A Twitter Inpired Health Care Reform Draft

 This was written using input from self-described liberals, conservatives, and independents – mostly on Twitter. Be part of the solution by adding suggestions and discussion. The current Partisan bill before congress is just as divisive as no plan. Unlike anyone in congress, I am demonstrably too poor, though, to have been lobbied. Enjoy.

I. Title – Reforming Current Government Health Care Offerings

A. All federal government health care initiatives shall be temporarily unified under a single administration for the purpose of transitioning all administration and funding to the individual 50 states and qualifying territories. During this transitional period, not to exceed five calendar years:

  1. Current federal payroll taxes that are applied towards federal health programs will be incrementally refunded to the new state authorities.
  2. State executives overseeing the transition shall have access to federal facilities and resources until the completion of the transitional period.
  3. An agreement will be reached between state and federal administrators on a required minimum benefits offering uniform across all new state programs not to exceed current federal offerings.
  4.  A state will have completed its transition when it is administering to all residents under its jurisdiction and receiving all funding that previously would have been received by the federal government through all mechanisms.

B. After completion of the transitional stage, state administration of health care insurance agencies will be free to enact whatever changes they deem necessary or acceptable to their citizens. Any alterations to existing operations must meet the minimum benefits requirement and must remain open to citizens’ review, through traditional democratic processes, at all times. Explicitly allowable alterations include, but are not limited to:

1. The addition of benefits to any of the available plans.

2. The ceding of administrative duties to a qualified not-for-profit organization which may include faith-based organizations.

3. Opening any program to residents of other states, pursuant to the guidelines set forth in section B of this title.

4. The merging of administration of previously separate programs.

5. Offering additional levels or tiers of existing programs and recouping additional costs through whatever mechanism deemed acceptable to the citizens of that state.

6. Setting conditions for enrollees to any state program.

7. Provided that a citizen’s state of residence has completed the transitional period, that citizen may enroll in any plan that they qualify for in any other state that has also completed the transitional period and has made such a program available to residents of other states.

8. Funding for the plan in such a case will be provided from the state of residence to the state administering the enrollee’s plan. If the cost of the plan exceeds the per capita amount collected in the resident’s state, the enrolling state may require the difference to be paid by the enrollee.

C. No state shall exclude or make in any way barriers to the cooperation of doctors within its jurisdiction with programs administered by other states.

D. States are explicitly allowed to provide incentives, financial or otherwise, to entice enrollment from its or any other state’s residents.

E. No state may set conditions or create financial penalties for private firms of whatever nature solely for the purpose of enticing enrollees or making it or any other state’s healthcare program attractive to citizens by way of hampering private competitiveness.

Title II – Reforming the Judicial Approach to Medical Malpractice

A. At the completion of the transitional stage described in Title I Section A, All states will become responsible for providing malpractice insurance to health care providers under its jurisdiction.

B. States may not require additional compensation for this insurance and are to pay rewards in malpractice from revenues collected for the administration of programs described in Title I.

C. States are exempted from coverage if any combination of the following criteria apply:

  1. The health care provider is found civilly liable for personal negligence such as intoxication while providing care or blatant disregard for patient health.
  2. It can be demonstrated that the health care provider received financial remuneration in any way that may have influenced care decisions.
  3. The health care provider is found criminally guilty of negligence.

D. Health care providers are required to carry malpractice insurance for the circumstances outlined in Section C of this title.

E. No health care provider may be found civilly liable in any malpractice complaint so long as they may demonstrate a good faith effort to provide care to the patient, are in good standing with the appropriate board of accreditation, and do not meet the criteria described in Section C of this title.

F. No malpractice complaint made for civil liability may name more than one defendant unless multiple defendants meet a combination of any of the criteria set forth in Section C of this title. Plaintiffs are not prevented from filing multiple separate complaints.

Title III – Enhancing Competition Among Private Insurers

A. Effective upon the passage of this legislation, all states are required to begin administering private health savings accounts for each of its legal residents. All states are required to abide by the following provisions regarding these accounts:

  1. Accounts must be transferable to other states when a citizen changes legal residence.
  2. Accounts cannot be denied to any citizen for any reason.
  3. Accounts need not be created without first being requested. No fee may be charged for the creation of these accounts.
  4. Accounts may be either individual or by the collective residents of a single legal address.
  5. Nominal fees may be charged for the transference of an account from one state administration to another or from individual to collective accounts and vice-versa. This fee must be demonstrated to only recoup the direct administrative cost of the transition.

B. Effective upon the state’s completion of Section A provisions in this title, all employers of residents whose health savings accounts have been established must make available all currently mandated funding for health care coverage to that account once requested. There shall be no fee for this change. The employer will continue to receive all incentives as if they were providing coverage directly.

