Newsplaining

Musings on Healthcare solutions 
     National policymaking has slowed down recently. With the failure to gain enough votes on the American Health Care Act, House Republicans are in the early stages of drafting tax reform while the Senate Republicans focus on the approval of Donald Trump’s Supreme Court nominee, Neil Gorsuch. Whether Gorsuch is an adequate choice for the Supreme Court or where exactly to begin with tax reform are several columns in themselves, I thought I’d take this time to postulate ideas about how to fix America’s healthcare system.
     With many up in arms about the shortfalls and failures of Obamacare (The Affordable Care Act), yet a majority in favor of its existence due to expanded Medicaid coverage and healthy subsidies that make health care for most, affordable, where exactly to go from here is nebulous.
     On the one hand, Obamacare did expand government-sponsored health insurance to more poor people, while granting large subsidies to those who don’t qualify for the expansion to purchase their own insurance. The total Americans impacted is well over 22 million. It’s because of this 22 million that the law was unrepealable.
     The AHCA, although continuing Medicaid expansion through 2020, limited just what Medicaid would cover, while also defunding the expansion through reversing the tax taxes on the wealthy, which funded such expansions. It also distributed subsidies based on age, rather than income, which would have forced many to pay more for their insurance, especially older Americans. Taking away 22 million peoples’ insurance wasn’t a good idea with an election upcoming in the rollout timeframe (2020).
     So then what is the problem with Obamacare, if it’s almost unrepealable due to its coverage expansion? It seems to be that most qualms with Obamacare come from those who make too much money for subsidies, and don’t qualify for Medicaid, leaving them on the hook for insurance premiums for plans with high deductibles, for care that costs too much.
     Obamacare tried to settle this matter with a strong individual mandate that forced people to buy insurance to keep insurance pools diverse, offsetting the true cost of plans. Republicans gutted said mandate, making it almost more profitable to not get insurance than have insurance, thus raising prices for everyone else.
     So what now? How do we provide insurance for poor people, while making insurance affordable for the middle class?
     What if we formed a voucher system that covered medical costs upfront, with the amount in vouchers dependent upon age and income?
     Much of the problems in both plans of health care stray too far in one direction, which makes conditions unbearable for the other side. Obamacare favored income, which in turn made shared pricing, which in turn alienated healthy Americans. AHCA catered to age rather than income, alienating the older population and favoring healthy Americans. Clearly, choosing one without the other doesn’t work.
     Said voucher system would work by going to a single-payer for all Americans…to an extent.
     It’s obvious that most Americans aren’t ready for a full single payer system yet, and it doesn’t appear to want one. The problem with single payer systems is that there’s longer wait times with less available equipment. While care becomes more efficient, it only becomes more efficient when it doesn’t require long-term or extensive medical procedures.
     A Medicaid-for-all voucher system would be given to every American to use towards medical costs.
     For instance: if I make $30,000 a year and am under 26, and not on my parents’ plan, I would be granted a $5,000 voucher. Because statistically, younger people see the doctor less frequently and for more efficient care (check-ups, infections, etc.) there’s no reason to give me more voucher money. This voucher money would be used as a reverse-deductible. The government would cover my first $5,000 in medical costs. If I exceed that $5,000, I would be on the hook for my remaining medical expenses. Meaning that I would need to purchase a private insurance plan, which would be customized to fit my personal voucher and age needs.
     As I get older, that voucher amount would change, with a cap at a certain amount of dollars, hypothetically for our scenario, that would be $8,000, which is the amount of money the U.S. spent on health care per capita in 2010, according to PBS.
     Such a voucher system would encourage me to seek and attain a higher standard of living, seeing as medical costs go up with age, and my voucher caps out at a certain amount. A higher wage and a better job would give me more money to spend on a healthcare plan. This plan also doesn’t encourage citizens to not work. Many Americans forgo better paying jobs to stay qualified for welfare benefits. Some Americans forgo getting a $1,000 raise because it bumps their tax bracket and takes away their benefits. The voucher system eliminates this problem with the cap and automatically increasing medical costs.
     Best of all, if an American doesn’t use all the money allocated to them, the government gets it back.
     One could then make the argument that no one would get private insurance until they burned through their voucher. This is where an individual mandate comes in. The AHCA disguised its madate as a premium fee to be paid to insurers in the form of a 30 percent increase for one year, if suddenly applying for coverage. Rather than give insurance companies extra money, a 30 percent tax on the plan could be then paid out to the government, separate from the insurance costs, effectively creating a market in which everyone must buy some type of plan, on top of this voucher system.
     I don’t claim to be an economist, nor do I know the overarching, long-term affects of such a plan, but in a democracy, it’s the people’s job to come up with and discuss solutions to problems. This plan is far from perfect, and would require copious amounts of research, but movements get started with going out on a whim.