How Do You Pay For It, Mr. President?

Nothing like a night of karate to get rid of aggravation and clear the mind. So my mind begins to stir, and I begin to wonder about children and how they need to be led and reassured and chastised.

Then it happened. I had an epiphany. The White House leadership believes we cannot think for ourselves and should not be allowed to do so. They want to do the thinking for us. This is why today's town hall meeting with the president was again very docile. He opened with a speech that told us why he thinks we need what he is proposing.

Not once did he say, "I have listened to what you want and have put together a team to work out a plan that will be best for all of America based on your concerns and your input." No. He sugar coated everything, then told us what he was going to do.

Unfortunately, he cannot bring himself to really listen to us. This is why 90% of the talking was done by him as he fielded what, 9 questions? He cannot bring himself to listen to us because he has already decided what he wants. Why? He seems to have programmed his mind to accept only one outcome for government - a "Americanized" form of socialism. He has spent years bouncing his ideas off of who? Socialists, Marxists, self-proclaimed "freedom fighters" (I mean a local terrorist), and a minister who spent a large amount of his time criticizing America.

Now that I have criticized him, let me build him up. President Obama can become the hero in all of this if, as a leader, he will take the lead and offer reform that the people can trust. Compromise is not bad thing. At least, he is trying to get something done (he just needs to remember that he represents us, not rules us).

We need health care reform but not at the extent he is proposing from the federal government. We do not need more federal intervention. We want less government, not more.

• Besides, if we need a public option so bad, then why not use medicaid as that option? Is it that bad?
• If they know that Medicare and Medicaid are losing money because of waste, then why not start there. Cut the waste and use it to strengthen those two programs.
• Next, use medicaid to cover those who are losing insurance for three reason: loss of job, pre-existing conditions, and dropped coverage. And let these conditions be the only conditions other than the normal threshold of Medicaids current coverage.
  
• Finally, make it easier for insurance companies to sell across state lines - this is what the commerce clause are for in our Constitution, right?

So how do we pay for it?

Just by cutting off the waste, says our President, we can pay for 2/3's of the plan. Then by magically changing the withholdings allowed for those who make $250,000 or more, we can pay for the other 1/3. Is he for real?

Why not do better?

Why not use the Empowering Patients First Act (printable copy)

Pillar #1: Access to Coverage for All Americans

• Makes the purchase of health care financially feasible for all – Extends the income tax deduction (above the line) on health care premiums to those who purchase coverage in the non-group / individual market. And, there is an advanceable, refundable tax credit (on a sliding scale) for low-income individuals to purchase coverage in the non-group / individual market.
• Covers pre-existing conditions – Grants states incentives to establish high-risk / reinsurance pools. Federal block grants for qualified pools are expanded.
• Protects employer-sponsored insurance – Individuals can be automatically enrolled in an employer-sponsored plan. Small businesses are given tax incentives for adoption of auto-enrollment.
• Shines sunlight on health plans – Establishes health plan and provider portals in each state, and these portals act to supply greater information rather than acting as a purchasing mechanism.
  

Pillar #2: Coverage is Truly Owned by the Patient

• Grants greater choice and portability – Gives patients the power to own and control their own health care coverage by allowing for a defined contribution in employer-sponsored plans. This also gives employers more flexibility in the benefits offered.
• Expands the individual market – Creates pooling mechanisms such as association health plans and individual membership accounts. Individuals are also allowed to shop for health insurance across state lines.
• Reforms the safety net – Medicaid and SCHIP beneficiaries are given the option of a voucher to purchase private insurance. And states must cover 90% of those below 200% of the federal poverty level before they can expand eligibility levels under Medicaid and SCHIP.
  

Pillar #3: Improve the Health Care Delivery Structure

• Institutes doctor-led quality measures – Nothing suggested by the Council for Comparative Effectiveness Research can be finalized unless done in consultation with and approved by medical specialty societies. It also establishes performance-based quality measures endorsed by the Physician Consortium for Performance Improvement (PCPI) and physician specialty organizations.
• Reimburses physicians to ensure continuity of care – Rebases the Sustainable Growth Rate (SGR) and establishes two separate conversion factors (baskets) for primary care and all other services.
• Promotes healthier lifestyles – Allows for employers to offer discounts for healthy habits through wellness and prevention programs.
  

Pillar #4: Rein in Out-of-Control Costs

• Reforms the medical liability system – Establishes administrative health care tribunals, also known as health courts, in each state, and adds affirmative defense through provider established best practice measures. It also encourages the speedy resolution of claims and caps non-economic damages.
• Pays for the plan – The cost of the plan is completely offset through decreasing defensive medicine, savings from health care efficiencies (reduce DSH payments), ferreting out waste, fraud and abuse, plus an annual one-percent non-defense discretionary spending step down.