Mooschcare

Now announcing: MOOSHCARE, a healthcare reform plan better than anything the Republicans can come up with.

This is emphatically not a plan to achieve full universal coverage. It's just a bunch of ideas that would take what we have now and make it work better. Most of these ideas are (very) loosely based off of the ideas the Republicans have been tossing around, specifically the House bill's waivers, the Cruz amendment, Ben Carson's high risk pools, selling insurance across state lines, states' rights, and ending the mandates. I wanted to see if you could turn these ideas into a decent bill, and amusingly, it ended up being a form of single payer.

There are four main prongs:

a) Allow some plans to offer less coverage than others in the same pool, but limit the spread in premiums to 20%, or less if a lower spread is set by state law. This means that, if I only want a barebones plan, I can get one at a 20% discount, but only if my state is ok with that. Because the barebones plans would cost the insurers considerably less than 80% of what the full plans cost, the barebones plans would pay more into the pool than they draw out, and would subsidize the comprehensive plans, while still saving money for people who don't want the full plans. This isn't necessary for states with stable insurance systems like California, but it would help states with less stable systems like most places in the South. At the same time, by limiting the spread to 20%, it would prevent people with pre-existing conditions from being charged an obscene amount.

b) Require all healthcare providers to accept payment from Medicare, and require all insurance payments to providers to be passed through Medicare, with a 5 or 10% fee. This is basically single payer, but with multiple, mostly private sector revenue sources, and would improve the efficiency of the system by consolidating billing (which is currently a tangled nightmare). It would make it so that every provider, everywhere in the country, would have to accept your insurance, because as far as they're concerned, it's all just coming from Medicare, and as far as your insurance company is concerned, it's all just going to Medicare. Combining all providers into a single network is necessary for having true competition across state lines, and for increasing access to health insurance in rural areas.

c) Use part of the 5 or 10% passthrough fee to fund a high risk pool or reinsurance program that would pay for extremely expensive patients. This would further stabilize the system, possibly to the point where the individual mandate could be safely repealed. It's loosely based on Ben Carson's healthcare reform plan from the 1990's (which is by far the best healthcare reform plan the GOP has ever produced), and would help avoid situations like the current problem in Iowa, where a single extremely expensive patient is threatening to sink the entire exchange.

d) Allow states, or multi-state funds, to count as insurers for the purposes of making payments to providers via Medicare. This would allow California to implement its own taxpayer-funded single-payer system, or (if it wants) to join with Oregon and Washington to create a larger West Coast single payer system. This would allow them damn hippies to get their single payer, and would allow the True American Patriots to keep their exploitative insurance companies. Because each side has what they want, and the battles over single payer, coverage expansion, etc. would be happening at the state level, this would allow things to finally cool down on the national level. Then, we could finally devote our political attentions to things that actually matter, like building an orbital launch loop, putting a bunch of massive solar power plants in orbit, and solving climate change via doom lasers.

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