Good Ideas in Health-Care Reform

Some of the best ideas in the debate:

1. Loan forgiveness for primary care physicians. We need 'em, there aren't enough of them, and they aren't paid very much, especially in comparison with specialists. Pushing more MD students into primary care will have an effect on all of our health-care experiences. In addition, Medicare and Medicaid (which supplies 40% of all the health-care dollars spent in the US) could increase their payments. Some proposals suggest 5-10%.

2. F*CK the Blue Dogs. One of the 'concessions' demanded by the Chien de Azure was to force the public option to negotiate without the purchasing power of Medicare, thus giving lie to their purported goal of cutting costs. Now, they say that it's unfair to force private insurers to compete with an insurance plan that gets to negotiate with the power of Medicare. That's kind of true. It's also true that it's unfair for Americans to think they have insurance only to face rescission at the hands of some faceless corporate cost-saving algorithm or, what's worse, a cubicle-dwelling person who has to live with the knowledge that their job is to look for ways to dis-insure their fellow human beings.

3. The Employer Mandate. Gotta have one, without it you'll have (by some estimates) 40 million Americans losing their insurance to enter the exchange system where they'll have to buy their own insurance individually, which is incredibly inefficient. Where the line gets drawn is important. Small businesses will have to be excluded or brought in gradually to make it politically palatable. Those that don't offer coverage will be taxed, which will help subsidize the cost of the government covering them in the public plan.

4. Get rid of Medicare Advantage. So, President Bush thought it would be a good idea to subsidize private insurers offering Medicare, only problem, they aren't as efficient as Medicare. So, Bush decided to simply pay more for it, 13% more. That's just dumb.

5. Keep the Public Option! So, the idea behind the public option is that it will offer insurance plans that benefit from lower overhead costs (money isn't spent to subsidize huge bureaucracies to decide who not to cover and there isn't any profit) and the possibility of access to the purchasing power of Medicare.

6. Tax the high-end 'gold-platted' insurance policies. The revenue can help fund the costs associated with covering more people (many through the Public Option). Besides, these policies help promote over-treatment.

7. End rescission based on 'pre-existing conditions'. One extremely important regulation, so important, along with the public option, will likely mean that the health-insurance industry succeeds in pushing and individual mandate.

8. End the fee-for-service system. The worst part of the system could arguably be the fee-for-service, it promotes over-treatment and waste. There are various ideas out there. Doctors could work in teams and get lump-sum payments, this is how the Mayo and Cleveland Clinics works.

9. Expand Medicare from 65 to 55. No one is seriously talking about it, but it's the best non-idea out there. It's politically impossible (akin to arguing for Medicare-for-all), so that's that. Ezra Klein describes here.

10. Robust health-care exchange. Ezra Klein calls it the most important part of health-care reform. In fact, I'll let him take it from here.

11. Disclose the value of employer health-care plans, it's a form of compensation after all.

And, finally...

Paying for it all...

1. Carbon Tax. For the dreamer in all of us.

2. Super-wealth surcharge tax. Why should people who make $25 million a year pay the same rate as someone who makes $250,000? Half of $25 million is still $12.5 million, that's enough, seriously. Besides, using the wealth of the uber-wealthy to make INVESTMENTS is what we are all about (Americans I mean, not socialists--well, us too).

3. Tax the gold-plated health plans. It might discourage over-treatment, and besides it's a form of compensation.

4. Close the loop-holes, all of 'em. I heard that Goldman Sachs paid less than one percent of their revenue in taxes, I mean, come on! At least pretend this shit is fair!