[Epaphras]

Thought of this the other day:

Why not expand Medicaid to include anyone, except after 200% of poverty-level, you pay a premium of 1% of annual income? Everyone continues to pay into the trust fund, but if you opt for the "public option" you pay an additional, modest premium -- and they can't deny you.

200% of poverty is about $28,000. Below that, you qualify for Medicaid. Above that, well as it stands -- good luck. But under this scheme, if you make $35,000 but are uninsurable or otherwise can't afford private insurance, your premium would be $350 a year, or $30 a month. If you make $70,000 your premium would be $700 a year or $60 a month. Maybe even add in a modest co-payment to help with costs too -- in Germany most people pay $15 a quarter.

Maybe make it 2 or 3% if 1 percent is unsustainable. Anyone know some quick math to figure out what % would be needed to make this work?

Too simple?

[JerryLove]

The total cost of healthcare is something like $7000 per (insured) person (I suspect the uninsured cost more). 300-million-people means we spend $2,100,000,000,000 ($2.1 trillion) per annum.

Of course, such figures fail to account for money already being spent (such as on medicate or medicare), nor savings from UHC. But if we were lumping all healthcare monies together into one pot, that's what the total has to be currently... because that's what we are spending.

[nolidad]

Originally Posted by Epaphras

Thought of this the other day:

Why not expand Medicaid to include anyone, except after 200% of poverty-level, you pay a premium of 1% of annual income? Everyone continues to pay into the trust fund, but if you opt for the "public option" you pay an additional, modest premium -- and they can't deny you.

200% of poverty is about $28,000. Below that, you qualify for Medicaid. Above that, well as it stands -- good luck. But under this scheme, if you make $35,000 but are uninsurable or otherwise can't afford private insurance, your premium would be $350 a year, or $30 a month. If you make $70,000 your premium would be $700 a year or $60 a month. Maybe even add in a modest co-payment to help with costs too -- in Germany most people pay $15 a quarter.

Maybe make it 2 or 3% if 1 percent is unsustainable. Anyone know some quick math to figure out what % would be needed to make this work?

Too simple?

I think this would be great if the govt. kept their hands away from it. Allow someone like blue corss to run it- if they can make savings- they keep the savings.

Teh only problem wiht Medicare/Medicaid is that the govt. takes the trust fund and use it for the general budget. I believe this or next fiscal year Mediacare is going to spend more than it takes- we only have Federal iou's in the trust fund so we either add to teh deficit or raise taxes to covfer the new deficit because Medicaid will be draiwng on its trust fund and there are no funds to draw on.

Other than that-it could work.

[JerryLove]

Originally Posted by nolidad

I think this would be great if the govt. kept their hands away from it. Allow someone like blue corss to run it- if they can make savings- they keep the savings.

Yes. It would be wonderful to expand a government program as long as the government isn't involved.

Teh only problem wiht Medicare/Medicaid is that the govt. takes the trust fund and use it for the general budget. I believe this or next fiscal year Mediacare is going to spend more than it takes- we only have Federal iou's in the trust fund so we either add to teh deficit or raise taxes to covfer the new deficit because Medicaid will be draiwng on its trust fund and there are no funds to draw on.

I don't think that's the only problem, but it certainly is a huge one.

[nolidad]

Originally Posted by JerryLove

Yes. It would be wonderful to expand a government program as long as the government isn't involved.

I don't think that's the only problem, but it certainly is a huge one.

well we keep the govt. involved- just making sure the contractor is doing their job.

Well Medicare like every other plan has problems- but the fact that this or next year we are going to see the deficit explode because medicare is going to drawing onthe surplus that is no longer there is enormous for the sake of the country. That is why th epoliticians should craft the bills then send them out to be enforced in areas like health care.

