beyond the question of the prices of health care, our present system of health care insurance suffers from two major flaws:

First, even though more Americans carry health insurance than ever before, the twenty-five million Americans who remain uninsured often need it the most and are most unlikely to obtain it. They include many who work in seasonal or transient occupations, high-risk cases, and those who are ineligible for Medicaid despite low incomes.

Second, those Americans who do carry health insurance often lack coverage which is balanced, comprehensive and fully protective:

–Forty percent of those who are insured are not covered for visits to physicians on an out-patient basis, a gap that creates powerful incentives toward high cost care in hospitals;

–Few people have the option of selecting care through prepaid arrangements offered by Health Maintenance Organizations so the system at large does not benefit from the free choice and creative competition this would offer;

–Very few private policies cover preventive services;

–Most health plans do not contain built-in incentives to reduce waste and inefficiency. The extra costs of wasteful practices are passed on, of course, to consumers; and

–Fewer than half of our citizens under 65–and almost none over 65–have major medical coverage which pays for the cost of catastrophic illness.

These gaps in health protection can have tragic consequences. They can cause people to delay seeking medical attention until it is too late. Then a medical crisis ensues, followed by huge medical bills–or worse. Delays in treatment can end in death or lifelong disability.

COMPREHENSIVE HEALTH INSURANCE PLAN (CHIP)

Early last year, I directed the Secretary of Health, Education, and Welfare to prepare a new and improved plan for comprehensive health insurance. That plan, as I indicated in my State of the Union message, has been developed and I am presenting it to the Congress today. I urge its enactment as soon as possible.

The plan is organized around seven principles:

First, it offers every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits;

Second, it will cost no American more than he can afford to pay;

Third, it builds on the strength and diversity of our existing public and private systems of health financing and harmonizes them into an overall system;

Fourth, it uses public funds only where needed and requires no new Federal taxes;

Fifth, it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the Federal Government.

Sixth, it encourages more effective use of our health care resources;

And finally, it is organized so that all parties would have a direct stake in making the system work–consumer, provider, insurer, State governments and the Federal Government.

Comprehensive health insurance is an idea whose time has come in America.

There has long been a need to assure every American financial access to high quality health care. As medical costs go up, that need grows more pressing.

Now, for the first time, we have not just the need but the will to get this job done. There is widespread support in the Congress and in the Nation for some form of comprehensive health insurance.

Surely if we have the will, 1974 should also be the year that we find the way.

The plan that I am proposing today is, I believe, the very best way. Improvements can be made in it, of course, and the Administration stands ready to work with the Congress, the medical profession, and others in making those changes.

But let us not be led to an extreme program that would place the entire health care system under the dominion of social planners in Washington.

Let us continue to have doctors who work for their patients, not for the Federal Government. Let us build upon the strengths of the medical system we have now, not destroy it.

Indeed, let us act sensibly. And let us act now–in 1974–to assure all Americans financial access to high quality medical care.”

–Richard Nixon, Special Message to the Congress Proposing a Comprehensive Health Insurance Plan, February 6, 1974.

Full text of Nixon’s message in 1974: https://www.presidency.ucsb.edu/documents/special-message-the-congress-proposing-comprehensive-health-insurance-plan

#healthcare #healthcarereform

— Marc S. Ryan

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