Thursday, July 23, 2009

A Single Payer Solution: Health Care Credit Cards (Part 2)

The US Federal government spent more than $808 billion in 2007 on health care (medicare, medicaid, Federal workers, VA hospitals, etc.). If you divide that number by every American citizen, that comes out to $2640 per capita. If that $808 billion in Federal health expenditures were utilized as an 80% subsidy for a single-payer health care system then the Federal government and its citizens would be spending approximately $3300 per capita, which would be a higher per capita expenditure than in Ireland, Japan, Italy, Spain, Singapore, the UK, Canada, Sweden, Australia, Germany, and France, all with higher health rankings than the US according to the World Health Organization. So the US Federal government already spends enough money on an annual basis to provide quality health insurance for every American without any private health insurance dollars at all, if these Federal dollars were used as efficiently as they are in most other advanced nations.

Its my argument that a Federally subsidized health insurance credit card system is the best way to utilize the health care dollars currently spent by the Federal government. And in order to implement such a system, I would do the following:

First I'd immediately replace the current Medicare system with a Federally subsidized Senior Care credit card insurance system for all American citizens 67 years and older:


Senior Care credit card:

No purchase fee for seniors ,
$10 user fee,
80% Federal subsidy,
<$25 (final payment), $25, $50, $75, $100 fixed monthly payments. Maximum unsubsidized debt: $25,000
$10 late payment fee
$100 delinquent payment card reactivation fee

Monthly payments for unsubsidized debt on health care credit cards for seniors:

$25 per month for unsubsidized debt of $300 or less
$50 per month for unsubsidized debt of more than $300 to $900
$75 per month for unsubsidized debt of more than $900 to $1800
$100 per month for unsubsidized debt of more than $1800 to $25,000

So if you're a senior and you use your Senior Care card to pay for a simple $200 physical check up, 20% of those charges would be billed to your from the HHS (The United States Department of Health and Human Services) plus a $10 user fee. So you'd be charged $40 for a $200 physical check up plus a $10 user fee ($50: $25 per month for two months). That's it!

If you're a senior paying $100 per month for medicine, $20 of debt plus a $10 user fee would be added to your monthly credit card debt. If you had to use your card to pay for a very expensive procedure like a $50,000 for a hip replacement and short hospital stay, the HHS would charge you $10,000 ($100 per month for nearly the next 7 years until monthly payments would finally go down to $75 per month for a year, then $50 per month for another year, and finally down to $25 per month). Of course, you could always use your card to get your hip replacement in an HHS approved country like the UK which would cost you only $2800 instead of $10,ooo ($14,000 charge to the HHS) or $2400 in France ($12,000 to the HHS) or $1200 in India ($6000 to the HHS).

Secondly, I'd provide all parents and guardians, both citizens and permanent residents, in the United States with the opportunity to purchase Child Care credit cards from the HHS for a $50 purchase fee (this would be charged to the card):



Child Care credit card
:

$50 purchase price,
$10 user fee,
$10 late payment fee
80% federal subsidy,
<$10 (final payment), $10, $20, $30, $40, $50 fixed payments Maximum unsubsidized debt: $100,000
$50 delinquent payment card reactivation fee

Monthly payments for unsubsidized debt on children's health insurance credit cards:

$10 per month for unsubsidized debt of $120 or less
$20 per month for unsubsidized debt more than $120 to $360
$30 per month for unsubsidized debt more than $360 to $720
$40 per month for unsubsidized debt more than $720 to $1200
$50 per month for unsubsidized debt more than $1200 to $100,000

If you use a Child Care card for a $200 dollar check up for your child, the HHS would charge you, the parents and purchasers of the card $40 plus a $10 user fee ($10 per month for 5 months). Need $5000 braces for your 12 year old? The HHS will charge you $1000 dollars ($40 per month for 7 months, followed by $30 per month for a year, $20 per month for the next year, and $10 per month for the final year). What if your child's medical credit card still has debt on it even after he or she becomes an adult. Well its not their debt. Its your debt. And you have to continue paying off their unsubsidized debts until their gone no matter how many months or years it takes. So if the poor health of the child your brought into the world accumulates very high medical debts on the Child Care card you purchased, be prepared to pay $50 per month for many years after your child has become an adult (this system is affordable but not free!).



