BillboCare! A modern solution to the healthcare issue.

-- opus in progressu -- Once again I am not sure what many folks are thinking when it comes to what is commonly referred to as Obamacare, more specifically the Patient Protection and Affordable Care Act.  I personally don't like the Obamacare label.  Legislation should be looked at on its own merits, not just on who champions it. Going forward I will refer to this legislation as ACA and although well intended, it is a terrible tax and not sustainable long term. Unfortunately, we have to abandon it and reboot our healthcare product and delivery system.  The only concept that will work long term is to let Americans decide for themselves what health care they purchase "in potentia emptor".  I might have a way to do that.  I am calling it BillboCare (every initiative needs a clever moniker or flag).

But first, as always, Dr. Bill thinks we need to step back and examine where we are, how we might have got here and where it is we want to go.  Without documenting the history of employer based healthcare post WWII, or what we now refer to as the "cafeteria plans/deductions allowed under IRS Section 125, our immediate concern is the increasing costs that Americans are paying for healthcare.

QUIZ QUESTION: Who thinks "healthcare is affordable"?  Anybody?  If you say it is, I have a followup question "when was the last time you or a family member were actually sick or needed healthcare?" Even folks who might be a bona fide beneficiary under the ACA will tell you there is nothing affordable about it, and the annual deductibles should you need healthcare are killing them. Dr. Gruber told us it was a tax and they were counting on the "stupidity of the American Voter" when they forced it upon us.  I hear stories of folks having to "wait till next year" to go see the doctor since they cannot afford the deductibles.

Unfortunately, ACA solved nothing at the expense of taxing a couple hundred million of us, raising the average cost of care, forcing many to lose their preferred physicians and putting an increased administrative burden on businesses and medical providers.  Luckily we passed it on Christmas eve, so we could read what was in it (it was voted on before it was published.. that in and of itself should be a crime.)  And even if the intent of the party line legislation (thanks Arlen Specter you traitor) was noble (and not just to benefit the insurance lobby who wrote it), its execution was definitely flawed on about every level.  If you take it's intended goal of insuring 49 million and grade that against the best numbers any reasonable person would conclude it is a giant failure.  The Obamacare Facts website says there are 17.6 million signed up which includes medicaid signups. The best math I can prove is that ACA might have caused 5 million in new sign ups (not displaced folks whose policies were cancelled or the medicaid folks).  5 million folks were assessed an IRS tax penalty (I wonder if that increases or decreases blood pressure. mmm even Dr. Bill can see that).

So what do we do now?  Republicans have never been too clever in these problem solving areas, their solution is usually to do nothing and ignore the real elephant in front of them (see what I did there?). Meanwhile, our Democratic friends think money is printed from thin air and it is their/our duty to feed, school, house and healthcare everyone, even asses who do not follow our laws (somebody got it?).  Since they are both, wrong let me propose a terribly wonderful more better solution.

• I propose that we allow Every American who wants/needs healthcare to obtain services at their local VA medical center and they can pay whatever they are able (everyone pays something).

That's right, government provided healthcare (notice I did not call it free, since nothing is free). Now, this new class of patients will sit behind the service personnel in terms of waits or preference but we can handle them all.  And I do not envision this "government provided healthcare to be "concierge level service" like you might find at Cedar Sinai or Johns Hopkins.  This is basic government supplied coverage and we will charge the folks as much as they can pay (5% likely).  I encourage all folks to participate in the more dynamic private healthcare system which is costing some folks around as much as 40% of their after-tax income.

Now based on a modest amount of research, it appears the VA system provided "healthcare" to 5.9 million customers in 2016 at a cost of $65 billion or roughly $10,972 per person.  While the entire VA budget is $182 billion, the VA system itself has many other missions in addition to healthcare including benefits ($110 billion), national cemetery maintenance, various research programs, loan and mortgage assistance and several other programs.  The VA balance sheet shows it has $6 billion in assets so it is very stable and can easily scale up to absorb twice the customers with twice the (or something less than twice) the absorbed cost.

Now many will deflect and talk about a few horror stories concerning VA service instead of giving this proposal serious thought.  But remember how many the VA has really served since 1930.  We need to provide a solution here rather than "kick the can" further down the road.  I am afraid the future is more about "snowflakes needing a safe space" than someone "tightening their belt and saying get out my way, I got this" while they climb the mountain or slay the dragon.  If we cannot go back, my solution works on many levels going forward.  It will be way less costly to manage this benefit this way than the current ACA.  More importantly, it allows those who can to provide and make choices for themselves.  There is no instance where consumer choice did not make products better and more affordable.  Sure the VA has problems as does every business especially those managed by the government (no offense government folks and honestly, we should be embarrassed that we have not fixed things at the VA.) My proposal assumes we fund this correctly and hire proper management.  And sure this is quasi-socialized medicine but maybe not quite as bad as forced-communist medicine.  In our modern progressive think-set it is assumed and perhaps necessary that we provide for the millennial snowflakes who were not taught to provide for themselves.

