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Tuesday, December 29, 2009

Bank of America's Website: Making the Health Care Industry look good by comparison

I had no idea that refinancing my mortgage would have given me such a source of blog material. I would like to think that my previous posts explored business models and lessons learned around the financial services industry rather than complaining about daily inconveniences. However, this post will be different. I am going to happily just complain about daily inconveniences in a way that provides all the insight of a post about hating the morning commute or feeling ill after eating too much Taco Bell.

The bank that owns my house is now Bank of America. Previously, I had such feudal relationships with Countrywide and Wells Fargo and enjoyed the web sites of my lords. With Wells Fargo, I set up automatic re-occurring payments, could find my payment history and tax information easily, and it was very easy to navigate. I actually had happy thoughts about wonders of technology when I gave them most of my pay check every other pay period.

Bank of America, by comparison, makes your average health insurance or hospital website look slick and brilliant by comparison. What makes this ironic is that health care companies often view financial services as an industry that has solved some of the issues that health care still struggles with. Financial service have an excellent understanding of their cost structure, are good at handling sensitive personal data, can effectively explain complicated concepts and services, and are good at working with individual customers on a retail level. These are still goals for the health care industry.

Here's how Bank of America's website has failed to meet those goals and spurned me to openly mock them:

1. I have had to call them 4 times to explain how to do something on their website: Since the most basic business case of any website is that it will reduce customer service calls, this should be a big problem. I had to call them to:
1. Set up a password
2. Figure out how to verify my bank account which involved clicking on "Account Details", then "Manage Account", then "Services", then "Verify. How is anyone expected to figure that out on their own?
3. Figure out how to pay my bill. It turns out their menu bars on the top are for people with regular accounts and the main page is for my specific mortgage.
4. My absolute favorite was calling them to go paperless and not get bills mailed to me. The "Go paperless" button is just an FAQ. The customer service rep had to do it for me and could not tell me how to do it on the web. I almost expected to have to send a letter in the mail to request that Bank of America stop sending me mail.

2. I still have to call them 2 more times: Some things that I would like to do are 1) set up reocurring payments and 2) have bills emailed to me. However, it's easier to set up calendar reminders on my email so I'll just do that instead.

3. Their privacy features are draconian: Protecting financial data is a good thing so I should have no complaints. Only problem is that when I call and verify my account number, zip code, enter my options, and a customer service rep gets one the line, I get logged off due to inactivity. Therefore, the rep has to wait for me to log back in and ask my question. Bank of America could 1) not log me off so quickly, 2) answer their phones quicker, or 3) improve their website so I don't have to call customer service to explain things to me.

I also don't know the answer to most of their security questions like the name of my best friend's pet since he had 12 reptiles growing up.

For a final score card, Bank of America can't explain simple concepts on their website and renders their website almost inoperable with their privacy rules. You cannot easily pay a bill on a website even though one would think that a bank would want to make it as easy as possible for a customer to part with their money.

I'm suddenly feeling better about the health care industries chances of implementing health care reform.

Thursday, December 24, 2009

2010 Health Care Predictions

For those of who belong to religions where we think Jesus was just a really good carpenter, we have a lot of free time on Christmas Eve. Thus, this is a perfect time for my planned post on 2010 mostly health care predictions.

A year ago, I boldly predicted there would be a lot of talk about change but not much done. For the most part, I was right as we have not finalized the latest health care bills yet. However, I was wrong about no changes to the Medicare Advantage program. A reduction of payments resulted in benefit reductions, 25% average increase in premiums, and approximately 20% of plans exiting the market. Scrutiny increased significantly signaling that future insurance marketing will become even more highly regulated. When reform is fully implemented, it's likely all health plans will have the same templates for all documents explaining benefit plans. That's not a bad thing except for the fact that Medicare considers 33 pages to be a reasonable length for a benefit "summary". If that's a summary, you can imagine what the full book looks like. Health care reform may result in deforestation.

For 2010 predictions, I will continue to shoot down the middle:

1. Seniors finally realize what is happening to Medicare Advantage but don't riot: There will likely be additional cuts to revenue that Medicare Advantage pays health plans which will result in an average increase of $30 per month for seniors. The Republicans repeatedly raised this point to try and foment a senior rebellion but the Democrats countered by claiming that the only cuts would be to health plans' profits.

As Medicare beneficiaries realize the true impact, they will rise up and announce that they are still happy with the Medicare program. They don't need gold plated health plans and understand they are not immune to the health care increases.

