Editor’s Introduction: This week’s CSA Online First by regular contributor Harrison Chow, M.D., is a tongue-in-cheek approach to having open discussion about the future of health care in the state of California. With a whimsical “cocktail napkin” angle, Dr. Chow examines a broad scope of reform ideas, which he hopes readers will use as a spring board for sharing their own thoughts and ideas in the comments area below.
Well it’s a slow afternoon, and I’m watching a news show recapping of the Supreme Court’s hearings and the legality of the Affordable Care Act (ACA) or “Obamacare.” With a glass of California Pinot in hand to relieve the inevitable stress these discussions cause, I receive an email requesting submissions for CSA Online First. Health care reform and Justice Scalia’s broccoli mandates are on my mind, so I jot some of the best ideas I can recall on a cocktail napkin (very Silicon Valley and dawn of MICRA-like). I welcome your reactions jotted in comments below. A warning that these ideas are far from detailed or comprehensive (you can only fit so much on a cocktail napkin), and they may already be covered in the ACA text. (I’m still procrastinating on reading the 2700 pages of the ACA.) If anyone takes offense, I’ll just blame it on too much Pinot, so here they are – enjoy.
- California Should Be More Like Texas – No, not in threatening to secede, but in approaching health care reform and a potential, universal system, not at a federal level, but at a state level. California’s population is greater than that of Canada or Australia, with more money and resources–essentially, California is a large country in many ways. A wealthy, innovative, socially liberal state with excellent health care institutions like California should be able to create its own comprehensive health care system.
Why This is a Good Idea? The model of applying a comprehensive national health care program in a country as large and diverse as the U.S. never made sense to me. For example, insurance coverage for contraception is controversial in some states. In California, birthplace of free love, Internet pornography and San Francisco’s Castro Street, we–as a state seriously debating legalizing prostitution–have advanced social arguments well beyond debating the use of contraception.
- Form a non-partisan California Commission on Health Care Access – Recently billionaire Charles Munger (of the Berkshire Hathaway fortune) funded the widely popular and effective redistricting of a California political district by such a commission, through the California ballot process. Perhaps Mr. Munger or another beneficent billionaire can help bypass the dysfunctional California legislature one more time?
Why This is a Good Idea? The partisan bickering that has paralyzed the state legislature has prevented California from addressing any major state problems. Like the Redistricting Commission, the Health Care Access Committee could consist of one third each, of Democrats, Republicans and Independents, with an uninsured member of each group assigned to the panel to focus on creating a sustainable health care access model in the state.
- Junk Food Tax –The snack tax idea on processed foods should be revived to raise revenue specifically for health care access funds.
Why This is a Good Idea? The growing obesity and diabetic rates in the U.S. and California have been linked to access to processed, “junk” food. Any concerns about the financial impact on lower income Californians should be outweighed by health care access benefits that this demographic would receive. Fast food cheeseburgers and sodas, as well as the more high-end croissants and crème brulee could be taxed; any broccoli product, of course, would be exempt.
- Health Care Insurance Cap – Better known as the “Cadillac” plan tax (perhaps “Prius” plan tax would be more appropriate in California), California could cap the tax deductibility of health care plans to a local index such as a Kaiser plan or to a basket of health plans cost averaged.
Why This is a Good Idea? Entire markets are formed to minimize tax liabilities. Cheaper plans would become increasingly preferred, ostensibly slowing the growth of health care expenses. In any event any such revenues could again go into health care access funds.
- Health Care Exchanges (being formed currently under ACA) – Based on Switzerland’s model of universal access, at a state level (currently popular in Massachusetts) these exchanges would consist of entire menu of competing health care plans that are community-rated and ban discrimination based on pre-existing conditions.
Why This is a Good Idea? Californians could purchase plans more cheaply as individuals or as small businesses outside of the huge employer model that is favored currently. Most importantly it would provide economic flexibility in Californians moving between jobs, without being limited by health care coverage.
- Cheap Health Care Mandate – Every Californian filing taxes would be incentivized to prove possession of health insurance coverage or face some kind of fine, like $500 (the price of an iPad).
Why This is a Good Idea? The purpose of the fine would be to encourage Californians, particularly young working adults, to purchase cheap, catastrophic plans or move out-of-state (Nevada?) to become another state’s health care liability. The ACA’s fine of $2000 is too high.
- Senior Health Care Professional Corps – Any California-licensed medical professional over the age of 65 years working at an underserved California medical facility would be exempt from California income taxes for these wages.
Why This is a Good Idea? Such a group would create a pool of highly skilled (and badly needed) health care professionals (who ordinarily would be on a cruise ship somewhere), working part or full time to provide experienced care for needy Californians. This could draw professionals (physicians and nurses) from all over the country seeking a tax shelter.
- Uninsured Medical Arbitration Boards – Uninsured patients would have to seek redress for medical malpractice claims through medical arbitration boards first rather than through the tort system.
Why This is a Good Idea? The pressure of providing “free” care would be minimized from “nuisance” malpractice suits. Such boards would help remove a large impediment for physicians to volunteer care for the California indigent.
Well these are the somewhat uninhibited ideas for improving health care access in California, on a cocktail napkin. I look forward to your ideas and feedback in comments, below, and keeping this discussion open. Until then, be sure to eat your broccoli.