[Epaphras]

Originally Posted by nolidad

Teh only problem wiht Medicare/Medicaid is that the govt. takes the trust fund and use it for the general budget. I believe this or next fiscal year Mediacare is going to spend more than it takes- we only have Federal iou's in the trust fund so we either add to teh deficit or raise taxes to covfer the new deficit because Medicaid will be draiwng on its trust fund and there are no funds to draw on.

Medicaid covers the second-most expensive group of the insured (besides the elderly), and they don't contribute anything besides meager FICA taxes from their paychecks (if they have one). When you make the program available to a huge segment of middle-income, relatively-health individuals paying premiums, chances are that as a group they won't cost the system more than they contribute. In fact, the premiums could be configured so that it's ensured that they contribute more than they take out.

The worst you'd end up under a scheme like this would be a system that is revenue-neutral for the middle-income group, and running a deficit for the low-income group. That's exactly where we are now...except that middle-income earners would be able to access affordable health coverage independent of an employer, and without risk of being excluded for pre-existing conditions -- which doesn't exist now. And like I said, their contribution could be configured to off-set the high cost of the lower-income group (existing). You could even allow middle-income enrollees in Medicaid 2.0 to get a tax credit for their FICA contributions, since they are already paying a premium.

I think a lot of people would jump at the opportunity to get affordable health insurance independent of their employer and without the threat of a pre-existing condition.

[ICTHUS]

Originally Posted by Epaphras

Thought of this the other day:

Why not expand Medicaid to include anyone, except after 200% of poverty-level, you pay a premium of 1% of annual income? Everyone continues to pay into the trust fund, but if you opt for the "public option" you pay an additional, modest premium -- and they can't deny you.

200% of poverty is about $28,000. Below that, you qualify for Medicaid. Above that, well as it stands -- good luck. But under this scheme, if you make $35,000 but are uninsurable or otherwise can't afford private insurance, your premium would be $350 a year, or $30 a month. If you make $70,000 your premium would be $700 a year or $60 a month. Maybe even add in a modest co-payment to help with costs too -- in Germany most people pay $15 a quarter.

Maybe make it 2 or 3% if 1 percent is unsustainable. Anyone know some quick math to figure out what % would be needed to make this work?

Too simple?

This sounds like a great idea.

In British Columbia, we pay into something called the Medical Services Plan (MSP). MSP coverage is required by law for all BC residents, and the rates are:

$54 /month for one person
$96 for a family of two
$108 for a family of three or more

The premiums are govt. subsidized according to income according to the following scheme.

Adjusted Net Income	Subsidy Level	One Person	Family of Two	Family of 3 or more
$0 - $20,000	100% premium assistance	$0.00	$0.00	$0.00
$20,001 - $22,000	80% premium assistance	$10.80	$19.20	$21.60
$22,001 - $24,000	60% premium assistance	$21.60	$38.40	$43.20
$24,001 - $26,000	40% premium assistance	$32.40	$57.60	$64.80
$26,001 - $28,000	20% premium assistance	$43.20	$76.80	$86.40
Over $28,000	Full Rate	$54.00	$96.00	$108.00

System works relatively well here. Just some food for thought, Epaphras, such a system as you describe is already more or less in place in this province (except for people who make 28k or more with a family of 3+ they contribute about 4.6% of their income to health care, but presumably/hopefully a family of 3 would have much more income than 28k/year)

[Epaphras]

In continuing thinking about this, a proposal like this would not require new departments or programs -- it would simply scale-up an existing program -- and it would also require only amending existing law, not drafting new legislation ripe for pork. The delivery and process systems are already in place, down to the county-level. Seems like a no-brainer to me.

I know this doesn't address Medicare. Maybe merging both Medicaid and Medicare into Medicaid 2.0 would be a solution -- so you could either look at it as making Medicaid available to higher-income earners, or making Medicare available to people under 65; the end-result is the same. Currently the public system provides care for the lowest-income and elderly populations -- the two most-expensive groups. Everyone pays but only those groups benefit. If everyone not only paid but could benefit from it, it would help dilute the enormous costs of Medicaid and Medicare, since more people would be paying in than paying out (you would have control over that in fact -- whereas now you'd have to get a FICA tax increase through Congress to make it self-sustainable: good luck with that!).

