SENATE BILL: Reforming Atlasian Public Health Act of 2014 (Debating)

[Potus]

Popping back in to support a new policy, albeit a very market-oriented one.

I have talked about healthcare on the forum a lot. The original bill I proposed was really more of a tweak to the system than a legitimate reform. The original bill reduced Fritzcare costs significantly and saved the government billions of dollars. It also introduced plenty of cost-cutting policies. But, all in all, it's more of a major fix than a real reform.


Since we're now attempting to model a whole new healthcare system, I would encourage the Senate to fully repeal Fritzcare and replace it with a better, freer system. This starts with a standard $7,000-$9,000 annual, refundable tax credit to purchase healthcare. This credit would be the same no matter what plan the person purchased. This creates an incentive to avoid overutilization. Implement an HSA policy, similar to the original bill, that will allow people to save for the more routine costs.

Develop a new set of risk management practices. Provide a high risk pool and a senior pool, for example, that negotiates prices and provides an additional subsidy to acquire insurance. These two policies make care accessible to every single Atlasian. Period. Universal access.

We've also got to look at cutting the actual cost of care, which everyone seems to be neglecting. Create a tax advantage for providers that reduce costs and overhead and in turn reduce prices. Think of it like a tax deduction. You can deduct 30% of your savings from the previous year on this year's taxes. If you increase costs, it's a negative deduction. It would increase your tax bill. This provides a strong incentive for coordinating care and reducing cost.

There is, of course, the standard regimen of pro-competition reforms. Tort reform, allow sale of insurance across state lines, and establish exchanges. We can explore further cost-cutting fixes later. Some might include stripping a lot of regulations off the book, allowing providers to set the educational standard for becoming a doctor, and legitimately tackling the college affordability issue in a smart, pro-market way.

[Potus]

The "used car salesman" thing is taken care of by establishing exchanges. It prevents people from basing all of their healthcare decisions on advertising or whatever. By having a simple, side-by-side comparison of insurance plans, we counteract the used car salesman. That solves that problem.

Choice in insurance is plentiful. The variety of insurance networks also creates a sort of backdoor choice in providers. Empowering patients to pick insurance that is cost effective and is what they need while allowing them to save would work wonders. It addresses the vast majority of cost drivers in healthcare.

By guaranteeing universal access and empowering savings, we can finally focus on cutting costs at the provider level. The efficiency deduction I talked about above would go a long way to creating an incentive to make care better in quality. It improves delivery. The original bill here included employer wellness programs, which are an effective way of reducing longterm costs.

My plan would start with guaranteeing access and the ability to save. From there we would focus on cutting the cost of care at the point of delivery. The standard credit actually becomes worth more over time. By addressing cost drivers of care, the cost of insurance is reduced because of competitive pressures in the exchange and across state lines. It makes life easier on everyone in the medical system.


I like the idea of the real world REINS Act. The act made all regulations that would cost over $100 million be passed through Congress, here it could be the Senate. We should have a full audit of our medical system in terms of cost of government. Then we should focus on reducing the cost of government.

[Potus]

For one thing, insurance plans are very very complicated, by launching a brave new world where consumers (horrible word) choose their own care policy you'll leave behind the vulnerable, who'll be preyed upon by used car salesman who sell flashy but useless schemes. People don't want choice, they just want not to have to worry about paying for healthcare when they're suffering serious illnesses, and not be crippled with huge costs.

I said back in February and I meant it, that the poor, the veterans, mentally ill and those with pre-existing conditiosn would be taken care of and that preventative care had to be maintained as accessible. Any plan I formulate will do this and any plan that will get my vote has to as well.

To an extent though we have to get people more focused on their healthcare not necessarily for the sake of wanting them to desire a choice, but to get them to make more responsbile choices lest it bankrupt the system. Anyway I have to go again.

Damn it, I never have enough time... 

We just need to transition the healthcare sector. Gradual repeal, not "wake up to a different" level of change. Start phasing out benefits, maybe start-up grants for private medical providers and insurers. We can transition the country to the model I proposed fairly easily.

[Potus]

This is alright, though a tad complicated. Of course, not as complicated as Fritzcare. The mandated savings accounts are definitely intriguing, but I have my reservations. The public hospitals, in my mind, would end up being similar to RL HMO's that become second-class care facilities.

The way this addresses cost drivers is similar to the way my model addresses cost. The standard health credit would do everything the Singapore model does. I'd love to have a legal framework for matching contributions into an HSA.

Really, the only bureaucracy my plan has is the people that mail out the money for insurance. This system, and the Fritzcare system, seem to have a lot more messy, faceless government nonsense in the way.

The efficiency deduction I talked about also creates an incentive for coordinated care and increasing efficiency. That is a major cost driver that the public option in Yank's and Shua's plan tries to address with a public option and Singapore addresses with VA-style hospitals. Those are both much, much costlier than creating a tax incentive to lower cost and a tax disincentive to increase cost. It is an easy fix that will yield results without the cost of single-payer, a public option, or VA-style hospitals.

[Potus]

The unnecessary procedures that you're talking about are, in large part, caused by two things. The first is defensive medicine that is incentivized by the way medical liability works. The second is the lack of care coordination.

We address the first one with limits on damages, and maybe some sort of government guaranteed liability insurance for medical providers. Reforming the way we go about medical liability will release the amount of unnecessary procedures and bankruptcies among medical providers. This cuts back those useless procedures.

The second one is a bit tricky but I proposed it earlier. Create a tax variable for institutions that coordinate care and promote efficiency. The Health Efficiency Tax Deduction would either decrease or increase your tax liability depending on whether the cost of providing care increased or decreased during the previous year. This creates a strong incentive to coordinate care and reduce costs.



Also, any discussion on cost containment should also include discussion of intellectual property. We need to embark on a liberalization of our copyright laws in order to foster competition and innovation. By opening up the intellectual property market and allowing small businesses and individuals to capitalize on their ideas and knowledge, we can push medical technology and pharmaceuticals to new heights with competition. Many times, people say care continues to increase in cost because of medical tech's march forward. It is not a good solution to slow that march, but rather increase it. By devaluing the current technology that is very effective, we raise the bar for care across the board and expand access to today's technology.

[Potus]

Excellent job. Congratulations.