C. Money in these accounts may be used without penalty of tax to pay for either health insurance or directly for medical services. If, in a given tax year, the holder of an account maintains health insurance at least equal to that mandated by Title I of this legislation, any funds that remain in the account may be refunded after being subject to all federal, state, and local taxes on personal income.

D. Any private insurance firm that accepts money as payment from a customer from these savings account must pay taxes on this income unless that firm complies with all of the following provisions:

  1. Enrollment to the plan is offered to any individual at least once per fiscal year and for no less than ten business days.
  2. Enrollment information gathered by the firm during this process is limited to non-protected class demographic data with no reference to current state of health.
  3. The cost of the premium of any plan it offers must be uniform among all individuals of similar demographic data and may not be revoked so long as the customer remains in good standing. Coverage may not be revoked but premiums can be adjusted when a customer changes legal residence to reflect rates paid in the area of new residence.
  4. The firm may offer no financial enticements or other incentives to have customers cease their existing contract.
  5. The firm provides a mechanism to extend coverage for no less than twelve months in the event a customer in good standing experiences unemployment or other traditionally qualifying personal crisis.

E. No firm shall in any way be punished for not complying with Section D of this title.

Title IV – Regulatory and Anti-trust Reform

A. The federal government shall cease regulation of all health insurance providers within five years of the enactment of this legislation. Responsibility for regulation of this industry will be entirely upon the administration in each state. Disputes between states with differing regulations, when necessary, shall be adjudicated by the federal court system.

B. No state regulation shall include any of the following:

  1. Any provision that prevents an insurer from providing rebates or other incentives to customers for meeting regular and objective benchmarks for personal health.
  2. Any provision that requires coverage of cosmetic procedures in excess of what is mandated by that state’s public health coverage base plan.
  3. Any provision provides incentive or punishment or expressly regulates insurers in such a way as to advantage employer-based health coverage over individual coverage or vice-versa.
  4. Any provision that results in a structural advantage of state health care programs over private firms so long as a particular customer may qualify for that state program and the private plan regulated would not exceed 20% of that customer’s income.
  5. Any provision on its citizenry that imposes difficulties on or prohibits those legal residents from obtaining health care insurance from any entity outside of its jurisdiction provided that contract is within the jurisdiction of another of the fifty states or United States territories and protectorates.

C. The federal and state agencies traditionally purposed with investigating and prosecuting anti-trust legislation will continue to do so with the following modifications regarding health care insurers:

  1. Executive compensation is not to be expressly limited unless it can be demonstrated that total compensation during any five-year period grossly exceeds total profits of that executive’s firm and only if the firm accepted money from individual medical savings accounts described in Title 3 of this act.
  2. Any two or more private insurance firms may not jointly negotiate compensation with health care providers and any incidence of this practice is a violation of anti-trust law.
  3. No firm may have any involvement in negotiations between health care providers and providers of health care goods.
  4. No provider of health care goods may personally deliver any form of compensation to health care providers or health care insurers. Branded materials like brochures, stationary, and other goods that when packaged do not exceed $20 in value are allowed but must be requested by a health care provider and made available without obligation. Any demonstration of a health care good must be made available to the general public.
  5. Within the framework of existing intellectual property rights, any product that is provided to foreign governments or entities must reflect its actual cost to citizens of the United States of America during its first five years of availability. Acts of charity are excluded from this provision but must be absolute and without any form of remunerations.
  6. A private firm may participate in the provision of health care insurance to enrollees in a state program only if all negotiations are made public and archived, and only if the resulting contract is subject to the review and approval of that state’s citizenry no less than once every five fiscal years.
  7. Violations of existing anti-trust provisions or those set forth in this section will be prosecuted criminally, when applicable. Rewards for civil liability will be made to individual health care savings accounts, when available, or to state health care administration(s).
  8. The accounting records of any firm that accepts payment from any individual health savings account must be made permanently available to the public at the completion of every fiscal year in which it received such funds.
  9. If any firm or persons receive funds from accounts described in Title III of this act but violates any provision of Section D of that title, those parties will be subject to full prosecution by any and all affected parties. Fines in such a case will be distributed as described by Provision 7 of this Section C of this Title IV.

Title V – Addressing Uninsured, Underinsured, and Illegal Residents

A. A resident of any jurisdiction of the United States of America is considered uninsured if that person carries no health care insurance, is not eligible for the base insurance offering administered in their state of residence, and cannot contract for a qualifying private insurance plan that does not exceed 25% of their income.

