The most frustrating aspect of America’s healthcare debate is that designing an effective national single-payer health insurance system that would meet most Americans’ needs would be simple.
The real problem is that our so-called political leaders on both sides of the aisle refuse to take that step for a wide variety of reasons. To prove how easy it would be; and to pass time I designed such a proposal I call 21st Century Medicare. The basics of the proposal are outlined in the question and answer solution below.
21st Century Medicare
Q: What is 21st Century Medicare?
A: A single-payer health insurance system that all Americans would participate in.
Q: Would the government take control of or run clinics or healthcare facilities under 21st Century Medicare?
A: No, the only role for 21st Century Medicare will be to pay for healthcare. Care will be provided by the existing healthcare system. 21st Century provides the financing.
Q: Who would be eligible for 21st Century Medicare?
A: All citizens and legal residents of the United States. All legal visitors to the United States would also be covered.
Q: Will there be any age or income limits for 21st Century Medicare?
A: No, all Americans will be able to participate it in regardless of age, pre-existing conditions, health, employment status, income level, criminal record, or residence. Since the vast majority of them will be paying taxes to support the system they should have access to it.
Q: Would there be premiums for 21st Century Medicare?
A: No because it would be tax-supported. Participation in the system would be free for all Americans. All a person would need to do to participate is enroll.
Q: How will you finance 21st Century Medicare?
A: There would be a 3% tax on all individual income and a 5% tax on all corporate income. That might be augmented by sales taxes on things like candy, soda pop, alcohol, tobacco, and marijuana.
Q: Would there be any limits or restrictions on those income taxes.
A: No limits, millionaires and billionaires will pay the tax on all of their income including investment income. There would be an exemption or tax credit for the first $24,000 in household income to protect the poor.
Q: Would the income tax be collected as withholding or billed to taxpayers?
A: That would depend on the kind of income. For salaries, wages, and payments to freelance or contract workers it would be withholding. For business or investment income it would be added to the yearly tax bill.
Q: How would Senior Citizens be affected by 21st Century Medicare?
A: They would no longer have to pay premiums and separate plans for prescriptions. There would also be no requirement to register for 21st Century Medicare at any age. Seniors would also see the cost of eyeglasses and non-cosmetic dentistry covered by Medicare.
Q: Who will administer 21st Century Medicare?
A: The federal Centers for Medicare and Medicaid, which already exists. No new bureaucracy will be needed. Instead, hat entity will be renamed the Center for Medicare.
Q: What will be covered by 21st Century Medicare?
A: Any medical procedure, treatment, drug, medical device, surgery, therapy, test, or process that is approved by the National Institutes of Health or the Food & Drug Administration.
Q: Will dental and vision be covered by 21st Century Medicare?
A: Yes, non-cosmetic dentistry, eye tests, eyeglass lens, and the first $100 in eyeglasses will be covered.
Q: Will birth control be covered by 21st Century Medicare?
A: Yes. That would end the horrendous practice of forcing employers to finance medical procedures they disagreed with.
Q: What about ambulances, paramedic care, and emergency medical transportation? Would 21st Century Medicare pay for them?
Q: Will 21st Century Medicare cover nursing home or long-term care?
A: Yes, if it is prescribed by a doctor, and not paid for through other means.
Q: Will 21st Century Medicare charge deductibles?
A: No, it will cover 100% of medical bills or prescriptions at a rate determined by the Center for Medicare.
Q: Why are there no deductibles?
A: Deductibles generate useless paperwork, raise costs, and put a terrible burden on working families. They are the worst part of our healthcare system.
Q: How will 21st Century Medicare control costs?
A: The same way Walmart and Amazon keep prices low. The Center for Medicare will set one price for each medical procedure, surgery, drug, medical device, treatment etc. that will be charged nationwide. There will be one price and it will be nonnegotiable.
Q: How will you get healthcare providers to accept that price?
A: We will use modern technology to pay all approved claims from approved providers electronically within one business day. That means they will get cash in their bank accounts with 48 hours. The long-term goal will be instant payment of all valid claims.
Q: Would there be copays?
A: No copays would be required. We might allow minimal copays such as $5, $10, or $25 at the provider’s discretion, but they would be discontinued after the first year. This would be done to get providers to participate. The long-term the plan would be no copays. Instant payment of claims should eliminate the need for copays. Copays exist to cover the provider’s costs while they are waiting for claims to be processed.
Q: How is such fast payment processing possible?
A: By simply adopting the same payment processing procedure now used by companies like Visa, MasterCard and PayPal. That is paying all claims that meet the criteria instantly, and having no requirement for review or approval. If the claim meets the criteria the system will simply approve it automatically and release the funds.
Q: What about fraud?
A: We can simply adopt the anti-fraud procedures used by organizations like Visa and MasterCard. That is fraud detection would occur after payments are made. If fraud is detected, it would be a law enforcement matter. Providers suspected of fraud would be suspended or banned from the system and treated as criminals.
Q: Would anybody be required or forced to participate in 21st Century Medicare?
A: No, all Americans would be eligible to participate but nobody would be forced to take part. Nobody would be forced to buy health insurance but they would pay taxes.
Q: What about the uninsured? How would providers deal with them under 21st Century Medicare?
A: The provider would simply bill the Center for Medicare. If the claim was approved, the Center would pay it then refer the matter to the IRS. The IRS would send the uninsured person a letter offering three choices: pay the bill in the cash, have the amount added to their next federal income tax bill or take out of their tax refund, or enroll in Medicare and pay no bill.
Q: Would 21st Century Medicare support for-profit or nonprofit healthcare providers.