Third, Federal employees, veterans, and military personal would be immediately issued Adult Care credit cards:


Adult Care credit card:

$1000 purchase price (charged to the card),
$20 user fee,
$10 late payment fee
80% federal subsidy,
<$25 (final payment), $25, $50, $75, $100 fixed monthly payments Maximum unsubsidized debt: $25,000
$100 delinquent card reactivation fee

Monthly payments for unsubsidized debt on health care credit card for adults:

$25 per month for unsubsidized debt: $300 or less:
$50 per month for unsubsidized debt: more than $300 to $900
$75 per month for unsubsidized debt: more than $900 to $1800
$100 per month for unsubsidized debt: more than $1800 to $25,000

Non Federal employees could purchase the card for $1000 (charged to the card after it is ordered). Private employers would also be given the opportunity to purchase the Adult Care card for their employes. A $1000 dollar one time purchase fee for employees would obviously be a lot better than paying the private health insurance companies $4700 on average per employee every year. Unions might also insist that employers pay for the purchase an Adult Care card for a spouse ($1000) and children ($5o for each child).

A $200 medical check charged to your Adult Care card would cost you $40 plus a $20 user fee ($25 per month for two months plus $10 for the third and final month). If you're pregnant and are having a baby and you charge all of your doctor appointments and delivery cost on your card to a total cost of $10,000, the HHS will charge you $2000 ($100 per month for two months, followed by $75 per month for a year, $50 per month for the following year, and $25 per month for the final year of your 20% debt).


What if you're a non-citizens?

Under my plan, all adult permanent US residents would be eligible to purchase a Federal Guest Care credit card:


Guest Care credit card:

$100 purchase price (out of pocket),
$10 user fee,
$10 late payment fee
no federal subsidy,
<$25 (final payment), $25, $50, $75, $100 fixed monthly payments Maximum unsubsidized debt: $25,000
$100 delinquent card reactivation fee

Total Debt on health care credit card for permanent US residents:

$25 per month for a total debt of $300 or less
$50 per month for a total debt of more than $300 to $900
$75 per month for a total debt of more than $900 to $1800
$100 per month total debt of more than $1800 to $25,000

The Guest Care credit card will be pretty much self financing since no Federal subsidy is provided and since user fees are also charged. The advantage to non-citizens who are living and working in the US is that they will still have the convenience of paying off their health care cost gradually over several months. I should note, however, that under my scenario, the permanent resident will still be able to purchase the same Child Care credit cards as the children of US citizens. Of course, permanent residents would still have the option of purchasing health insurance from private companies. But I would require by law that no one could work in the US without some sort of public or private health insurance.

A $200 physical would cost a Guest Care card user $200 plus a $10 user fee ($25 per month for 8 months plus $10 for the final month of payment). A $10,000 charge on a Guest Care card related to pregnancy would cost the card holder $100 in monthly charges to the HHS for at least 6 years until the next lower monthly charge would be reached. Still there are monthly premiums charged to individuals with private health insurance a lot higher than that.

But what happens if you're one of those rare individuals that ends up having extremely severe medical problems and expenses and your unsubsidized health care credit card expenditures exceed the $25,000 maximum unsubsidized debt? One option is to simply start paying down more of your unsubsidized debt ($100 in debt reduction gives you $500 in available health care credit). Another option would be to replace your Senior Care or Adult Care credit card with an HHS Critical Care card.


Critical Care card:

$150 purchase price,
$150 fixed monthly payments (for the rest of your life),
5% of annual income (for the rest of your life)
Maximum total outstanding debt: $1,500,000

After purchasing this card, if your annual income declines-- so will your annual additional payment to the Federal government since part of the payment is based on 5% of your annual income. However, if your annual income should increase after purchasing this card, then your annual payments will also increase. So if you should win the lotto it will be happy days for you and for the Department of Health and Human Services!

Further details on how these Federal health care credit cards will be introduced to the public and financed by the Federal government and secured against fraud and abuse will be discussed in the final part (Part 3) of this diary.

References

http://newpapyrusmagazine.blogspot.com/2009/07/single-payer-solution-health-care.html


http://www.dailykos.com/story/2009/7/23/754429/-A-Single-Payer-Solution:-Health-Care-Credit-Cards-(Part-1)

http://newpapyrusmagazine.blogspot.com/

Copyright New Papyrus Publications
Marcel F. Williams

1 comment:

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