B. A resident is considered underinsured if they meet the conditions of section one with the primary difference being that their current health insurance contract does not meet the base requirements mandated during the transitional stage of Title I of this Act, after the completion of that person’s state administrative transference.

C. Any person who is considered a citizen of the United States of America and is uninsured or underinsured within the framework of this section, who then seeks medical care which they demonstrate cannot be remunerated will be subject to the following conditions:

  1. Upon the good faith release from medical treatment, that person may seek a personal bankruptcy In addition to any traditional bankruptcy protection offered.
  2. To prevent bankruptcy, that person may contract to perform administrative tasks in service of the state or qualifying organization that covers the cost of their unpaid procedure(s).
  3. That person, regardless of their completion of either (a) and/or (b), is required to provide either proof of health care insurance meeting the minimal requirements of Title I or a bond to cover future care that is of no less value than $100,000 adjusted for inflation each year, beginning 2009.

D. Any person who seeks health care in the United States of America while they reside here illegally is subject to the following provisions upon receiving health care services which they cannot or do not reimburse:

  1. Upon release from the provider, the alien will be arrested, charged with all relevant crimes, and deported to their country of origin.
  2. If the alien’s medical condition cannot be stabilized enough for release but enough for transfer, they will be subject to Provision 1 but transferred at the earliest convenience to a facility under the jurisdiction of their country of origin.
  3. If the alien’s medical condition cannot be stabilized enough for transfer, they will be subject to the Provision 1 but will remain in the current health care facility.
  4. In the case that any of these provisions is invoked, total cost of care for these individuals will be billed to the sovereign government of that person’s country of origin. If such a country of origin cannot be determined, that person’s cost of care shall be billed to the United Nations. Failure to cover billed costs or prove the falseness of the alien’s claim of citizenship within one calendar year will result in all lawful remedies such as sanctions or penalties on trade.
  5. Any government or entity within the jurisdiction of the United States of America that willfully fails to enforce the provisions of this section or who generally qualifies as a “sanctuary” for illegal residents is additionally liable for the cost of care for those persons and ineligible for the transference of health care funding from the federal government of the United States of America as described in Title I of this act.

NOTE: 7/31/09 Fixed margins, numbering, references, a few language corrections.

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9 Responses to A Twitter Inpired Health Care Reform Draft

  1. @bishop_s says:

    It is kinda hard to read due to formatting issues, but I’m summarizing the major points of your plan as follows (correct me if I am wrong). Once we both understand what you are saying we’ll be able to debate the merits:
    1. GOVT RUN PLAN
    a. This plan means healthcare administered by state govts as opposed by the federal govt
    b. Residents of one state will be allowed to enroll in other states’ plans if they so choose, with funds being transferred from the home state to the plan state and the difference being made up by the individual.
    c. There will be uniform minimum standard of services available across all states in the country
    d. Everyone will be covered by the state plans (no exclusions)
    e. Plans will be funded by taxes that previously went to fed govt and were used in fed healthcare services
    f. Plans may have several tiers of services paid for through additional means of income
    g. Private insurance plans will be available to replace the state run plans
    2. MALPRACTICE INSURANCE
    a. Insurance will be provided by the states with no additional surcharge to the practitioners for cases practiced within state guidelines
    b. Practitioners will carry additional malpractice insurance for criminal negligence cases
    3. PRIVATE INSURANCE
    a. All residents will have HSAs
    b. Pvt Insurers cannot differentiate premiums within a demographic group. Caverage may not be revoked but premiums adjusted based on area of residence.
    c. Pvt insurers will be allowed to extend incentives to its purchasers
    d. Antitrust rules still hold.
    4. UNISURED, UNDERINSURED AND ILLEGAL RESIDENTS
    a. Citizens, if unable to pay medical costs, may seek bankruptcy protection
    b. After bankruptcy proceedings the citizen will be required to post a $100,000 bond for future expenses
    c. Illegal aliens will be charged with criminal offense and deported
    d. Costs of medical care for illegal aliens will be billed to the country of citizenship or the UN. If not paid by such country trade sanctions will be applied.
    e. Jurisdiction not enforcing this will be penalized by the fed by declaring them ineligible for transfer of healthcare fundings from the fed.

  2. rdickerhoof says:

    I need to think about how to get something worked out so individuals with good income can use HSAs to buy state plans. Given current discussions, that’s more of a compromise between market people like myself and those in favor of something like HR 676.

