(un)Affordable Care Act

The Affordable Care Act, which was one of the most prominent legislative feats of President Barack Obama, ultimately fails to deliver on two of its key pillars. The alterations made under President Donald Trump’s administration have done little to stabilize the teetering house of cards that is the Affordable Care Act, leaving millions of Americans without basic health care or paying an outrageously high price for their care.

Although there are loud cries for universal healthcare similar to systems used by other developed countries ranging from Canada to Japan, the focus of this proposal is not to call for an abrupt change in the American healthcare system that will create a significant economic shock and risk triggering an economic recession. Instead, this proposal focuses on a series of smaller changes that I hope will reduce the long-term costs of healthcare while also providing fundamental healthcare to all Americans.

Before I detail my own proposals, I wish to restate the two primary tenets of the Affordable Care Act as well as why I feel a series of smaller reforms will be a better replacement for attaining the same goals. The first major tenet of the Affordable Care Act is that ALL Americans should have access to affordable healthcare so that chronic illnesses such as diabetes or relatively minor bacterial infections do not turn into healthcare catastrophes leading to costly emergency care paid by compassionate tax payers and devastating loss of income leading to homelessness. The complication comes when the second tenet is introduced. The gist of the second tenet is that those with severe health problems should be offered the best care currently available without being plunged into homelessness or other financial ruin. The problem is that no insurance can insure anything against all possible losses, so requiring all Americans be covered against all possible illness results in an insurance policy that acts more like a savings account with exorbitant fees and negative yields than true insurance.

Plan for Immediate Relief:

  1. All employers MUST offer a MINIMUM of 8 hours of PAID sick leave redeemable in 1 hour increments per year. This allotment of sick leave shall be forfeit if not used within a calendar year and the intention is that it will be used for routine care such as physicals, eye exams, and dental visits. For a minimum wage worker earning $7.50/hour, this benefit is estimated to cost the employer $60/year.
  2. All employers MUST offer a MINIMUM of 72 hours of PAID sick leave beyond the 8 mandated in the first point and shall require no formal documentation to claim. The intent of this rule is to provide some relief to the workers living paycheck to paycheck so as to allow time for treatment to take effect or reduce the number of people exposed during the infectious stage. The estimated cost under the prior assumptions would be $540.
  3. All Americans shall receive $250 credit towards a routine eye exam and a pair of standard glasses per year. For most people, the current Affordable Care Act lacks essential vision coverage and this is a fairly inexpensive way to ensure everyone has access to the most basic of vision services.
  4. All Americans shall receive $500 towards routine dental cleanings, exams, x-rays, fillings, and extractions. Personally, I’d like to see this with a one time catch up provision so people can get dentures or more cavities filled as maintenance is a lot easier when starting from a healthy mouth. I understand the limits are quite low, but again many Americans don’t have dental coverage so this is still an improvement over the current Affordable Care Act.
  5. All Americans shall receive $500 towards routine doctor’s visits to include either routine physicals or diagnosis of illness.
  6. All Americans shall receive $500 towards routine immunizations.
  7. As medically necessary, patients will have $7650 towards care overseen by a licensed medical professional. Notable exceptions for this pool include: all medical products not billed directly by a licensed medical professional, pregnancy expenses, fertility treatments, and all procedures not medically required. The goal of this rule is to allow for flexibility in meeting individual medical needs without creating a cumbersome list of allowed services. I understand there are significant societal benefits for ensuring expecting mothers receive proper care, but as a matter of national policy I am operating under the fantasy assumption that people won’t have children if they can’t afford the associated costs.

By my estimates, this could cost as much as $3 trillion a year, BUT one must realize that this number is consistent with the national average for healthcare as things currently stand. It should also be noted that for a variety of reasons, not everyone will use the full allowance of healthcare allotted to them so I am estimating the real cost will start at $60 billion.

 

Plan for Long Term Relief:

  1. Redesign the national curriculum to teach biology and chemistry classes with more of a medical focus without sacrificing the basics principles of the science. For instance, a revised lesson on evolution may instead focus on adaptations made by bacteria to evade antibiotics rather than the more classical examples involving the beak shapes of finches in the Galapagos Islands. In a chemistry class, students could be asked to write the balanced chemical equation for the complete oxidation of glucose in the citric acid cycle rather than more classical hydrocarbon oxidation.
  2. Provide scholarships that revert to loans that cover the full costs of entering any of the medical professions in exchange for 10 years in a public clinic.
  3. Instruct the NIH and NSF to assert a proportional ownership stake in any patents derived from public research. Additionally, there should be centers designated to pursuing leads from other research. One huge problem with the way current research is run is that an academic researcher may inadvertently publish information about a promising drug that prevents the drug from carrying a patent and therefore prevents it from ever reaching the market. Another large problem with current research is that different academic groups have different specialties and relatively few research groups are equipped to identify and screen potential drugs. By creating research centers specifically for screening potential drugs and running clinical trials, it will ensure more research expenditures affect the clinic. Money generated from patents owned by the NIH and NSF will be spent on furthering national research.
  4. No product requiring a prescription shall be advertised in a broad manner and doctors shall not receive any compensation from those offering a medical product. Instead, doctors shall use an electronic clinic system integrating charting, diagnostic trees, and drug facts. The clinic software will synchronize with the FDA’s database of approved drugs and present the findings from the clinical trials in a summary form in real time. Side effects observed in patients will also by sent back to show trends beyond the original clinical trials. Doctors will then prescribe multiple drugs for the same treatment so that the pharmacists can work with the patient to find the best drug from the list.
  5. Drugs whose patents have expired shall be made available from a publicly owned manufacturing facility in order to avoid companies arbitrarily raising prices to extort higher profits.
  6. Medical debt shall be collectible against most assets subject to excluded income formulas. This provision is aimed at making insurance return to its original purpose as a measure of protecting assets rather than a savings account for future needs. Yet, once private insurance and non-exempt assets have been depleted I believe the nation should take on any additional expense provided the care is medically necessary.

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