Obamacare supporters often charge that Republicans and other opponents only complain, without offering alternative solutions to address the problems with our current health care system. They claim that Republicans are opposed to any changes in the current system. This is absurd. Virtually everyone I know, Republicans, Democrats, and Independents alike, agree that our current system has problems that must be addressed; but, most also agree that the system should not be scrapped in favor of national health care. In fact, there are a half dozen or more proposed Republican health care bills that the Democrat leadership has so far refused to consider and the liberal media have ignored. Even President Obama has repeatedly said that his opposition has offered no alternatives. Although he maintains that his door remains open to any legislators who would like to offer alternatives, he has actually refused to meet with any Republican who has an alternative to offer. During his most recent televised address, the President completely ignored several Republicans who stood and waved their alternative proposals - partisan politics as usual.
So, in the hope that some Obamacare supporters are willing to transcend partisan politics, the following is a compilation of some of the alternatives that are commonly discussed in conservative circles, but receive scant attention by the liberal media and press. These proposals would go a long way toward solving the two greatest problems with our current health care system: decreasing the spiraling costs of healthcare, and providing healthcare insurance for those who cannot obtain or afford it.
• Transportability. Nearly everyone agrees that healthcare insurance should become transportable. Employees should be able to own their own insurance, and pay for it with pre-tax dollars just like the corporations now do. Employers could of course contribute toward the cost of this insurance just as many of them now do with employees’ 401Ks. Since individual employees, and not the corporations, would own the policies, the employees could take the insurance with them if they change jobs.
• Buying healthcare insurance across State lines. Again, nearly everyone agrees that individuals and corporations should be able to purchase health insurance from the most competitive bidder, regardless of State boundaries. Currently, most States prohibit the purchase of health insurance from any company that has not been pre-approved by the State. Such restrictions on purchasing health insurance should be eliminated. Purchase of health insurance should be open, just like automobile and property insurance. Some policies will be better or cheaper than others and the free market will sort them out.
• Pre-existing conditions. Again, nearly everyone agrees that people should not be refused health insurance coverage because of pre-existing conditions. There is no problem, of course with insurance companies offering a discount to healthy folks who don’t smoke, and do exercise and maintain proper weight, etc.
• Health Savings Accounts (HSAs) - this one is apparently controversial, because it is currently available and quite popular, yet all of the current legislation proposed by Democrats eliminates it. An HSA allows individuals and families to purchase catastrophic health insurance coverage, i.e., a very high deductible, while assuming responsibility for all health care expenses below the deductible. Except for small co-pays, health care expenses above the deductible are paid for by the insurer. The purchaser must then contribute funds into a Health Savings Account using pre-tax dollars. Once the purchaser has deposited an amount equal to the deductible, contributions can of course stop. The money in the HSA can be withdrawn, with no tax penalty, for certain expenses such as education, purchase of a home, or health care. When any amount is withdrawn, contributions must of course resume until the deductible is met.
• National Catastrophic Health Care Insurance (NCI). Again, the insurance would only cover catastrophic costs above a certain limit, and the purchaser would be responsible for routine costs below the limit. The coverage would be standardized and the implementation would be similar to the existing national flood insurance.
• Routine health care. The primary feature of both HSAs and NCI is that routine health care is paid for by the individuals, as opposed to the insurer. This feature has the great benefit of decreasing the overall amount spent on health care for the following reason. People who have only a small health insurance co-pay and/or deductible tend to go to the Doctor or the ER for minor problems; and, they have no incentive to object to, or even inquire about the need for, expensive tests and procedures. When such visits, tests, and procedures are paid for by the individuals themselves, as opposed to insurance, they visit the doctor less, and question the necessity of tests and procedures.
• No medical bankruptcy. Because both plans pay for virtually all healthcare above the deductible/limit, HSAs and NCI would both preclude any participant from ever being bankrupted by medical bills.
• Advantages of HSA. The advantages of HSAs over NCI are that the HSA savings are required and are made with pre-tax dollars. Additionally, once an amount equal to the deductible has been deposited, no further contributions are required. With the National plan, individuals would have to either pay the initial health care costs out of pocket, with after tax dollars, or use the ER.
• Tort reform. This is a complex process that must simultaneously protect the rights of individuals who have been harmed, while precluding spurious lawsuits. A reform that is often mentioned is that the fee collected by the suing attorneys should be limited. These attorneys should of course be reimbursed for all of their out of pocket expenses, but their fees should be capped, say at $1,000,000. Another reform might be to contribute any punitive damages above $1,000,000 toward providing indigent health care insurance, for example, rather than enriching tort attorneys. There are many other tort reforms to be considered, but the end result must protect the individual right to sue while ending spurious law suits.
• Living wills. For most of us, a huge proportion of our lifetime medical expenses will be encumbered during the last year of our lives. Other cultures allow you to die peacefully at home, in no pain or discomfort (drugged to the hilt if necessary), as opposed to undergoing terribly expensive, horribly intrusive, demeaning, and often painful, medical procedures. However heroic such medical intervention may be, I'll take the peaceful death at home, thank you. The primary culprits here are loved ones who cannot bear the thought of parting with the patient (particularly if the patient is young), urged on by medical personnel trained to save the patient at any cost. We need a nationwide campaign in the media, churches, synagogues, community centers, hospitals, rehabilitation centers, and nursing homes, etc. to convince everyone, especially those with terminal illnesses or conditions, to prepare a living will. A living will specifies the patient’s choices regarding various medical procedures, and thus spares loved ones the trauma of making those difficult decisions for them. Please note that I am not suggesting we require anyone to refuse care, and I am certainly not suggesting that any provider be required to deny care or procedures - only that the dying person should retain the option to refuse care and die with dignity.
• Local clinics. Emergency Rooms should be supplemented by local urgent care clinics, whose function it would be to provide routine care such as treating cuts, sprains, colds, flu, minor infections, etc. – more serious problems would be referred to ERs. Such clinics could be headed by Nurse Practitioners and/or Physician Assistants without the involvement or supervision of MDs or DOs (Federal and State regulations would have to be changed to allow this), and the required medical equipment would be minimal. Whether paid for by individuals, insurers, or public funds in the case of the indigent, the routine care provided by such clinics would cost a fraction of ER care. The clinics would also reduce ER overcrowding and allow ERs to treat emergencies as opposed to routine health problems.
All of these are ideas that could be enacted or encouraged by the federal government. All of them would greatly improve, yet be consistent with, the current system. No one would have to give up any benefits they already have. Most importantly, none of them require a national health care system.
Perhaps we will someday conclude that a national health care system is in our best interests. But let’s not be impulsive about reaching that conclusion. Let’s be prudent and proceed deliberately. Let’s debate the issues at length and hold a long and detailed national discussion. Let’s try to fix the problems before we consider scrapping the entire system. Let’s take some baby steps before we jump off the cliff. We do not have to do this immediately. This has been an ongoing problem for at least 25 years – it is not a crisis. We should address the issues rationally and sensibly. We must resist the attempt by the President and congress to rush through the biggest and most expensive legislation in our history without giving the nation a chance to consider options and understand the wide-ranging implications. Let’s take a deep breath, and really think about it.
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