  3. deannalee13 says:

    I have a major problem with this plan it still has a formula (#1 D. States are explicitly allowed to provide incentives, financial or otherwise, to entice enrollment from its or any other state’s residents.to profit on public health care plan) that allows shareholders to make profit on the pubic plan.
    Look I don’t think the tax payers should pay for the wealthy to profit on the public plan health for health coverage. If the private medical insurance industry wants to profit off health care that fine I just don’t think that the American tax payer should pay for the wealthy to make money off the PUBLIC PLAN for health care reform.

  4. @bishop_s says:

    Ok, based on no counter comment I assume my summarizing is correct. No for my comments on the plan itself.

    For starters, I agree with the provisions where state provided insurance will coexist with private insurance. Some people say that this will lead to the death of pvt insurers, which, I think, is a total balderdash. Given a set of rules, pvt industry will always be able to come up with a set of value added offerings that will make it more attractive to many people (just like in education or mails, where public and pvt sectors compete and coexist, with handsome profits for the pvt industry).

    However, I start having problems when one issue mixes with something totally unrelated – in this case healthcare with immigration control. Ppl should start realising that the vast majority of illegal aliens do not come here because they think that this is a paradise. Rather they are trying to flee conditions in their home country which comparatively are hellish for them. This has been true for most migratory movements, whether due to religious persecution in England in the 16th-17th century, Irish famine in the 19th century, or political persecution in Europe in the early part of the 20th century. Horrible living conditions here were no match for the hell back home so ppl came here. And all these times there were ppl here who did not welcome the immigrants except as a source of cheap labor. It is exactly what is happening now, although the source countries are different. So starting to grab them when they approach for healthcare and deporting them back to their countries will not resolve any problem. And, to think that their home countries or, much worse, the UN is going to pay for them is simply not realistic. Applying trade sanctions because a man’s bill has not been payed? Will not work… and the only way this will be used is as a sort of weapon for some issue totally unrelated to healthcare. So let’s work on trying to fix the healthcare without muddying the waters with other things.

    Unlike deannalee above, I agree that states should be allowed to entice subscribers from other states – this will increase competition which can only be good for the consumers.

    I do think that states should decide upon the best treatment practices, and no cap on costs covered by the state if the patient follows the recommended treatment plan. If the patient wants to “choose” treatment not recommended by the plan then he/she can take pvt insurance and pay increased premiums for the wider choice available. I do not agree with my having to pay higher premiums, as happens now, because some people want the best and the most expensive care available whether it has been proven to work or not. If you still want it then pay for it and more power to you! 🙂

  5. eleganterica says:

    I disagree with Bishop_S, I think that the healthcare issue and the illegal alien issue are linked. Mixed, maybe not, but linked. We are talking about a public plan, funded by taxpayer dollars. How the non-taxpaying uninsured are addressed by this plan is topic worthy of discussion.

    Though, I don’t want the health care industry becoming an arm of the INS. Social Services (child protection), yes of course… but not this.

    I do agree with Bishop_S that the UN should not be involved. The function of the UN is not to pay for the healthcare of the uninsured… it exists to foster cooperation in international issues… e.g. to stop wars between countries. This is much more important and should not be deterred.

    I don’t think private insurance is going to “go away” like the end-of-timers are claiming. Private insurance will be able to offer additional services to those willing (and able) to pay.

    I am one of the lucky ones who has private insurance through my job and have been very pleased with it. I know that this is not the case for many, and I understand the need for change.

  6. Mark Welkie says:

    I am opposed to any “solution” that devolves responsibility to the states rather than the federal government. The states individually simply will not have the bargaining power of the federal government and will therefore not be able to hold down costs, which are rising so much faster than general inflation only because of the greed of corporate insurers and drug makers.

    Who cares if health insurers go out of business because they can’t compete with the government in providing quality health insurance at a reasonable price. They should just go the way of the telegraph companies. We will all be better off.

  7. Kecko says:

    As a fellow American who does believe in our individual rights, it first must be stated that I do admire the attempt to generalize a, “Health Care Plan” based on the initial concept of states’ rights. As I summarize my opinion on your plan I must make it clear, I am biased and cannot support such a plan. I will point out specific postulates you prescribe by asking, 1. How is this improving our current system and 2? What protections is in-place for the consumer with such a plan. I also ask if the author could explain in an easy to read format, without such legalize, so not just I but everyone could understand the point of view you represent. When dealing with concepts, which I perceive this to be, the details evolve as it naturally progresses to fruition, but this generalized draft seems more inclined to be written to obfuscate detail of mechanisms.

