Let’s be honest, the entire American Healthcare system needs and overhaul. Not just a small one, but a massive one. This is not a debate on if it should occur, it is simply a message that we all know to be true. There needs to be a change to the system, and it needs to happen sooner rather than later. Many people are wondering, why is it that Republicans control Congress yet cannot get an official “repeal and replace” ready for helping the nation?
The reason simply is over how terribly over-conservative these bills are. Plus, the recent plans of repealing without replacing was nonsense. It would serve to help no one and forces prices to actually go up in 2018 by 20% over the current Affordable Care Act. That means that right now, you’re better off keeping a law that is costing you a ton of money because the plan of repeal would cost you EVEN MORE!
No wonder people voted against it in Congress, right? The American Healthcare system is needing a change, and both Republicans and Democrats agree on this. The question is, how can they possibly overhaul the system? What could they possibly do to help Americans to get improved healthcare ALL can afford? We at the Top 5 got to thinking about that very same group of questions.
That is why we came up with a list of five ways to fix the American Healthcare System. We based this on the current single payer model, with some differences. We’re calling it The American Healthcare Model. We’re simple people at Top 5. Let us know if you would want all or none of these things to come into play from lawmakers in Washington soon.
Ten Essential Benefits Should Be Split Up
One of the things universally liked by Obamacare was the ten essential benefits. The American Healthcare system originally did not have to offer all things, which made it tough for people to get proper care…especially at reasonable prices. The ten essentials changed all that when they included prescriptions, maternal care, mental health, and much more. More women were covered for maternal care than ever before under this, in fact.
The problem is that including them all makes it tougher to price things for people. It means that, since all have to be included, you are now getting a package forced on you that has to be offered at a high rate in order to accommodate. Even if you just want a basic healthcare plan, you cannot get it. These benefits come with it. While that may sound good in theory, it isn’t. It forces you to buy a package that you don’t need at a price you cannot afford most of the time. At least, without the federal help offered.
This is why a tier system would be a better option. For those who want every single thing, you could buy the highest tier to get it. Tiers are already in play, but they are basically all the same. Insurers would have too much power if we allowed them to mess with this. So we would need to force one plan to have it all.
As for men and women, plans would differ. Men do not need to buy maternal care or anything to do with female healthcare. That said, they could get a plan without this in it and it would cost less.
Remove Federal Mandate
The current Affordable Care Act law requires people to have healthcare, or else they pay a penalty for it. Basically they pay a tax, or a fine to be blunt about it. This is also a problem for employers, as they also have to offer healthcare if they have 50+ employees. This forced most companies to lay off many people and/or mostly employ people part-time instead of full-time. Literally, people would work 39 hours a week so that ownership could avoid the insurance rights.
Others lost their insurance due to their bosses not being able to afford the cost of it, and simply accepting the tax instead. In fact, many feared this coming before it actually went into action and pushed employers to lay people off earlier. Many needed full-time employees and could not afford to lose them. This forced them between cutting jobs or providing the new ACA insurance, of which was highly priced of course. The tax was much easier.
No longer will this be the case. Employers would be required to offer healthcare to full-time employees, but they can provide the system we would employ. Plus, they can make the plan that best fits them from affordability, to greatness of care provided. The idea would be to allow employers to use a local insurance provider for base insurance. They could provide other healthcare options, but a base could include a variety of different things.
Emergency Care, Prescriptions, Maternal and Mental healthcare, and much more. However, they could add the gambit if they chose to do so.
American Healthcare Packages
As previously mentioned, we would break up the current ten essentials. This means that you could pick all ten essentials or you could pick only a few. This way, you’re allowed to get the plan you need at a reasonable price. Since insurers would be forced to offer all essentials that people would want, it means they have limited power. They need some in order to give proper pricing. However, they don’t need a complete power-shift to them because it pushes them to offer half the coverage for less.
By saying you would like a package that only includes primary doctor visits, prescriptions, and emergency care, you may save a great deal of money. This allows you to have less coverage, but if you feel this is all you need, then clearly that is all you need. That is what freedom is about.
On top of this, since we’re sort of adding the single payer option… so you can ADD coverage to your own line. Let’s say, for example, your employer offers a nice healthcare package for you. However, it is missing some key things like maternal and mental healthcare. You can talk to an insurer and simply buy this only. You could shop for the right insurer to offer this as well.
