Op-Ed in Raleigh, News and Observer

I have an op-ed in the Sunday Raleigh (N.C.) News and Observer offering a bipartisan way forward on health reform that I think makes sense regardless of what the Supreme Court says about the Affordable Care Act. If you are a reader of this blog, it will be familiar fare.

If you are coming here from the op-ed, here are some related posts:

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University https://academiccouncil.duke.edu/ . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

10 Responses to Op-Ed in Raleigh, News and Observer

  1. Randy Wagner says:

    Mr. Taylor,
    We have corresponded before on healthcare in the US and I have enjoyed your op-ed articles. I totally agree with your News & Observer piece from today that we must have a solution that includes both sides of the debate’s main objectives; skin in the game and as close to universal coverage as possible.
    Over the past year I have reached out to the DNC, the White House, Kay Hagan and David Price with a concept that I have been trying to start a dialogue with respect to initiating a healthcare solution on a national basis should the mandate in the Affordable Healthcare Act be found unconstitutional. We cannot afford to wait for the Court’s decision to be handed down without having a blueprint for another option. Too many people’s lives are at stake.
    My proposal is to utilize the existing players in the healthcare delivery system; insurance providers, hospitals, doctors and caregivers but access the system on a “national basis” through an association of existing CREDIT UNIONS. As you know many credit unions are already offering healthcare to their members. However, their individual group sizes are too small to impact costs. My goal would be to allow credit unions across the country to “pool” their groups into one creating a group plan base of potentially millions of insurees. Currently, there several National Credit Union Associations that serve as the interface for each state and have the infrastructure to start the process. This will accomplish several goals. It allows for insurance purchase across state lines which has been a Republican goal. It utilizes the for profit system that has been a Republican demand. It engages the current players in the healthcare system, who are in large part the Republican lobbyist groups who have backed their election campaigns for decades. It would reduce the burden of healthcare costs from employers while not transferring it to the government. But most importantly it accomplishes the establishment of the Public Option that should have been in the Affordable Healthcare Act in the first place. Additionally, a group of this magnitude would have the “buying power” to impact caregiver’s costs which has been recently reported to be the single largest driver in cost increases.
    I predict that a healthcare plan made of lets say, 50 million Americans should create access to an 80/20 copay plan with a $500 deductable that includes a prescription drug card for a family of four that should cost about $500 a month. If not, then it will become obvious that the current system can never control costs and some form of an American single payer system will become inevitable.
    I would appreciate your thoughts.
    Randy Wagner

  2. steve2 says:

    Reading the comments, it is sad how misinformed much of the general public is on health care issues.


    • Randy Wagner says:

      Can you be a little more specific? If you are inferring that an industry the size of the healthcare/insurance sector which has serious lobbying power is going to just fold and allow either a government run single payer system or a radical reworking of who is involved in the system with the gridlock in Washington for the foreseeable future is think would be a stretch at best. The concept I am proposing is an interim solution; but helps control costs in the short term and provides coverage for scores of people who will be thrown from their policies should the mandate gut the Affordable Healthcare Act and gives some time for the country craft a more permanent solution.

      • Don Taylor says:

        @Randy W
        I think Steve is talking about the comments at the news and observer site. I will get back to the ideas tomorrow…..running today

      • steve2 says:

        Yes. Sorry for the confusion. I was referring to the newspaper comments.


  3. P Gray says:

    Here’s a more complete suggestion along the lines of your proposal. I feel this suggestion has more probability of working for those at the lower socioeconomic levels, especially those who have no excess disposable income to devote to health care until something happens where they are forced to respond to a health care need for themselves or their family. Set up a health care financing structure where 50 million dollar block grants of US government funds are sent to local banks for use in this health care financing proposal. The banks would be required to administer these funds in a responsible manner, and the banks could keep interest income from these funds that accrued during times that the funds were at the bank and were not used for health care costs. The banks could apply for as many block grants as they feel they could use. Congress would set regulations for how these funds were divided among states and how they were divided among banks inside individual states. Local population would then have the option to sign up for this health care funding proposal. Once a person signed up for this health care type of funding, then the banks would be required to pay for these person’s health care costs using the funds present that the banks received for this program via the block grants. It would be stipulated that the banks would not be required to send out any more payments once the funds had been depleted. The payment specifics would be that the costs are paid to providers and health care institutions at the Medicaid level. The persons who use this system would be required to pay back the bank for their health care costs, with a stipulation that their annual payback cost amount for any particular year in question would never exceed a specific value equal to 10% of their actual gross income of the person for the year in question. The person’s using this system would be required over their lifetime to pay back their balance until it was fully paid off, even if during a particular year they had no health care costs, they still would have to pay off their balance (if they had one) at the max rate stipulated above. Their balance would be considered as a tax requirement, since the block grants were derived from US government funds. Therefore, all the collection and penalty functions of the tax code could be applied against these individuals if they chose not to pay back their annual amount in a proper manner. There would be no limit on who could use this program, including that people on welfare could use it, but they still would have to pay back their balance with the stipulation that their income from welfare payments would be included in calculating what their annual income was. To make this program a universal health care system the following would be applied in the event that someone died before paying off their balance. The cash value of their estate would be required to pay off their balance except that the following calculation would be applied. The maximum amount of their health care costs that remain to be paid under this program that the cash value of their estate would be required to pay off would be set as a maximum value of 50% of the cash value of their estate at the time of their death. Any amount of their health care costs balance remaining under this program after this max 50% limit on the value of their estate was applied would be considered a balance that the person (or the executors of the person’s estate) were not required to pay off. To set how the remaining balance would be paid, the following calculation would be applied: 50% of the remainder of the balance would be paid by the federal government to the health care institutions and/or providers involved over a 24 month time frame in equal monthly payments, and 50% of the remaining balance would simply be forgiven by the health care provider or institution involved.

    • Randy Wagner says:

      P Gray,
      Your idea has some interesting components. My take is it would be a program to provide lower cost financing for payment at Medicare rates to people who are already sick and engaging the healthcare system. Whatever fixes the country may wind up using your idea could be independent of them and an alternative to someone who purchases ongoing healthcare insurance. I feel that the healthcare system in our country is the single biggest contributor to what will eventually bankrupt the nation. It is an anchor on the backs of businesses and causes people to lack job mobility which is stifling to all involved. We are the last industrialized nation to tackle some sort of single payer government backed plan to tend to the health needs of our citizens. I equate that requirement as equal to defense. It effects everyone’s security just as our nation is protected by our defense department’s role. The problem is that we have allowed a total free market approach to a product that everyone HAS to buy while placing the insurance companies as the middlemen-brokers to distribute the product which insulates the population from the providers. When the caregivers raise prices which they have been doing in record fashion, the broker just raises the fees and the public is forced to pay it. What makes the industry so afraid of the ACA is that it is perceived as the first step to some sort of single payer system; and it probably is.
      My proposal is a form of the public option and the State healthcare Exchanges that are in the ACA. I have contacted the national Credit Union associations with my concept as they should be the ideal organizations to build and implement in each state the infrastructure to form a national pool of insurees. My biggest fear is that the individual mandate will be struck by the Supreme Court collapsing the whole system and there will be nothing in place to implement an alternative plan. I suspect it will be several years of gridlock trying to get something done if this occurs.
      Thanks for spending time formulatin your ideas as they too have merit. It is just this kind of thinking outside the norms that Washington is so lacking in.
      Randy Wagner

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