2. No one else riots over the passage of health care reform either: Although opinion polls on the health care bills place it on the same satisfaction level as the latest straight to DVD version of American Pie (Does Eugene Levy need the money that badly?), Democrats will not be punished in the mid-term 2010 elections. As the incumbent party, they will lose some seats.

However, the public will better understand the benefits that they got from the health care bill and forgive its shortcomings. I also realized that the Republicans won't get punished for spending most of the debate playing Sudoku. Republicans always oppose new social benefit programs just like they did with Medicare in 1965. I think that it's part of the oath that they take when they join the party.

3. Health Insurance Reform Passes! In other bold predictions, we still don't resolve the question of whether people to drink Miller Lite because it tastes great or is less filling. Congress will produce one bill that passes. It's major provisions will start earlier, in 2013, to realize benefits sooner. There will be no Public Option plan.

4. The Health Care Construction Boom is over: Architects bemoan the loss of one of their more lucrative lines of business. The restrictions on health insurance will reduce the amount of money in health care. There is now only enough to money to pay for the Boomers hospital stays in the existing supply of beds. The next boom will be in technology that keeps patients out of hospitals and doctor's offices since space and supply won't increase.

5. State start working on their own health care reform: We saw the federal government's best effort with health care reform. While admirable, it's kind of like the best effort of whoever is playing quarterback for the Chicago Bears. It fell short. The states will stop waiting for the federal government for solutions and start designing their own. This will make health care even more local and regional which will hurt national plans. However, it will represent the best chance for true heath. care. reform.

6. We finally learn how to pronounce 2010: People who call it Oh-10 will be viewed in the same light as those who think global warming is caused by polar bear farts. Aught 10 is too awkward. Ten will work just fine.

Tuesday, December 22, 2009

Health Care Reform: What happens next

When all is said and done with the likely passage of the health care bill, more was said than done. Everyone probably watched one of their favorite parts disappear. Whether you really wanted a public option plan, were really hoping for some serious efforts to reduce Medicare spending, or really wanted a death panel to go after grandpa and perhaps your strange uncle, it's not happening.

What will happen is that in 2013 or 2014, it will be a law for everyone to have health insurance. Insurance companies will no longer deny anyone, not provide care for a pre-existing condition, or not give you whatever plan you want. Basically, that's it and it's a good thing. People should not be denied access to health care based on their employment status. Insurance companies actually don't like having to build up elaborate systems to deny people and would prefer that everyone join the party (and pay their premium to join that party).

There will be a period of adjustment as we come to terms with this notion of the individual mandate or the idea that we all have to carry health insurance just like we need auto insurance. This adjustment will come with the realization that there is a direct connection between everyone buying insurance and the affordability of insurance. The young, beautiful, and healthy need to pay now in order to have insurance when they are old, sick, and need cosmetic surgery (which will not be taxed by the way. Instead indoor tanning salons will be taxed to help pay for this. No, I couldn't make this stuff up if I tried). Just like we get a taxes for Medicare taken out of our pay check in order to enjoy it when we're older.

For those who were fans of the Public Option plan, you all know that I think you are wrong. However, the Public Plan really died in the House bill when it required negotiation with health care providers instead of jamming Medicare rates down their throats. With that clause, the Congressional Budget Office analysis ruled that the Public Plan will cost more then the average private insurance plan. As a result, policy wonks breathed a sigh of relief over their fears of accidentally writing about the "Pubic" Plan since spell check will never catch that.

The idea of 55 year olds being able to buy into Medicare would have never worked. Medicare would cost $800/month and it would not cover routine doctor visits nor would have an out of pocket maximum which would limit the most you would ever have to pay (a common feature of private insurance plans). The only Boomers who would pay that are those who cannot get other insurance, would use thousands of dollars of services per month, and the result would be skyrocketing premiums. That is called the insurance death cycle (not to be confused with death panels).

For those who still worried about costs and how we'll pay for this, that question will be answered in 5 years when the bills start to come. Health care policy has always addressed access first and cost second. Massachusetts is looking at cost control as we speak with global payments and Accountable Care Organizations. Medicare has produced the DRG system and other changes in the past to address the solvency of the program and will do so again. Cost containment will be part 2 of health care reform.

Now that the debate is wrapping up, enjoy the holiday season, sit back, relax and play the Have sex with, Marry, or Throw Off the Cliff game with Joe Lieberman, Ben Nelson, and Sarah Palin (My answer is Palin, Lieberman, Nelson). We'll have an individual mandate and no one will be denied health insurance. Disaster didn't happen and a government bureaucrat won't ever get between you and your doctor. Unless, of course, you're talking about an abortion with your doctor and in that case all three branches of government will be lined up outside of your uterus.