A: It would not make that distinction. Any licensed healthcare provider that follows the rules would be eligible to take part in 21st Century Medicare. That includes religious organizations, nonprofit organizations, government-run facilities, even employer owned clinics or hospitals.
Q: How would people sign up for 21st Century Medicare?
A: Anybody would be able to sign up online at the 21st Century Medicare website or through the 21st Century Medicare App at any time. Any American would be able to sign up when by checking a box on his or her tax return. Parents would sign up for their kids, and organizations can sign up on behalf of individuals.
Q: Would there be open enrollment for 21st Century Medicare.
A: Yes we will have true open enrollment. Anybody would be able to enroll in 21st Century Medicare at any time. Open enrollment will be 354 days a year, seven days a week, and 24 hours a day at the 21st Century Medicare website and app.
Q: Could employers enroll their employees in 21st Century Medicare?
A: Yes. They could, they can even it a make it a part of the job application or orientation process.
Q: Would employers be required to offer health insurance?
Q: Could employers require employees to enroll in 21st Century Medicare as a condition of employment?
A: Yes, they would. Remember, employment is a voluntary agreement between two individuals or an individual and an organization. A person who takes a job agrees to a restriction in freedom in exchange for pay.
Q: Would private health insurance be banned?
A: No, if Americans wanted to spend their own money on private health insurance they would have that right. No company’s business would be made illegal.
Q: Would employers be able to offer their own health insurance plans under 21st Century Medicare?
A: Yes, employers would be able to offer their own insurance.
Q: Would people be able to participate in 21st Century Medicare and private insurance at the same time.
A: Yes, enrollment in any other health insurance plan would not affect eligibility for 21st Century Medicare?
Q: Why is that?
A: Those people would be paying taxes to support 21st Century Medicare they should be able to participate in it.
Q: What about other government health insurance plans such as the Veterans’ Administration (VA), Tri-Care, Medicaid, Indian Health Service, CHIP for children, etc.? How those be affected?
A: CHIP, Tri-Care, and Medicaid would go away because they would be redundant. Veterans would participate in the VA; and 21st Century Medicare, at the same time. The same would apply for Native Americans on the reservation.
Q: How will children be covered under 21st Century Medicare?
A: Parents or guardians would simply sign the kids up for it online or through the app, or when they filed their taxes.
Q: Would people able to sign up for 21st Century Medicare at the clinic or doctor’s office?
A: Yes!! All they would have to do is provide their Social Security number, or show a valid ID. If the facility had an internet connection any provider would be able to register patients for 21st Century Medicare by going to the 21st Century Medicare website or app.
Q: What about the poor and those receiving government benefits how would they enroll?
A: Whenever a person applies for any government benefit such as Food Stamps, Social Security, Social Security disability, unemployment insurance, etc. He or she would have the opportunity to enroll in 21st Century Medicare as part of the enrollment process. 21st Century Medicare enrollment would be part of every application just as is it would be part of every tax return.
Q: Would there be a separate health insurance plan for federal employees?
A: No!! All federal employees from the President on down to the janitor would have to enroll in 21st Century Medicare as a requirement for employment. This would include Congress and all members of the federal judiciary. They would have to enroll in it as a job requirement. The military would have to enroll in 21st Century Medicare when they were inducted.
Q: How will healthcare providers know people are participating in 21st Century Medicare?
A: All 21st Century Medicare participants will have a chip card just like those issued by Visa or MasterCard. The chip will enable the provider to bill them and access their healthcare records.
Q: How will the providers bill 21st Century Medicare?
A: Simply by entering the card in the system either through a reader or typing the number in. Just like billing Visa or MasterCard for anything else. It would be possible to run it through cash registers and card readers. There would be automatic billing procedures for continuing care or procedures.
Q: What if the card was not available?
A: Long-term we would probably go to biometric means such as retinal scans or Fingopay. Providers would also be able to look up the person via his or her Social Security number. We might also create a 21st Medicare App similar to Apple Pay.
Q: How will 21st Century Medicare connect to the providers?
A: We will simply use the existing infrastructure already built by Visa, MasterCard, PayPal, Square, etc. It would simply be added to the major billing systems as another option. No provider or business would probably need to buy any new equipment. More importantly, we would not need to build new technology or infrastructure.
Q: What about people in prison?
A: 21st Century Medicare would simply reimburse the jail or prison system. The prison would simply sign up on the inmates behalf, and the facility or the healthcare providers it contracts with would bill Medicare for all services provided. The same procedure would be followed for those in mental institutions.
Q: How will fraud be combatted?
A: We would set up a law enforcement agency similar to the FBI that would investigate fraud and help the U.S. Justice Department prepare charges against the perpetrators. The agency would investigate allegations of fraud, and audit the system to detect fraud. A potential name for this agency would be the Bureau of Healthcare Investigation (BOHI).
Q: Would claims be reviewed for fraud?
A: Yes, but after they are paid. The approval process is automatic, if a claim meets the criteria it just paid, just like Visa covers your card payment if you have the money or credit in your account. The Center for Medicare would have the power to throw providers out of the system, and cancel cards. We would use modern business practices like auditing and sampling to combat fraud.
Q: Why no review until after payment?
A: We want to eliminate bureaucracy and unnecessary costs. Much of the cost of the present U.S. healthcare system comes from the fact that bureaucrats have the power to hold up claims. This often occurs because the bureaucrat is trying to justify his or her job, not because anything is wrong. There is no evidence this prevents fraud, and it certainly adds to costs. The last thing we need is another layer of bureaucracy.
Q: Why do you call it 21st Century Medicare?
A: The name sounds cool and Medicare is a proven brand name that Americans accept.
This proposal first appeared at Market Mad House please check us out.