PURPOSE: To provide affordable health care for all Americans without resorting to government controlled and/or mandated universal health coverage.
HOW: By identifying the causes of deficiencies in medical coverage and proposing moderate and practical solutions combining free-market options where possible and government oversight and regulation as needed.
This plan, if implemented, would mandate the following:
Base corporate medical coverage deductions on percentage of coverage for total workforce.
Change hours for full-time designation from 40 hours to 30.
Provide incentive for corporations to extend benefits for employees temporarily or permanently terminated for reasons other than cause.
Provide access to affordable health care coverage for owner and employees of small businesses (including small farms).
ITEM #1. Base corporate deductions for medical coverage on percentage of coverage for total workforce
Problem: Corporations are not offering affordable health coverage to all employees. Basing deductions strictly on total costs often results in “top-heavy” coverage standards, with executives receiving lavish, all-encompassing coverage while the rank and file are provided substandard or no coverage.
Solution: Base deductions for corporate medical costs on the percentage of total (full and part-time) workforce provided coverage.
Of course, many factors will need to be considered as to what defines provided coverage: Cost to worker, co-pays, family vs. individual coverage, prescription coverage, policy limitations and so forth. Government must determine and invoke minimum standards to provide this definition.
In a perfect world, minimum standards would include preferred-provider organizations (PPOs), but in reality most corporations will probably gravitate toward health maintenance organizations (HMOs) due to cost considerations. This is acceptable, provided that the HMOs are government-approved and not overly restrictive. Again, minimum standards must be met.
And it must be reiterated that deductions are based on the percentage of TOTAL workforce, not just full-time. Item 2 expands further on why that is so important.
ITEM #2. Change full-time designation from 40 hours to 30.
Problem: Many corporations (Wal-Mart is one example) deliberately limit working hours to less than 40 hours to avoid full-time worker designation to much of its workforce, and thus do not offer said workers coverage. Therefore, these workers are cut off after working 30-39 hours and cannot get coverage unless they take another full-time job, or a second part-time job in order to pay for private health care.
This leaves workers not only less time to spend with their families, but also forces them to fill an additional position that could be filled by another able-bodied individual seeking employment.
Solution: Change the mandatory designation from 40 hours to 30.
It must be pointed out that this is NOT to suggest the implementation of a mandatory 30-hour work week (where any hours worked over 30 would be subject to overtime pay), but rather an incentive to end the practice of deliberately limiting the hours of workers who are full-time in every other sense but are designated as part-time due to this policy.
It is believed that companies would be reluctant to add to their workforce to make up the reduced hours, but even if they chose to do so, their percentage of uncovered workers would increase and thus the corporate deductions suggested in item #1 would decrease.
Item #3. Provide incentive for corporations to extend benefits for employees temporarily or permanently terminated for reasons other than cause.
Current policy: Once an employee is laid off or terminated for reasons other than cause (i.e., economic considerations or elimination of position), s/he loses their benefits.
Problem: Loss of coverage due to temporary layoff or termination due to other than cause can sometimes be more traumatic or potentially catastrophic than the loss of the job itself. While many can often find other work, many of these new jobs are of lesser stature and may not provide sufficient coverage or require a probationary period before benefits are extended to the worker.
Solution: In the event of temporary lay-offs or termination due to other than cause, coverage would continue for a minimum of 60 days, with the affected employee's paying his costs either from unemployment benefits or from new employment.
The corporation would no longer have to include the worker as part of its total workforce, but could still claim the deduction. This would then increase their deductible percentage, making it worth their while to extend the benefits.
It would have to be noted that if the worker is eligible for medical coverage at his new workplace, he cannot choose to continue his coverage under his old employer. Again, some government oversight would be required to prevent abuse of this policy.
This policy would not be extended for persons terminated for cause, i.e., gross insubordination, ethics violations, harassment, theft of corporate property, chronic absenteeism and so forth.
Item #4. Provide access to affordable health care coverage for owner and employees of small businesses (including small farms)
Current policy: Small business owners (and their employees) and the self-employed must purchase costly private health insurance.
Problem: Small businesses cannot afford to provide employees with affordable medical coverage.
Solution #1: Allow small business owners and self-employed workers to organize insurance/benefit associations in order to purchase bulk coverage and other services at reasonable cost. Any initial start-up fees could be provided as one-time government grants or 100% tax deduction.
Solution #2: Allow small business owners and self-employed workers to piggy-back on larger corporations coverage packages and to extend coverage to their employees, in return for such considerations as discounts for corporate employees on goods and/or services.
Allow both the small business and corporation to deduct these costs. Though this would be, in the vernacular, “double-dipping”, it is believed that the saving in medical costs and additional tax relief would be pumped back into the general economy and therefore worth the expense. In addition, these costs would not have to be absorbed by taxpayers.
Of course, in order for this to pass muster, some concessions may have to be made to the insurance lobby in order to successfully implement this proposal.
CONCLUSIONS
The idea that government can guarantee universal coverage is unrealistic and cost-prohibitive. The idea here is to make it worthwhile to the market to provide coverage for as many employees as possible, discouraging intentional limiting of hours worked to avoid providing coverage, and decreasing the burden to taxpayers. Special attention must be paid to small businesses, which currently fall through the cracks when it comes to purchasing and providing affordable coverage.
The primary problem with the plan will be determining what defines employer-provided coverage. The government must ensure that certain standards are met (using factors mentioned in item #1), so as not to have companies giving employees $10 a week to buy aspirin and then trying to write it off as comprehensive coverage.
The unemployed (and unemployable) would still be allowed to participate in Medicare and Medicaid programs funded by taxpayers, but it is my belief that by implementing the above steps would mean more affordable coverage for more workers without costly government intervention or socialized medicine.
LONG-TERM SUGGESTIONS AND SOLUTIONS
We also need to not turn our usual blind eye to the quality of life that has lead to our increasing health care needs. The proliferation of cheap, unhealthy fast food and the subsidies that promote the production of same must be carefully looked into. The increase of CAFOs (confined animal feeding operations) and monocultures in our agriculture have had a direct negative effect on our national health by producing foods that may be less expensive but are also less nutritious. As a long-view solution, the USDA and agricultural policy in general needs to be reviewed and revised.
Likewise, funds must continue to be provided to schools for physical education programs, with less emphasis on games or athletics (though these should not be eliminated altogether) but with increased emphasis on personal health and conditioning. Not every child is going to be adept at all sports, or any sport in some cases, but they must not be discouraged from achieving and maintaining their own personal fitness. Offer students an alternative to team sports competition, which has a tendency to exclude the weaker and less-coordinated, who are then discouraged from participating in healthy exercise from fear of further humiliation. Offering running, bicycling, weight-training, and aerobics as an alternative would ensure that more young people would continue the road to healthier lifestyles. Our future as a nation depends on it.