Sunday, December 20, 2009

What Generation Y Wants with Health Insurance

Last week, I attended 2 focuses groups that asked Generation Y their thoughts about health insurance. We all had some theories about what this generation wanted. I was right about one of my theories but otherwise was completely surprised by their opinions and knowledge of insurance. About as surprised as I was when the punk rock attired participant said that he was most interested in the tax savings associated with a Health Savings Account (HSA).

As I had previously posted, I had a theory that Generation Y believed that health insurance costs hundreds of dollars. If they knew that they could get fairly comprehensive plans (albeit with deductibles of $5000), for less than $125, I thought that they would be interested. It turns out that I was right. For those who were employed, they said that they could find the money to spend $125 per month for insurance that they thought was a good value.

However, they typically weren't quite ready to make that purchase due to self-admitted laziness or attitude that health insurance isn't completely important yet. For the most part, they were willing to gamble with being uninsured.

What surprised me the most was 1) Generation Y pretty much has the same interests in health insurance as other generations, 2) they have deep privacy concerns and a healthy skepticism of using the internet for health care services and information, 3) they are very savvy potential purchases of health care.

1. When it comes to health care, we're all pink on the inside: Even Senator Max Baucus assumed that Generation Y just wanted coverage for emergencies or catastrophes when he designed a "Young Invincible Plan" in his initial bill. However, the participants didn't feel like it was worth buying insurance if they couldn't use it. They wanted comprehensive coverage for doctor office visits and prescription drugs. They wanted the kind of coverage that they had with their parents' plans.

2. Privacy trumps all: We had some assumptions that a more on-line, interactive experience via the internet would be extremely attractive. Turns out, that they are just as concerned about privacy and having their health information on-line as any other generation. They were just as skeptical about the advice that they would get and who was behind the experts on various websites.

The recent Facebook privacy changes were cited as a driving force for this concern. As a side note, I could visualize Facebook's downfall during this session. While I never thought that people would stop using Facebook, privacy was the bedrock behind their exponential growth. If that foundation crumbles, so could Facebook.

3. They may not have bought health insurance but they know how to shop for it: When we have previously showed insurance plans to older participants, it has taken them a while to understand how it all works. The Generation Y participants, for the most part, were very easily able to understand how much services would cost them and what kind of value they would get for their money. Some of them were as good as the average actuary with their calculations.

If and when Generation Y starts buying health insurance at the same rate as the rest of the population (or is required to start buying it), it looks like they will understand the health insurance market as well as anyone.

Monday, December 14, 2009

Mt Hood rescues, Locator Units (MLU's), do you need a rope, and how tough is it to climb

Unfortunately, there has been a winter climbing accident on Mt Hood. Two climbers are still missing on the west side of the mountain near Reid Glacier and one was found dead. It's always heart wrenching to hear these stories. No matter how many times that I climb Hood (3 times), I am still drawn to it and plan to climb it this winter. I always hope that my training, conditioning, and safety measures will get me down safely. After that, everything else is out of my hands.

Whenever there are these highly publicized accidents, 2 questions emerge in the media which are:
1. Why aren't all climbers required to carry Mt Hood Locator Units (MLU's) or other tracking devices?
2. Should climbers have to pay for their own rescues?

Portland Mountain Rescue, a volunteer organization of highly trained rescuers and educators, answered both questions very well in their press release. However, I will elaborate on the first question since I think that it's a hard one for the public to understand and climbers have a hard time explaining it.

There are limits: MLU's are little boxes worn on a strap that is carried outside someone's jacket or backpack. They only work on Mt Hood where sensors are set up, the climber has to activate the signal, and this signal is only detected if someone is actively looking for it. It's not like a bat signal that goes out in the sky when there is danger. If a group is taken by surprise by an avalanche or the person who is carrying the MLU falls and is knocked unconscious, the signal will not be able to be activated.

It is not the most important piece of equipment: The other limits to MLU's is that it doesn't create an instant rescue. A climber needs warm clothes, food, or a bivy sack to survive cold conditions. Even better, the climber should have rope, pickets for creating anchors, maps, compasses, or first aid gear so they can avoid the need for a rescue or possibly move themselves out of harm's way. Or even better yet, climbers should review weather and snow conditions to they know if they should be climbing in the first place.