This means that you would shop for the right package that you can create yourself. Therefore, you may not get all you need from your employer but you can still get what you need from insurance.
American Healthcare Prices
We all know the biggest issue with healthcare has to do with premiums. It’s all about affordability, and the major issue is that insurance is not affordable for a bulk of the country. If that is the case, we should then make it affordable. The best place to start is with deductibles and out-of-pocket maximum. How do we avoid having an issue here? That is all starts with the plans used.
So we’re going to start with a couple tiers, which are not the full amount but it’ll provide a high, medium, and low outcome that will go with the plan picked. This example will show you three tiers of the American Healthcare Plan, which would give an example of expenses.
High Plan: $1200 Deductible/ $3000 out-of-pocket maximum
Medium Plan: $1800 Deductible/ $4000 out-of-pocket maximum
Low Plan: $2500 Deductible/ $5000 out-of-pocket maximum
As one would expect, the higher premium you have means the lower you’ll pay on the deductible and out-of-pocket costs. The lower you pay, the higher those might be. The reason for this is that it encourages you to pay more by going up, meaning insurances can make some extra money off of you. Yet you save in the end too. It’s an incentive to achieve yet another incentive. Plus in the end, you might very well save money.
Some may never go to the doctor, meanwhile there might be an emergency come up and they need to be covered. This allows for you to get the care you need and you know that you’ll never cross over $7500 in healthcare bills. This way, you’re saved regardless and that is why this plan is still helpful. It helps to avoid those pesky $40,000 hospital bills.
American Healthcare Plans Extended
You ever get tired of seeing those pesky premiums seemingly go up and up, while also seeing incredibly high costs to even visit a doctor? It’s annoying, right? How about we change that. This will of course only be a base, as insurers can charge anything around this and can pay for various things depending on the plan. Since plans are always quite huge in explanation of benefits we’re going to narrow things down so you know what you need to know without causing you to freak out reading the rest of this.
Our plan would be to put on a government cap. The highest plan, which would include everything, would be at $300. That includes all ten essential healthcare add-ons that Obamacare had, and it would include the lower deductible and out-of-pocket. This would hopefully encourage other companies to get involved, as $300 for everything seems relatively low but since it is not forced it allows for people to pay to get what they need.
The other plans would come into a territory where, out of the ten essentials, you pick a certain number of them to narrow down what you need. So you may want prescriptions, but could add on maternal care, mental care, etc. We could also add in family rates. So for example, the highest care is at $300, so two people would equal $600. Why not cut that down to $500 to $550? This would bring prices down to get in families of people. Deals would be offered to help everyone and save money. Insurers also get more money out of this in the end too.
2 or less essentials puts you in a lower plan. 3 to 7 put you in the mid-plans, and of course 8 or 9 would get you into the next to highest. Then 10 would get you to the highest. Visits as well as prescription prices will depend on the plan you have. The highest plan sees lesser charges, but that is simply due to the higher premium. For example, a primary doctor may be $10 for the highest plan, but it would be $35 to 50 for the very lowest plan. Specialists and ER material would be different in price too.
The American Healthcare Additional Add-On
Out of network prices are some of the most miserable to pay for people. In some states, it is impossible to have two major companies because doctors don’t accept everyone. For example, Blue Cross and Blue Shield may be in every office across the state you’re in. Meanwhile, an insurance like Healthcare Systems, Inc. wants to be accepted in other offices but aren’t at that time.
They have to then get into various places, and may manage to do so. However, it will take a lot of time in order to make that happen. This makes it harder, therefore they will make out of network costs high in order to get you to go to the places they work with. No longer. Offices will be required to use any insurance provider, but with a catch. They must try them for a period of six months. If that particular office seems to be screwed over by the insurer, or find the company difficult, they can remove them from insurers they take.
This will then push for insurers to create competition, as they’ll all be accepted out of the gate. From there, it is up to them and how they work with each office when it comes to remaining with major hospital partners or private offices. American healthcare can improve in competitive environments, as prices will drop in order to beat out others. While we’re putting up caps, we very well could be seeing insurers going lower than that to accommodate.
Meanwhile, if insurers seem to cause problems with offices, they don’t have to be accepted back after a certain period of time. However, they have to make a legitimate reason for this…so it could cut down on top companies trying to kick out other insurers. This will cut down on possible problems for new companies as well as medical offices. Plus, out of network costs will be minimal due to the acceptance across the board.