    The way I read this plan to be was not a plan, but a way to dis-assemble the current federal health care systems we have in place, and on the surface this seems to include Medicare & Medicaid, and then re-formulate it into a fully subsidized state ran system. I see no protections for the consumer or “bill of rights” for fair practice, and I also perceive this plan to be another, “health insurance saving account plan” with a non compete clause with the private marketplace. I also strongly argue that certain states would be forced to increase the state tax burden on an individual state by state basis because of high population centers being forced to cover a bigger burden of un-insured or subsidized cases, ie handicapped and elderly. That being said, I will try to explain why I feel this by disputing the postulates in a chronological order.

    I A) All Federal government health care systems will be temporarily unified? Is this Medicare, Medicaid, and Veterans? Is this even individual government agencies and will Congress then have to start with their own state plan?

    I A)1. Federal payroll tax shift to individual states? Again is this equitable and what kind of time frame to help mitigate ongoing claims directly on the system, who covers, more transition details are needed.

    I B)2. Administration duties to non-for-profit which may include faith-based? This on the surface seems to defy the constitutional separation of church and state. Who are the faith based organizations and will it be a cross section of all faiths! Can this be discriminatory as written?

    I E) no set conditions or financial penalties by way of hampering private competitiveness, this screams non-compete and doesn’t give any re-course for private insurance to change anything with the way it currently does business.

    II A) States must provide Malpractice Insurance? How, who will set it up, Will there be an escrow pool? Very Vague and almost un-feasible base again on the assumption that there will be 50 different sets of rules? Can this become homogenous or quasi-governmental?

    II B) how will it get additional compensation if the fund cannot pay out on a reward? Do they then have to issue bonds or get loans from the fed?

    II E) no provider may be found civilly liable in any malpractice complaint as long as demonstrative good faith attempt? Isn’t this very general and subjective? What is judicial rights of plaintiff if it can’t go to higher court than state, and isn’t there a direct conflict of interest to always rule in evidentiary for the state? What of private insurers. Is this fair for private insurance to not have the same protections as the state? I would also state that, “What is deemed not liable” How about accidental miss-haps? Prescriptive mistakes or botched surgeries to name a few?

    II F) not being able to class act a suit would slow the system to a crawl. Imagine multiple claims would take years on same set of circumstance. If the plan was developed to save money, this postulate in itself would wreak havoc on an already taxed judicial system.

    III A) how will, “Rate of Return” or “Type of Investment” be addressed. Are these straight savings accounts based on current rates or are they pools of muni-funds? Who manages individual return and is there a hedge against inflation or market downturn?

    III B) Mandate? What, When, How? Based on percentage of income? Based on studied statistics? Elaborate cost to individuals

    III C) Again what amount and during what period or is it per calendar year?

    III D) Private Insurance can take from the fund and then pay taxes unless it complies, but as your postulates suggest, and this I may be way off base, Private insurance must offer insurance to a prospect but may refuse or deny coverage without any recourse, thus skirting the rule. Very subjective and without protections for the consumer, seems weighted heavily to the insurer to still cherry pick saver applicants over higher risk.

    IV A) The federal government shall cease all regulation of all providers within 5 years with disputes be adjudicated by feds if states cannot remedy? Again my main dispute is there are 50 different states with 50 different sets of rules? This is not possible unless a, “Bill of Rights” is legislated along with any state run plan, homogenous across state lines.

    IV B) State cannot regulate provisions that have structural advantage over competing private firms unless a customer cannot afford a premium on basis of a 20% threshold on the customer’s income as the requirement? So if a middle class man is making $100K, his material requirement would be $20,000 premium before he is eligible? This give an unfair advantage to the private firm before regulation would kick in.

    IV C0 1. Executive compensation regulation based on 5 year profit totals in gross excess and only if they take from the pool of state run savings accounts? There is no incentive to even consider the savings accounts and will be avoided. If it’s one thing we learned about the TARP debacle, Executives would rather let their companies fail than take a pay cut. Talent thinks it’s entitled without boundaries!

    IV C) 3. No firm may have any involvement in negotiating between HC providers and the providers of HC? This needs to be elaborated because in our current system, without the negotiation strength of the firm, prices will continue to rise.

    IV C) 6. There will be a vote of states citizenship every 5 years?

    V C) Penalty phase for non-insured seems very severe and has to be softened with, “Bill of Rights”

    V D) this one is emotional for me since I know many men and women who make our country work but get nothing but scorn and disdain. Sir do you cut your own grass or cook your own eggs at a diner or does your wife have a cleaning service. Get real, without comprehensive immigration reform, this postulate is pure ignorance.

  8. kmita says:

    This is a manufactured crisis. The healthcare bill is a smokescreen for more govenment control. There should be no bill at all. The government should get out of it altogether.
    see: obama and the Stategy of Manufactured Crisis
    http://tinyurl.com/4dzmmq

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