A simple proposal for health care

In the last Presidential debate, the candidates talked about their health care proposals (or more accurately, why the other guy's proposals were terrible.) Neither candidate was willing to endorse a single-payer system; that seems to be the "third rail" of U.S. health care policy. Yet the private insurance market we've got is working none too well: The U.S. pays by far the most for its health care, both in absolute terms and as a percentage of GDP, compared to other industrialized countries, yet the quality of care that U.S. residents receive is among the poorest of all those countries, and 47 million Americans are without health insurance.

The private market isn't working, but a single-payer system won't fly politically, so let me humbly propose a system that might:

First, the U.S. Government would split the country into four regions, Northeast, Northwest, Southeast and Southwest. The right to sell health insurance would be auctioned off in each region, just as the FCC auctions licenses to use the airwaves. The highest bidder would win the right to be the sole health insurance provider in that region, and the license fees would go to help pay the Government's part of this plan.

The insurance companies would all have to play under the same basic rules: No limitations for pre-existing conditions. No exclusion of conditions. No waiting periods. No one can be turned down. Personal insurance rates would be set based on age and family size. Companies would have the choice of buying their own insurance for employees, subsidizing employees who purchase insurance, or letting employees get insurance on their own. Everyone would have to get insurance from their employers or purchase it themselves.

The Federal Government would provide reinsurance to the insurance companies for catastrophic illnesses, thus eliminating the reason for insurance companies not to cover patients with AIDS, cancer and other life-threatening diseases. The license fees paid by the insurers would go into the reinsurance fund.

With a single insurance company to deal with in each region, administrative costs for health care providers would go down dramatically, which should result in lower costs. The licensed insurance companies would have far more leverage to negotiate prices with health care providers and drug companies.

This system would allow just about everyone to get insurance at affordable rates, and would maintain a multi-payer system. It would lower (or at least stabilize) costs. And, it would force insurers to pay for their participation in the system with license fees. Senators McCain and Obama, you're welcome.

Obama by a landslide

You read it here first...Barack Obama will win the U.S. Presidential election next month in a landslide. John McCain and his handlers are going to try to do anything and everything possible to attack Obama personally, but it's not going to work. Everywhere I go, every news program I watch or listen to, and every newspaper I read, I hear the same thing: People are angry. Their living standards are poorer than they were eight, or even four, years ago. Their retirement savings are in jeopardy. Their homes are worth much less than they paid for them. The student loans that they arranged for their children are being withdrawn, leaving them scrambling to find new lenders.  Businesses can't get financing, so they're laying off workers, cutting back on orders and, in the worst cases, going out of business.

The worst mistake that the Republican party made in decades was when it decided to put all its chips on George W. Bush, even though John McCain was winning primaries and gaining momentum. Had McCain been in the White House in 2000, we almost certainly wouldn't have gone into Iraq, and we might not be in this financial mess. Unfortunately, the John McCain of 2000 isn't running in this election. The John McCain of 2008 is a political opportunist who seems to make critically important decisions on a whim, the most devastating of which, in my opinion, was appointing Sarah Palin to be his Vice-Presidential candidate. Eight years ago, he might have been able to get away with that; given that he would have a 1 in 6 chance of dying in office were he to be elected now, his decision has to be seen as grossly irresponsible, especially given that there were many other female Republicans with far more experience and qualifications to be President.

Given the many problems that this country has, I would much rather have Obama and his team, rather than McCain and his "ready, fire, aim" approach, in charge. I think that the bulk of American voters are coming to the same conclusion.

Can we get this deal done, please?

I've been watching the stock market yo-yo and the liquidity markets freeze up while we wait for the on-again, off-again bailout plan. At this point, tt doesn't matter which party was responsible for the failure--either one could have produced the 12 additional votes that were needed for passage. The U.S. Senate plans to vote tonight on a modified bailout plan that keeps the basics of the plan voted on last Monday, but adds some tax benefits for individuals and small businesses, and raises the maximum per-account level of FDIC insurance from $100,000 to $250,000. Whether these sweeteners are enough to get the 12 additional votes needed in the House, let alone hold onto the votes that the original bill got, remains to be seen.

The lack of safeguards that I complained about in a post on my "Feldman File" blog was addressed in the version of the bill that originally went to the Senate. While I despise what got us to this place--the almost complete disconnection of capital from its underlying risk that's led us to having no idea how much more than a trillion dollars of securitized mortgages and other debts are really worth--we have to act. We've got to make sure that people can still get home, car and student loans, and that businesses can buy inventory, meet their payrolls and keep their doors open.

As I write this, it appears that "the tide is turning" with members of the House who voted against the original bill. Their "call ratio" from constituents is turning in favor of the plan, thus giving them the political cover that they need to vote for the revised bill. However, I won't count on anything until the bill passes both Houses of Congress and is signed into law by the President.

POV: Critical Condition

Last night, I watched a documentary in PBS's POV series called "Critical Condition". It takes the viewer into the lives of several families, all of which are being systematically destroyed by the lack of medical insurance. One man, a diabetic, has his foot amputated while he still has medical insurance, rather than have surgery that could have saved his foot but that would have had to take place after he lost his insurance. A woman undergoes a chemotherapy regimen for advanced-stage cancer that probably could have been treated more effectively or even cured, had she been able to seek treatment earlier. A man with non-alcohol-related cirrhosis of the liver and Type II diabetes, who could have been treated easily with medications, literally falls apart because he couldn't afford the medicine.

While these stories play out, the film lays out some cold, hard facts about the U.S. medical system. For example, it points out that on average, hospitals charge patients without insurance 2 1/2 times as much as they charge insured patients. It also notes that the U.S. pays more of its GDP than any other industrialized country for medical care, yet over 47 million Americans have no medical insurance.

Every U.S. Senator and Representative should be made (forced, if necessary) to watch this truly heartbreaking documentary. There is absolutely no excuse for there not to be good medical care for all Americans. What's more, as this documentary points out, early intervention would not only have saved lives, it would have saved literally hundreds of thousands of dollars in critical care that was required when manageable conditions became life-threatening. Our medical system costs far too much for the benefits that our citizens are getting, in large part because of this focus on critical interventions rather than preventative care.

If you didn't get a chance to watch it, I encourage you to contact your PBS station and ask them to replay this important documentary. It's available for purchase, but the more people who get to see and talk about it, the better.