Mosler Health Care Proposal


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Mosler Health Care Proposal

  1. Government funding for a full time, $8 per hour job that includes full federal health care coverage for the worker and dependents.

    This immediately triggers market forces that will result in all businesses providing health care benefits as a matter of competition.
  2. As a matter of economics and public purpose it is counter productive for health care to be a marginal cost of production.

    No economist will disagree with this. Unless going to work makes one more prone to needing health care, making the cost
    a marginal cost of production distorts the price structure and results in sub optimal outcomes.

    Therefore government should fund at least 90% of health care costs paid for by businesses.
  3. Long term vision subject to revised details:
    • Everyone gets a ‘medical debit card’ with perhaps $5000 in it to be used for qualifying medical expenses (including dental) for the year.
    • Expenses beyond that are covered by catastrophic insurance.
    • At the end of the year, the debit card holder gets a check for the unused balance on the card, up to $4,000, with the $1,000 to be spent on preventative measures not refundable.
    • The next year, the cards are renewed for an additional $5,000.
    • Advantages:
      1. Doctor/patient time doubled as doctor/insurance company time is eliminated.
      2. The doctor must discuss the diagnosis and options regarding drugs, treatments, and costs with the patient rather than an insurance company.
      3. Individuals have a strong incentive to keep costs down.
      4. Doubling the time doctors have available for patients increases capacity and service without increasing real costs.
      5. Total nominal cost of approx. $1.5 trillion ($5,000×300 million people) is about 10% of GDP which is less than being spent today, so even when catastrophic costs are added the numbers are not financially disruptive and can easily be modified.
      6. Eliminates medical costs from businesses, removing price distortions and medical legacy costs.
      7. May obviate the need for Medicare and other current programs.
      8. Eliminates issues regarding receivables and bad debt for hospitals and doctors.
      9. Eliminates the majority of administrative costs for the nation as a whole for the current system.
        Patients can ‘shop’ for medical services and prices as desired.
    • Disadvantages: Those more in need of the rebate at the end of the year may elect to forgo treatment beyond the $1,500 not subject to the rebate.
    • Doctors may be able to more easily convince patients of unneeded treatments and expensive drugs vs insurance companies.


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48 Responses to Mosler Health Care Proposal

  1. Steve Wierhake says:

    Very interesting proposal. I’ll share it with my friend who is heavily involved with PNHP (Physicians for a National Health Progam). PNHP is advocating single-payer, “medicare for all”.

    For Mosler’s proposal, I would want regulation requiring insurance companies to offer the catastrophic plans to all applicants, with no pre-existing condition limitations, or at least no permanent limitations.

    Reply

    WARREN MOSLER Reply:

    that would be covered by ‘Medicare for all/no copays/no donuts/no charges’ once the annual allotment of $4000 has been exhausted, thanks!

    Reply

  2. Cezary Wojcik says:

    The purpose without a method how to achieve it or method without a purpose produces sub-optimal solutions.

    Reply

  3. Cezary Wojcik says:

    Dear Warren,

    All “Health Care” systems i know of are actually “Disease Care” Systems. The one you presented seems no exception. If Medical staff is paid for curring (freeing from disease) people then decent supply of unhealthy people are required to perpetuate the system at the level which compromises supply of doctors and demand for curration services.

    True HCS treats people illnesses as a cost and long-term health as a benefit. So medical sector should be paid for customers who stay healthy and treat curring unhealthy people processes as a cost.

    Reply

    WARREN MOSLER Reply:

    my proposal has some of that
    the 1000 for preventative that’s use it or lose it
    and the incentive to stay healthy and get your $4000 christmas present each year

    Reply

    Cezary Wojcik Reply:

    @WARREN MOSLER,

    To legitimately assess your proposal a model should be constructed and researched for different scenarios. Anyhow medical sector is still paid for caring about the diseases not health of people.

    In true HCS you, and your doctor, would be the most benificiary of the system in terms of money as you look like in your early 40ties, slim, healthy and happy. :-)

    Merry Christmas
    Cezary

    Reply

    WARREN MOSLER Reply:

    agreed! So the Polish guy goes to the eye doctor, who asks him if he can read the bottom line. The guy says ‘read it? I know the guy!’
    ;)

    Cezary Wojcik Reply:

    ,

    The guy you think can’t read the bottom line: “and the incentive to stay healthy and get your $4000 christmas present each year” is fat, do not exercise at all, reluctant to go to doctors except within the yearly $1000 budget, is going to cash-in the same $4000 gift for Christmas. :-) He will abstain from doctors until his precocious death.

    If the HC system is designed to award those who don’t need any incentive to stay healthy and assist in shortening lives of those who are not disciplined to care for their health properly, this kind of incentive definitely makes the point.

  4. Cezary Wojcik says:

    What’s the purpose of the Health Care system described in “Mosler Health Care Proposal” ?

