"Healthy Americans" Act: More Good news than bad?

Excerpts from an article by Steve Trinward that appears to have been censored at its original source

A new national healthcare plan was revealed this week, sponsored by Sen. Ron Wyden, a Democrat from Oregon. On first glance, it may appear to be just another variation on the Hillarycare model for socialized medicine, and in some ways it seems to be being promoted that way. However, this may be a case where marketing undercuts the reality, the way so many Hollywood films of recent vintage have done. (Who could have known how sensitive Adam Sandler's characters in Spanglish or 50 First Dates could be . based on the same old slapstick shown in the previews?)

Is it possible to craft a program that can blaze a path toward a true reform in healthcare? Let's find out, by examining the major ideas being brought forth in the Wyden plan. To begin with, let's summarize (details below): The Good News: (1) The program focuses strongly on wellness and prevention as a paradigm for healthcare; (2) It stresses self-responsibility, and offers a way out of the "employee benefit" box; and (3) It pushes for "portability" and individual ownership and control of that wellness. The Downside, at least for many libertarians, is: (a) how many mandates there are for government involvement in making this happen, requiring compliance from many segments of society, including those same individuals and their employers; (2) the fullscale trampling of the Tenth Amendment, mandating state creation of local coverage programs and monitoring of the results; and (3) perhaps most significantly, the lack of mention of Medical Savings Accounts, or other methods for funding self-responsible wellness, as part of its prescription.

Aside from this, however, there's a lot to recommend here. From the very first sentence, although the title is "Guaranteed Private Coverage," the explanatory statement following it (in the summary document) reads, "Within two years of enactment States must create a system as outlined in the bill to provide individuals the opportunity to purchase a Healthy Americans Private Insurance (HAPI) plan that meets the requirements of the Act." Notice how it says, "provide individuals the opportunity," not "require" them to; unless this is just more politico-speak, there's clearly some element of choice here.

On the other hand, the next section DOES use some coercive language: "Adults (over age 19, U.S. citizens, not incarcerated) must enroll themselves and dependent children in a plan offered through the state-wide Health Help Agency (HHA) [emphasis added] unless . [a laundry-list of specific exceptions]." It also then calls for a penalty for non-compliance, based on the period of such non-compliance times the average monthly premium for an appropriate plan, plus a 15% penalty, payable to the given state's HHA.

This seems coercive, and indeed it is; however, given the incentives for getting on board with the program, this might be considered almost forgivable. Note that the Senator does not mandate all of this in a vacuum. He begins by promoting the idea (long overdue, and presented several times in this space of late) that employers should stop providing health insurance for their hired hands, and should instead reallocate their funding of current programs to pay-raises, so the employees can do so themselves.

The catch is, those employees would then be expected to put that extra money into paying for their own health coverage, choosing among existing plans and those newly created under the program. The good news is, Wyden is encouraging self-responsibility for able-bodied, employable individuals, offering them an incentive to take charge of their own wellbeing. The bad part: As mentioned in the summary at the top, there's no reference anywhere in the document to medical savings accounts, or to combining high-deductible coverage with an MSA, or permitting any unused windfall (provided the person has maintained proper checkup and screening appointments, and been found hale and hearty thereunder) to become one's own "property" at the end of each year. Both concepts would not only allow for some intelligent decision-making for each of us, but would also enhance both cost savings and personal responsibility in the process.

There's also a very strong precedent already in place, in the existing employee programs at Whole Foods Company: The owner no longer pays insurance premiums, but pays the deductible amount on the policies of his workers - at the beginning of each year, and directly into their hands, to do with as they choose, while they remain responsible for maintaining their own wellness by whatever means possible. If at year's end, there is money left over, it's the employee's to spend as (s)he chooses. (Also, we might note, since this natural foods store-chain has both progressive and libertarian roots, one might think Sen. Wyden would already know of this program.)

As noted above, the Senator also would infringe further on the 10th Amendment to the Constitution, by mandating what each state should provide - "at least two plans that meet the requirements of the Act" - as well as in dictating what such plans may include: "(1) plans similar to the Blue Cross Blue Shield Standard Plan provided under the Federal Employees Health Benefit Program as of January 1, 2007; (2) plans with additional benefits added to the standard plan so long as those benefits are priced and displayed separately; and (3) actuarial equivalent plans to the standard plan." States-rights activists might not buy into this idea - however well-intended it may be - yet that intention is pretty clean on its surface......

An entire section of the HAPI plan addresses the division of "responsibilities" (thereby setting it far apart from almost every other government program within this editor's awareness). The requirements on individuals are simple: Enroll oneself and family in an approved plan, and pay the premiums required. If you wish to be subsidized for all or part of your premiums, you must turn in the proper paperwork, and keep the local HHA aware of any changing conditions or addresses. Otherwise, it's up to you to pay your premiums and use the services as needed. (Here's a chart showing the projected relative effect on various types of people in this plan.)

From employers, Wyden seeks an annual (relatively small, compared to paying health insurance premiums) administrative fee (based on the number of employees) and a transition from paying those insurance premiums, to paying workers more directly, so they can do so for themselves. (Companies above a certain size that aren't now providing such benefits would be expected to find a way to begin paying their workers some sort of increase, or suffer rather large fines. Here, the details are somewhat fuzzy.)

Moreover, says Wyden in no uncertain terms, "Individuals own their medical records." He wants us to start taking control of our own documentation, which is not all that burdensome, if we're getting regular preventive care from a chosen set of healthcare providers. (This chart shows the relative effect on various levels of employer-status.)....

And finally, the role of the Feds themselves is spelled out [paraphrasing here]: (a) fund insurance-premium subsidies; (b) establish a new "Healthy Americans Public Health Trust Fund" to feed with premiums and employer contributions (Wyden apparently believes in the "lockbox" concept that's worked so well for Social Security); (c) create a tax credits system for employees and employers who comply immediately with the new programs (as well as for retirement coverage); (d) create a Healthcare Standard Deduction for all citizens (mitigating or offsetting taxes on money spent on your own wellness), based on the level of coverage taken on; and (e) generally getting out of the way otherwise.....

Wyden also seeks to establish a baseline income-level, below which one would be eligible for total subsidy of such policy premiums, setting the current "poverty level" ($9,800 individual, $20,000 for a family of four) as that marker, with a sliding scale of subsidies extending up to the $40K ($80K per family) income-level. Again, by meshing a program that pushes people toward self-responsibility with one that subsidizes them directly, he tempts the fates to lose all perspective. Charitable work should not be conflated with pay-your-own-way and "hand up" ideas, lest both efforts be attenuated by the lack of clear intention.

Is this idea perfect? No, it still includes some very coercive features, which must be eliminated before it could truly become a self-responsible system. Does it address the major problems of the present healthcare mess? Yes, emphatically so. It also shows some promise for leading to a future where the vast majority of us are healthy, wealthy . and a lot wiser about what we do to our own bodies - that keeps them going longer, stronger and less in need of all that expensive "end-care" that is bankrupting us all. Senator Wyden is to be complimented on a very strong and extensive first step on this issue.

More here or here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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