It's the most intensive measure:
In summary, focusing on MLU's for the primary tool for mountain rescues is like focusing on pace makers or cholesterol lowering drugs as the primary tool for preventing heart attacks. It's the equivalent of ignoring diet, exercise, education, monitoring or other preventive measures. It's like someone ordering a Hardee's Thick Burger, large fries with mayonnaise, and a Diet Coke. The Diet Coke doesn't cancel out the other mistakes. The MLU is held up as a silver bullet of mountain rescue when it's really about the planning, conditioning, and proper equipment. Focusing on MLU's is really misplaced focus. Yes, they are helpful but not as helpful as the other things that I mentioned. I think that I have run out of analogies to use and encourage reading the Portland Mountain Rescue site for other examples.

Is Mount Hood tough to climb and do you need a rope? I get a fair amount of google traffic with these questions and I have yet to completely provide my opinion. Quite simply, yes it's tough to climb and you do need a rope and pickets (also called protection). I have only climbed the south side which is the easiest side and the chutes have become quite steep. Going up and down the chutes involves snow climbing so some loose snow or foothold could easily result in a slip. If someone slips, they risk a fast slide off a short ridge. Unless someone is very experienced or comfortable, I wouldn't climb it without a rope team and pickets. Pickets are 2 foot long metal bars with a carabiner clip attached. A climber drives them into the snow and clips the rope through the carabiner. A rope team without a picket or protection mainly allows the whole team to potentially fall if one member falls.

Caveats abound and I gear this advice for a fairly new climber who is researching. Someone looking for specific route information or climbing routes other than the south side have already stopped reading. Someone who is wondering about a less tough climb should check out Mt St Helens. Someone who was really wondering how tough my hood was, has already put a cap in this blog's @ss.

Saturday, December 12, 2009

What is still unanswered by the Personal Branding Movement

I learned about the notion of creating your personal brand on-line through web surfing and mainly perusing Brazen Careerist where apparently helping someone develop a personal brand can be a profession. The way that it works is one should develop a niche area of expertise and make comments, write blog posts, tweet, or other things to indicate your expertise in a certain area. The issues one faces is focusing on 2-3 key messages that reinforce that brand and resisting being a little wild on the internet by posting pictures involving jello and farm equipment with the accompanying explanation.

One reward of developing a strong personal brand is that employers will find you on the internet. Another is that when you do apply for a job, your future employer will find all of this wonderful content that shows what a strong contributor you are in the field of farm equipment and fruit flavored instant desserts.

As you can guess from the picture at the beginning of the post, I am skeptical about the notion of on-line personal branding. I think that it's really funny to bring up cows when every anyone talks about branding. By the fact that I blog under a pen name and I do not stay in one established niche shows that I don't follow personal branding 101. While my focus is on health care and MBA admissions, I indulge myself by dabbling in posts on climbing, knitting, social media, and colonoscopy and animal husbandry jokes.

The main reason for my skepticism is the one question that on-line personal branding has yet to answer. Hiring managers or recruiters can realistically spend one minute screening a candidate. Why would they spend any additional time perusing anyone's on-line brand? The real value to a recruiter or hiring manager is speed to learn specific skills or background for a specific job. Linked In works very well in that regards. Perusing the empire of a candidate's thoughts through multiple websites does not.

A recruiter will probably do a quick Google search or use the Bing. However, keep in mind that's part of the one minute spent on an application and is likely more a rule out function. The goal is to try and find out if you can write more than 2 sentences without dropping the f bomb or if you are an active contributor to Farm Animals Gone Wild (which returns 342,000 search results if anyone is interested). The search is mainly used to find a reason to exclude.

If someone indicates that their blog or website on a resume, it will get looked at. However, I felt that a partner at a public relations firm summed up the role it plays in a hiring process nicely when he said, "I looked at her blog, saw that she could put 2 sentences together and had no major typos. That showed me that she knew how to write." As you can tell, there was not a lot of time spent reading a post on the careful deconstruction of the value of Twitter.

In later rounds, someone might get asked for a portfolio, especially in certain fields. It's probably expected that portfolio will be on-line. However, a brand and a portfolio are two different things that shouldn't be confused.

Otherwise, I see this one minutes time frame as a question that branders have yet to address in all of their How-to-brand posts. What would you say in response all you career personal brand advocates and coaches?

