Medicare-Advantage-For-All plans (MAA) can deliver an American health care system capable of achieving affordable and accessible health care for every American. Medicare-Advantage-For-All will be designed to attract the young and middle-aged Americans that have not been able to take advantage of Obamacare. We envision these plans to be offered right along-side the ACA/Obamacare plans, which currently only cover 8.4 Million participants. All residents of the U.S., who are not eligible for (or covered by) other health insurance, will be able to participate in these new MAA plans. The MAA Plans should be especially attractive to students, low wage workers, and all the other people who comprise the 30 Million uninsured Americans, who cannot afford to buy ACA health insurance.
This sounds great, right? But, how will this be funded/paid for?
Medicare-Advantage-For-All will be funded just like Obamacare; however, unlike Obamacare, MAA will generate significant savings in the overall expenditure of health care paid by the federal and state government and the American people and our domestic businesses.
We envision a two stages process, something like an Apollo rocket. The first stage is the extension of a Defined Contribution Plans, like most large American employers use, to create access to medical care for the American people that don’t already have health insurance. The second stage would be the introduction of a revolutionary next-generation Medicare Advantage plan we are calling “Apollo” after the successful space program.
The first stage program will initially be financed similarly to the Obamacare/Affordable Care Act (ACA). Government subsidies will be provided to those American citizens that meet specific income guidelines. There will be income levels, above which the cash subsidies will be made phase into tax credits received by the participants at the time their taxes are paid. Anyone above certain upper-income levels that should be able to afford a reasonably priced health insurance plan would pay premiums for the programs without any government assistance on a sliding scale. No one will be required to participate.
Overall, the programs will be less expensive by design. But to start, like all the new federal health plans in the past, we expect some over subsidization and underpricing of the programs, as was the case with both Medicare and Obamacare. After the first two years though, costs should stabilize, as they did with the ACA. If we are successful with the integral health and wellness programs, the positive effects of the program will gradually lower the actual cost of health care. This will take a few years, but all the benefit plans will start out being less costly than Obamacare Qualified Plans for several reasons:
- First, they will be engineered by insurance experts using all the latest information. These modern programs will not be subject to unnecessary federal regulations that force health insurance companies to offer benefits that people don’t need.
- Second, the Department of Health and Human (HHS) services would cooperate with the carriers to work out constructive capitation reimbursement schemes that effectively shift the risk from the federal government to the carriers. This will require them to assume full responsibility for the health and well-being of their members. In addition, HHS will appropriately participate in favorable provider cost negotiations to make the first-generation product as cost-effective as possible.
- Third, adverse selection will be minimized. The old-world provisions of waiting periods for certain benefits will be allowed for premium health products. All pre-existing conditions will be accepted and covered immediately, but not necessarily by all plans. Some Pre-X programs will be paid for like Medicaid, financed on more of a cost-plus basis with shared responsibility between the federal and state governments wherever possible. Nothing suggested here will preclude Block-Grant funding.
The first stage programs will be common sense Defined Contribution health insurance contracts, like those commonly used by most large employer groups with integral employee wellness initiatives. We believe the second stage Defined Contribution plans will be much more revolutionary. They will reward the participants for improving their health condition. Premium credits and increased benefit levels will be given to reward participants for specific healthy behaviors. People will be rewarded for maintaining and improving their health, and these people will not be required to pay more for Americans, who are fully capable, but either cannot or will not take care of themselves. No one will be left out in these programs, and no one will be disadvantaged. However, those people who can maintain a healthy lifestyle but for whatever reason do not choose to do so will have to pay a little more for that their health insurance. This is only fair and reasonable, considering that they are more likely to make use of their health plans. This second stage program is going to require some creative financing because traditionally we have financed health care by charging the healthiest people among us more than we should, in order to pay for the unhealthiest among us. This was the impetus for the Obamacare Individual Tax Mandate, which was repealed. We have to start rewarding the correct behaviors rather than condoning the incorrect behaviors. As Warren Buffet says, “We can not continue to do the wrong thing indefinitely.”
Every participant in Medicare-Advantage-For-All will be underwritten as an individual with full consideration of their specific health condition. Each person’s rates will be directly associated with his/her health condition and changes in that condition, like car insurance. If you have a lot of car accidents or speeding tickets, you are going to pay more than someone who never had a traffic ticket and never had an accident. This is just common sense, but we don’t use common sense when it comes to health insurance. Some of our politicians want to remove all personal responsibility when it comes to a person’s health condition in favor of government responsibility. That isn’t how it works in the real world.
The new Defined Contribution Apollo Medicare Advantage contracts will require special underwriting. The traditional underwriting for these programs will have to be substantially restructured to allow individual participants to pay vastly different rates for essentially the same benefit programs based on their health condition. Some plans may wish to allow beneficiaries to enroll for two- and three-year periods. These longer-term contracts would have stronger economic incentives for both the carriers and the beneficiaries to promote wellness and preventative care. The ability for our medical practitioner to initiate, reinforce, support, and monitor their patients will be properly rewarded and supported by their reimbursements under this new Apollo type plan.
Our Medicare-Advantage-For-All plans should be able to reduce the risk and consequently, the expense of chronic illness by about 50% in the first two years. These savings would amount to more than $1.3 Trillion annually and reduce the NHC-GDP by 6% percent to approximately $2.35 Trillion Dollars, or 12% of Total GDP to start.
This target population for this plan is primarily the 30 Million uninsured Americans plus the 8.4 Million Obamacare subscribers, about 75% of which receive federal subsidies in order to make the ACA programs affordable. Medicare-Advantage-For-All is not looking to replace Obamacare. What we want to do is create a program that the America people can afford to choose. A program that will give Americans a choice that will attract most of the uninsured Americans that Obamacare has failed to attract.
If we are successful with an affordable, comprehensive insurance plan with an integral health and wellness component, other health plans will quickly incorporate these features into their programs. Eventually, everyone, except perhaps fee-for-service Medicare and collective bargaining agreements, will have state-of-the-art health and wellness programs that will lower everybody’s rates and improve the general health of most Americans.
If we do this right, the federal government will be able to reward the health plans, as they do now under the STAR program, with more federal money based on their ability to improve outcomes, improve health status and reduce the overall cost. If we get the incentives right, everybody wins. The effect of this reduction will lower the cost of health care and health insurance for individuals and businesses and will increase our health condition, our productivity, and our competitiveness as a nation. We firmly believe that in order for the United States to remain a competitor in world markets with the greatest health care system on the planet earth, we need to commit ourselves as a nation to achieve the lowest national health care GDP of all the high-income developed nations by the year 2030! If we can return man to the moon, and plant an American flag on Mars, we can certainly achieve the “best” health of any industrialized nation on the planet.
For all these reasons listed, this is how we will pay for Medicare-Advantage-For-All.
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