    Reply

  5. no chasing.
    for the first 4,000, patients pay the doctors directly on sight.

    On sight? How does the patient or the doctor know in advance, what the doctor is going to do? Or does it come at the end: “You cannot leave this office until you pay me.” :)

    Warren, Medicare exists. It is simple. It works. People like it. Are you also suggesting that your system replace Medicare for those who already have it? Or is this a system in addition to a system?

    Reply

    WARREN MOSLER Reply:

    Yes, I pay my dentist and eye doctor when I leave, and sometimes my doctor as well, when no insurance companies are involved.

    Yes, I like Medicare, and my proposal includes it for everyone, once their $4000 is exhausted.

    And for those on Medicare now, they don’t start using it until their $4,000 is exhausted, saving
    heaps of doctor time, admin. time, etc.

    Reply

    Rodger Malcolm Mitchell Reply:

    @WARREN MOSLER,

    So we disagree on $4,000, and that is supposed to be an improvement over straight Medicare?

    The “save doctor time, administrative time” thing is bogus, because collecting from patients will be no easier than collecting from the government, and there will be no one to monitor prices. And please don’t think patients can do it.

    For me, I’d rather have Medicare than to be bothered checking prices, paying bills, negotiating with doctors, figuring when my $4,000 is up, and all the other hassle.

    I suspect doctors too, would rather not fall into the “airline system,” where lowest price wins, no one makes money and everyone gets lousy service.

    Anyway, “Medicare for all” is easy to visualize, so maybe you should call your plan “Moslercare, to give it an identity.

    My main hope is to get everyone in America covered, and if “Moslercare” will do it, so be it.

    Reply

  6. While I agree with the overall thrust of Warren’s proposal, I have trouble with the details:

    “Everyone gets a ‘medical debit card’ with perhaps $5000 in it to be used for qualifying medical expenses (including dental) for the year.
    –Expenses beyond that are covered by catastrophic insurance.
    –At the end of the year, the debit card holder gets a check for the unused balance on the card, up to $4,000, with the $1,000 to be spent on preventative measures not refundable.”

    So, a poor person must decide whether to spend on health care or receive $4,000. This is counter-productive.

    “Doctor/patient time doubled as doctor/insurance company time is eliminated.”

    Wrongly assumes the doctor is the one who deals with insurance companies. Mostly, secretaries deal with insurance companies. The typical doctor will not have additional time for patient care.

    Rather than a complicated, convoluted program, requiring even more record keeping by individuals, I suggest the federal government merely provide Medicare (Parts A, B &D) to every man, woman and child in America.

    Reply

    Tom Hickey Reply:

    @Rodger Malcolm Mitchell,

    RMM: “Rather than a complicated, convoluted program, requiring even more record keeping by individuals, ”

    Right. and I would add research and decision-making, often beyond an individual or family’s capacity. It’s necessary to figure in the transaction cost, and the aggregate cost likely increases when it is impacting millions of people all the time. Medicare for all is the efficient way to go, and it eliminates those hidden transaction costs transferred to individuals as a negative externality, which acts as a “tax” by socializing expense.

    Reply

    WARREN MOSLER Reply:

    my proposal is medicare for all once the individual has spent his 4,000.

    Reply

    WARREN MOSLER Reply:

    Americans are concerned about people abusing the system, which my proposal addresses.

    And my ‘catastrophic’ is full Medicare with no donut holes, no co pays, etc.

    And it means less complication than yours as for the first $4000 spent doctors just get paid without dealing with Medicare, which will be about 80% of the time I’m told.

    Reply

    Rodger Malcolm Mitchell Reply:

    @WARREN MOSLER, “And it means less complication than yours as for the first $4000 spent doctors just get paid without dealing with Medicare, which will be about 80% of the time I’m told.”

    I doubt that chasing dozens of individual patients for payment will be less complicated for doctors, than being paid by Medicare. And, it certainly will not be less complicated for patients, who would have to evaluate and pay the doctor’s bills.

    As a Medicare patient, I don’t have to go through all that stuff. The doctor submits the bill; Medicare pays some or all; I do nothing.

    Finally, most doctors don’t personally handle office billing. They have a secretary who submits bills to Medicare.

    As for “abusing the system,” are we talking about patients or doctors? Billing patients directly certainly allows for more doctor abuse, because patients don’t know how to evaluate doctor bills.

    As for patient abuse, are you suggesting a large percentage of people visit doctors just for pleasure?

    We should follow the KISS (Keep It Simple, Stupid) principle: Expand the already-existing, well-tested, well-accepted Medicare — for all.

    Reply

    WARREN MOSLER Reply:

    no chasing.
    for the first 4,000, patients pay the doctors directly on sight.
    and doctors have to post prices on the outside of their doors, like gas stations.

    and yes, frees up office staff for alternative employment. aka, productivity increase

    mine is about as simple as it gets, from what i’ve seen.

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