Tuesday, December 8, 2009

The Public Plan: Know when to hold 'em and know when to fold 'em

The latest version of the Public Plan (or Public Option), which involves the government starting a health insurance plan to compete with other insurance companies, involved getting 5 liberal and 5 moderate senators in a room for a game of Truth or Dare and other drinking games. Not really, it was just the latest version of the Public Plan which involves the government contracting with insurance companies for predetermined plans like bidding for the Federal Employees Health Insurance, Healthy Kids, or Medicare Advantage. As a result, the Public Plan has now come full circle and now resembles other current government health plans. The government has contracted many plans through a competitive bidding process as its free market solution. One interesting note about the bidding process, is that with the Federal Employees Health Insurance, participating plans are required to offer best price or any price discounts that they give to comparable groups to the government. That's one of the key ways that the agency that manages this plan can claim victory for keeping prices so low.\

This is potentially the end to the biggest distraction to achieving health insurance reform besides abortion. The Public Plan has gone from Medicare Part E (for Everyone) to Cooperatives to Robust Plans to a simple government contracting process, like the same way they decide food service in the Pentagon dining hall.

While the Public Plan almost derailed health insurance reform, I see two successful outcomes. First, I think that Congress is finally realizing that the only way that the Public Plan could be a lower cost option was by paying providers 80% of market rates. In that regards, they gained a better understanding of true cost drivers.

Second, the Public Plan was a great bargaining tool for the Obama administration to gain concessions and support from the health care stakeholders. Providers of health care feared the lower reimbursement and insurance companies feared that it would cause providers to require higher reimbursement from them. Obama bluffed everyone with this hand.

The ones who lost the most with the demise of the Public Plan were those who really wanted a single payer system and saw this as the best vehicle. Their position was otherwise not addressed in health insurance reform. More time was spent talking about death panels than a viable single payer system. Given how marginalized their position was, I hope that they can parlay their lack of attention into a vice presidency spot for Dennis Kucinich or another one of their leaders.

With the looming end of the Public Plan, I think that it's time to remember the lyrics of Kenny Roger's karaoke classic, The Gambler which is "You've got to know when to hold 'em, know when to throw 'em, know when to walk away, and know when to run." I think that the Obama administration played the Public Plan hand as long as they needed to get concessions and then folded. The rest of the Democratic party needs to do the same and know when to walk away.

Saturday, December 5, 2009

What my Mortgage Refinance experience will teach us about Health Care Reform

Both of my dedicated readers (Hi Mom and Dad) may remember my experience refinancing our house and the lack-of-value-chain that the participants created. One link that I forgot to mention was the assessment process. Previously, the assessed value of the house always seemed to be exactly what the lender needed to justify the loan. Now, there is a third party system that schedules the assessments and keeps the lender at arm's length. This system was created per regulations by some entity to address abuses.

Apparently, it doesn't work that well. My lender complained about it and I wound up having two assessors call me to schedule times and some confusion was created. Further confusion was created when one of the third parties that scheduled the assessment told me that they hadn't been paid yet. However, I had been charged for the assessment by a different entity and my lender said they would figure it out. Based on the confusion from two assessors calling me, I actually think the wrong third party got paid. However, the technical term for that is "Not my problem."

A new regulated entity usually has some problems in the beginning that need to be worked out. Unfortunately, there is never a honeymoon period with new regulations where the impacted parties snuggle in bed together until the early afternoon. Even programs that involved giving away money like cash for clunkers or the first home buy tax credit had complaints about processing and turn-around times.

This is a long of making the point that when health insurance reform smacks us all across the face in 2013 or 2014, there will be an adjustment period. Someone will think they should have their dental implants covered and won't get them. Others will think that they should be paid for services and won't get paid for a while. The Health Care Exchanges that will open the much anticipated market bazaar for small groups and individuals will probably have the purchasing experience of a bizarre bazaar. The Exchanges are where previously uninsured individuals can use their government subsidies to buy insurance for the probably the first time in a long time so difficulties with navigating the Exchange will be heard loudly. Frustration is the gap between expectations and reality and expectations will be high. Reality will be lower and it will sound like long awaited health insurance reform is a clunker.

Therefore, we need to adjust our expectations about health care reform and give it time to work out the kinks. The last large government-pushed health care reform was the Medicare Modernization Act that brought seniors Part D or prescription drug coverage that was implemented in 2006. Today 90% of seniors are satisfied with this plan. This is up from 80% the year after it was first launched.

Despite a higher satisfaction rates than most Apple products have, the initial launch was almost a disaster. There were long wait times on the phone and confusion about whether drugs were still covered by Medicaid, the state program, for low income seniors. I was working overtime as a Spanish interpreter helping Spanish speaking seniors and health plan customer service speak to each other about prescription drug coverage. These calls involved my interpreting a long list of drug and dosage to help seniors find the drug plans that worked best for them. Try figuring out how to say Atenolol in Spanish or English. These calls were long (45 minutes) and painful to all involved. Although the start was as inauspicious as some new reality TV programs, the program was ultimately successful.