Of course, we also need to STOP borrowing from the Medicare/Medicaid/Social Security piggy-bank. That plus bringing in new revenue sources (middle-income earners under 65) will help stabilize the system and hold off the bankruptcy for a lot longer, hopefully until the Boomers die out.

[redbaron]

Ryan, just curious as to where all the money above the $54/mo for a person making 28k comes from. I'm assuming it has to come somewhere out of corporate or personal income taxes, but that's just a guess.

[Than]

People going to bat for private insurance companies (especially Blue Cross/Blue Shield) is the clearest cut case of Stockholm Syndrome I've ever seen.

[ICTHUS]

Originally Posted by redbaron

Ryan, just curious as to where all the money above the $54/mo for a person making 28k comes from. I'm assuming it has to come somewhere out of corporate or personal income taxes, but that's just a guess.

What exactly do you mean? Like, how does the system pay for costs over and above the total revenues collected from MSP premiums?

I'm not sure whether MSP runs a deficit or not and has to draw funding from other provincial programs.

*edit* Yeah, the premiums offset the costs of delivering health care by a little bit, but health care in BC still receives provincial funding (responsibility for health care is the domain of the individual provinces and territories, although mandated by Federal legislation)

[Epaphras]

Originally Posted by ICTHUS

What exactly do you mean? Like, how does the system pay for costs over and above the total revenues collected from MSP premiums?

I'm not sure whether MSP runs a deficit or not and has to draw funding from other provincial programs.

Just a guess, but if I were designing the system from the ground-up, I'd do it this way:

Based on a) current health measures of the population and b) the cost of medical services, figure out how much health care for any given individual will cost in a year; for an adult, for a child, male/female, age, etc. Then average all that together. Figure out the average cost for a single male, and single female (across all-ages). Then for a family size of two, base it either on two adults, or one adult one child. Then for three and up, assume one adult or two adults and the rest kids.

Once you have all those numbers, figure out (based on population figures) how much your population "costs" in health care in a year. Add to that budget projections for emergency room treatments and such -- what the trauma centers in your community would need resource-wise to provide care for a given geographic population -- including contingencies/forecasts for natural- or man-made disaster scenarios. Subtract from that any money coming in from the federal government (in our case, FICA tax), and you have a net amount. Divide that net by the number of people in each category, and you get a net yearly premium for each population category (single adult, adult couple, parent/child, parents/children, etc.). Divide that by 12 and you get a monthly figure for each group.

That is what individuals or families in those groups are required to pay. Then you apply the sliding-scale subsidies for income based on family size/composition. After that, employers can pay the premium for you as a benefit, or split it with you (or choose not to contribute).

Hopefully, your math would be good enough that your estimated "cost" per population group would be at- or below what they actually cost that year. You could use the same algorithms and math that private insurers use to forecast demand/risk, only for this it would be to determine what the premium will be, not who to cut out.

[Ridley's Own]

Originally Posted by Epaphras

Why not expand Medicaid to include anyone, except after 200% of poverty-level, you pay a premium of 1% of annual income? Everyone continues to pay into the trust fund, but if you opt for the "public option" you pay an additional, modest premium -- and they can't deny you.

Sounds a bit like the saw about Sen. Moynihan's statement during the Clinton Heath Care hearings... Why can't we just strike "65 and under" from the Medicare statute?

[JerryLove]

Originally Posted by Epaphras

In continuing thinking about this, a proposal like this would not require new departments or programs --

I'll go farther and say that it should drastically reduce the number of departments and agencies. Right now Medicare is separate from Medicade is separate from STARS is separate from vetrans is separate from government employees is separate from indegent emergency care, etc.

One program to rule them all.

[athanatos]

Originally Posted by JerryLove

One program to rule them all.

...and in the darkness bind them