There are some decent parts of it IF (and that's a big if) you swallow the line that the government should be in charge of health care. The worst part of it is the government math being used by both sides. I don't really believe that it will lower insurance bill, hospital bills, or doctor's bills in any significant manner. I also don't believe that it will kill the poor. They are all lying, and that's where we are in Congress today.
My personal thought is that we make it law that you cannot be turned down for an existing condition if you have not been without insurance for more than six months total or 4 months straight in the last two years. We let kids ride on their parent's policy until they are 26 IF they are in school. We make the over age 55 insurance no more than 5 times the cost of the age 20 insurance regardless of risk for the consistently insured. We mandate that they must offer at least one policy equivalent to the current "bronze" policy in every state they operate, beyond that, they can offer whatever they want as long as it is not fraudulent. We mandate state run high risk pool for the people who somehow just can't keep insurance and/or have serious pre-existing conditions and cannot get insured under the law, cap their cost at 5 times, and force insurers to write policies in the pool based upon their percentage of the normal policies written in a particular state. We mandate that for every level 3 and above ER a hospital group has, they open at least one urgent care clinic and staff at least one in a county or region 24 hrs per day. The clinic can run out of the same facility as the ER but must charge clinic prices. It does not have to be staffed by a MD 24-7. ER's may direct non-emergent cases to that clinic without penalty, and that clinic may be part of a trauma plan used by the local authorities. We mandate that medical providers cap prices for the uninsured/under insured at the highest negotiated rate paid by any state accredited insurance carrier with whom the payments under that contract constitute 5% or more of their business. That's the sum total of the egregious federal regulation.
We then allow insurers to compete with any policy across state lines. We allow them to deny ER payment for obviously non-emergency treatment like a normal cough or cold. We allow anyone who does not qualify for employer insurance to form or join a group based upon any affinity they choose and to collectively bargain for insurance coverage nationally. We cap punitive damages in medical malpractice cases at twice actual damages. We outlaw "certificate of need" practices by states and allow hospitals and clinics to compete based on price and quality. We allow medical providers to advertise their prices nationally and within states. We allow the corporate practice of medicine and allow PA's and NP's to see patients as a primary care giver and to prescribe nationwide.
We subsidize the high risk pool under-funding based on a $6,000 deductible policy (participants still probably qualify for the individual subsidy below) at 50% federally. States can choose to add their funds to that. We subsidize insurance costs for those below 200% of the poverty level for their household on a sliding scale from $1500 per person at or below poverty level to $700 per person subsidy at 180% pl . We do this using a refundable tax credit prepaid quarterly on a "EBT" like prepaid credit card that can be used only for healthcare insurance, direct healthcare, and prescription medications, and the balance can roll over indefinitely even if the holder no longer qualifies for new payments. We allow everyone in the fourth income quintile and below to write off medical and insurance costs they pay out of pocket over 10% of their income. We return Medicaid to pre-Obamacare regulations and levels and block grant the funding to the states. We provide "Pell Grant" like scholarships to medical students who promise to practice in poor and rural neighborhoods for six years after graduation. We somehow roll Medicare and Medicare taxes into this program over 20 years, hopefully saving it for the next generation. This is the total federal financial obligation.
States can now provide whatever additional help they see fit. If California wants to introduce single payer for Medicaid, go for it. If they want to raise the level of support for working families, go for it. Just use state money. The only thing they can't change is what is mandated above.
I'm probably being far more generous here than you would expect from a libertarian, but charity just isn't working anymore as the sole provider of indigent healthcare. No, we do not owe our taxes to anyone, and there is no such thing as "free", but until a better way of providing indigent healthcare comes along, the government probably has to be involved at some point, and taxes will have to pay for it. I mainly want the government REGULATION to lighten up to let the market work. Put the money into the hands of the customer, not directly into the hands of the insurers or the providers. Maybe they will shop around a little. One can only hope.