Health insurance reform is likely something that will be my problem and I'm getting ready for the disaster of a launch. However, it will be better than our current system.

Friday, December 4, 2009

The Time to Hate Health Care Reform is Over

It's easy to find something to criticize about the House and Senate health care reform proposals. They either cover too much abortion or too little. There are too many taxes on health insurance companies or there is too much new business and giveaways for them. Cost containment is either not taken seriously or a single payer system is not taken seriously.

The names of the legislation don't produce exciting acronyms. The House's Affordable Health Care for America Act would be AHCAA and the Senate's Patient Protection and Affordable Care Act is PPACA. What about Health Entitlement and Affordable Reform Treatise or HEART? The opposition could offer Healthy American Treatment and Empowerment or HATE?

Would COBRA (the option to keep your former employer's health insurance if you pay for it) still be around if it were called HMGPH instead of being named for GI Joe's archenemy?

The time to hate is over. The status quo is not a sustainable option and Congress has made more progress with health care reform than the last 40 years combined. As reform ticks closer, it's time to shape the solution rather than point out the flaws. If you can't be with one you love, love the one you're with. Republican Party, are you listening or do you enjoy being irrelevant?

I have criticized a national blogger for only pointing out the problems. Pointing out problems is easy blog fodder that can be written while sitting on the toilet. With this post, I plan to stake out my ideas for 1) the current proposals and 2) my ideal health care solution.

1. The current proposals: A health care reform proposal that will realistically pass will reshape the current system. Health care is a complex system that will take decades of tinkering since not all the parties in government take it seriously. The health care system also can't take a month off to reboot. Therefore, it is not realistic to expect a dramatic shift to single payer or another country's model.

With those very real constraints, I have to say that I agree with most of the current health insurance reform proposals. They shift money around from those with lots of insurance to those with none. That's the basic concept of insurance. They try to create rules to encourage good behavior. There is the hint of cost containment with an independent body that will make recommendations for Medicare that Congress must accept or reject as is. No horse trading, smoky rooms, or ear marks. Here's what I would change:

  • A real individual mandate: For health insurance to really work, everyone has to participate. The basic concept of insurance means that everyone has to pay into it, even if you might not use it. There needs to be a real penalty for not buying health insurance. The House's 2.5% of income is getting there. The Senate's penalties are closer to what you would pay for marijuana possession and last I heard, that's being mostly decriminalized.

  • Stop Medicare geographic discrimination: Original Medicare pays providers differently based on geography. That payment methodology is mostly based on how much is being currently spent so frugal regions receive less money. That means providers are paid less and less likely to accept Medicare patients. That's geographic discrimination as seniors in Florida get twice as many health care dollars and access to more providers than seniors in other states.

  • Don't mandate gold plated health plans: Congress is passing various mandates for health insurance plans such as lower deductibles, out of pocket maximums (which is the most that someone would have to pay in a year for health insurance), and preventive services for no cost. These are fairly expensive, comprehensive plans that will continue to shield the consumer from the real cost of health care. These mandated benefits could very well reach the levels of gold plated or cadillac plans which would cost someone (usually the employer) $8,000 per year, that the Senate is proposing to tax. These mandates are moving towards providing more insurance than is necessary. It's kind of like offering a buffet and hoping people don't overeat.

2. My ideal health care solution follows the US educational system or Germany.

There is a baseline government funded level of benefits. Medicaid and Medicare are dissolved except to provide subsidies for those with low income. The baseline level is determined using the same methodology as the Oregon Health Plan. A budget is set that would be a certain percent of GDP. Medical services are ranked, cost is estimated, and when the budget is used up, no more services are covered. Just like public school, everyone gets reading, writing, and math covered but if there's not money for art, music, or playground equipment, it may not be covered.
Everyone who offers a healthcare service from doctors to durable medical equipement has to fully participate. The role of this baseline plan is to prevent startvation but not provide an all you can eat buffet.

The private sector can still compete to offer more: The rest of medical services or art, music, and playground equipment or fancy private schools with uniforms and SAT preparation can be offered by employers to attract workers and insurance companies to sell fancy new insurance policies. Providers can offer services to attract those who have these plans and fight it out with insurance companies on how much they can get paid. The competition of the free markets can be unleashed without casualities.

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