Research Proposal: Health Care Reform Recommendations to the President

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Health Care Reform

Recommendations to the President on Health Care Reform

The United States health care system is in a shambles. While the wealthy have access to the best health care in the world and the poor are covered by government insurance programs, but many in the middle class are forced to choice between expensive health care coverage and other of life's essentials. Therefore, my respectful recommendation, Mr. President is that you reform our current health care system. Obviously, there is no single, simple solution to the state of health care in America. However, by incorporating several changes, it should be possible to make basic health care affordable for all Americans without an incredible increase in taxes and without sacrificing high American medical standards. The first change would be to make a government sponsored healthcare program, like Medicaid, available to all Americans. The second change would be to institute massive tort reform. The third change would be to require that any person opting out of either private insurance or government-subsidized insurance pay in full for medical services as they are received. The combination of these three changes would allow every person affordable access to quality medical care without requiring people to subsidize health care for those who opt out of insurance coverage.

When people suggest that government health care will not work, they tend to ignore the fact that government subsidized health care does work. The federal government subsidizes two health-insurance programs, which are then run by the states: Medicare and the State Children's Health Insurance Program (SCHIP). Though there are problems with both of these programs, they do manage to successfully provide health insurance to groups that would probably otherwise be unable to obtain health insurance. Expanding those programs would provide a feasible means of providing health insurance coverage for underserved populations.

Medicaid began as a program to supplement health benefits for those who were considered indigent, people who would currently be eligible for Aid to Families with Dependent Children benefits. While that group of people would still qualify for Medicaid, in the 1980s Medicaid was expanded to cover low-income pregnant women, low-income Medicare beneficiaries, and poor children who do not qualify for cash assistance. When the federal government identified a continuing gap in coverage, it instituted a similar program, SCHIP, to provide insurance benefits to low-income children on a sliding-scale fee for the families. However, the states have been left to administer both Medicaid and SCHIP, which means that benefits vary by state, as do the burdens. Some have found that the bureaucracy involved in both programs has discouraged people from participating in those programs. Despite their drawbacks, the programs have allowed millions of impoverished and poor people access to medical care. As a result, I would propose doing away with Medicaid and SCHIP, but developing a sliding-scale fee insurance program for all Americans. This program would not impact the right to purchase private insurance, but should allow all Americans access to basic health insurance. Like Medicaid, the program would offer as a vendor payment program. (U.S. Department of Health and Human Services). Like the current Medicaid program, states would have the option of providing direct payments to health care providers or paying them through prepayment arrangements. In addition, because the cost of living varies so widely among communities, states would have the discretion to set payment rates, as long as their payment rates were sufficiently high to attract enough providers to the program. The new national insurance program would continue to provide free health insurance to those eligible for cash assistance, and would consider a combination of income and assets to determine a sliding-scale fee for insurance for non-indigent persons. Furthermore, like Medicaid, the eligibility period for enrollment would extend three months in the past, so that if someone had neglected to obtain insurance prior to a catastrophic illness, they could still obtain insurance coverage. However, for non-indigent persons who failed to enroll until after a catastrophic diagnosis, the government could make them pay high-risk premiums to offset increased costs to other insureds.

One of the major problems with health care in the United States is that doctors have to pay huge malpractice insurance premiums, especially if doctors choose to practice in high-risk areas like obstetrics. For example, in 2001 in Pittsburgh, some doctors had malpractice insurance premiums of $100,000 per year. (Snowbeck). These exorbitant premiums can keep doctors from practicing, and can also dissuade them from accepting low-income patients, because of a belief that low-income patients are more likely to sue. One way to attract doctors to the national healthcare program would be to make tort lawsuit waivers part of enrollment in the government health care program. Any person covered by government insurance and receiving an accidental injury as the result of malpractice would be unable to sue their doctor for pain and suffering. Instead, the patient's recovery would be limited to the cost of continuing or remedial medical care, which would be covered under their existing insurance wages. Furthermore, patients could recover for lost wages, but would be required to waive the right to a jury trial and enter into mandatory arbitration with providing doctors. As a result, doctors who limited their practices to government-sponsored health insurance patients could carry lower amounts of malpractice insurance, because their potential liability would be lower.

Of course, not all Americans would turn to government-insurance, which would leave doctors vulnerable to the threat of practice-crippling malpractice suits. Therefore, I would suggest a more comprehensive form of tort reform, aimed at absolutely eliminating punitive damages in malpractice situations, unless a doctor has committed an intentional tort that would shock the conscience of the factfinder. Individual states have pushed for tort reform, and though it has not been the desired cure-all for expensive medical treatment rates, tort reform has helped usher in significant changes in some of these communities. For example, after Texas instituted tort reform, all but one of the medical malpractice insurance providers in the state lowered its premiums. (Texans for Lawsuit Reform). After enacting tort reform, West Virginia saw an increase in new physicians and a reduction in insurance defense costs for medical tort lawsuits. (Texans for Lawsuit Reform).

While Ohio did not see such dramatic results, it saw a decline in the rate at which malpractice premiums were increasing and had new insurers enter into its market. (Texans for Lawsuit Reform).

The idea of tort reform applies to two different, but related, areas of tort law.

First, tort reform works by limiting who can bring lawsuits and what types of injuries give rise to a tort lawsuit. This keeps the pool of potential claimants from getting overbroad and reduces the number of frivolous lawsuits, by applying sanctions for attorneys or plaintiffs filing non-meritorious claims. The second type of tort reform works by limiting possible judgment amounts for claimants, so that a medical injury does not result in a windfall payment for a patient. The recommendation of the American Tort Reform Association sets a reasonable limit on medical malpractice liability, which provides that "an effective medical liability reform measure will include - 1) a $250,000 limit on non-economic damages; 2) a sliding scale for attorneys' contingency fees; 3) periodic payment of future costs; and 4) abolition of the collateral source rule." (American Tort Reform Association).

Finally, because all non-insured persons would be able to get a government-sponsored health insurance benefit up to three months after diagnosis, another way to reduce costs would be to require immediate cash payment for services rendered for all non-insured persons. That way, hospitals, and ultimately the taxpayers, would not be responsible for paying for services for people who were capable of paying, but decided to opt out of having health insurance coverage. Hospitals and other health-care providers would be actively discouraged from extending any type of credit to patients who could not pay for services, and would be required to obtain payment for all but emergency services prior to rendering service. This requirement would simply prohibit medical providers from seeking compensation from the government for any patients failing to pay a medical balance due. This would actually have an impact on one area of government subsidized health care that frequently goes undiscussed. While incarcerated, prisoners have the opportunity to make money. In addition, many prisoners have significant assets. There is no reason for them to be exempt from the regulations otherwise governing the provision of health insurance to law-abiding Americans. Therefore, prisoners who desire medical coverage should be required to pay insurance premiums, or else pay up front for any and all medical expenses. This would also keep hospitals from charging jails and prisons more than the government insurance rates for services provided, which has traditionally been a problem when discussing payment for medical bills obtained to service incarcerated or in-custody persons. (Kershaw-Staley). Furthermore, an up-front payment system would encourage all Americans to obtain some type of insurance coverage.

While there is no single solution to America's health care crises that does not… [END OF PREVIEW]

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Health Care Reform Recommendations to the President.  (2008, November 7).  Retrieved September 15, 2019, from

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"Health Care Reform Recommendations to the President."  7 November 2008.  Web.  15 September 2019. <>.

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"Health Care Reform Recommendations to the President."  November 7, 2008.  Accessed September 15, 2019.