Let's be sure to consider the "cost of healthcare" for anyone who does not go to the VA which is most consumers at the margin.  By providing an alternative government service, the demand for similar private services will be decreased in a negative manner.  In theory, should millions of customer leave a market for something, absent some large immediate change in supply, the price of that something should go down as vendors compete for the consumers who are left.  That means the cost of healthcare in the private system should go down or at least not increase.

Let's be clear the real reason the cost of healthcare is twofold.  The first and foremost reason is most humans seem to take very poor care of themselves and enjoy many habits with negative health affects.  The second reason is that the "employer based insurance model" makes the consumer/employee ignorant to the true costs of the service.  Unfortunately most folks do not truly value the cost of surgery or a casket until they do.  By then, the price cannot be negotiated.  I am calling my plan BillboCare.  Please support it or come up with something better.

Sources: 2015 VA Financial Report, Blue Cross Blue Shield, Health Works Collective, Stanford Medicine, LA Times, Medicare Interactive, Kaiser Foundation, Financial Samuri

Legalize them All with a Penalty!

* YOU MAY BE READING THIS OUT OF ORDER*  - THIS IS A THREE PART SERIES AND THIS IS PART TWO - CLICK HERE TO READ PART ONE 

OK, previously we all agreed that there are millions of folks in American not subject to our immigration/legal system.  These "illegals" snuck into the country without permission or (more likely) they came in legally and have overstayed their welcome.  The majority are from Mexico, but there are also millions from Asia and almost none from Canada (proof a wall is not exactly the best solution here).  

While this number has remained relatively static during the last decade, it represents more than 10% of our workforce and 4-5% of our population and needs to be addressed.   While these individuals are likely all good people (this one infraction notwithstanding), the America societal structure and economic system is based on the Rule of Law and an orderly execution of the same.  We must get back to these beliefs and either amend our laws or adjudicate them.

The current president was elected on a promise of solving this illegal immigration problem.  No other nation in the world allows unfettered freedom to break their immigration laws like this.  Trump campaigned on a proposed solution to round all these folks up and send them back to where they came from.  While that is certainly one solution and the most true to the Rule of Law concept, I think perhaps we can accommodate the goals of the people while still solving the real source of the problem.

Accordingly, my proposed solution is that we immediately offer a nine month window of legalization to the (let's say) 14 million illegals currently in the USA.  That's right I said it, LEGALIZE THEM ALL.  But unlike the Reagan amnesty (which likely created this problem), I have a few additional rules to prevent it from ever happening again in the future.  There should always be a penalty if someone knowing commits a crime otherwise there is no disincentive and the crime will surely occur again.

For the next nine months, any illegal or undocumented alien who has been in the country over a year and really wants to be an American is welcome to go the nearest post office to file for special Citizenship and to be fingerprinted and provided a National ID (they can use this Passport to get state ID and other documentation). Certain felony criminals will not be allowed to participate in the program. There will be a $2,000 penalty for this documentation/amnesty but each individual registered under this program will be a full American subject to and entitled to social security, the draft, ACA and any other program America has to offer.  The only other penalty for this legalization is that this group of folks will never be able to vote in any election (Don't like this clause, please leave the country and come back legally.  Those here less than a year need to leave or register with a $5000 penalty).

After the nine month window, (THIS IS IMPORTANT) any undocumented person caught in America will be immediately placed in a detention facility subject to immediate deportation.  We will never again allow this problem to fester and grow to a level like this.  The $25 billion we make from the penalties should cover the cost of this administration (post office lost $9B last year).  

Look at that, with a couple of pen strokes I have solved a problem that appears to have alluded all our elected and appointed officials.  Now that this problem solved, we need to address their 30-40 million children who were born here (illegally) and who have birthright citizenship (coming soon).

IMMIGRATION SOLUTION 201 - Propose Solution that Addresses the Problem and the Need

I have an immigration solution that may be acceptable by all!

Sorry it has been so long since my last post.  While it appears that nobody read (or certainly followed) any of my previous advice, I shall nevertheless courageously forge on.  Citizen Bill is back.

I cannot watch another silly politician on TV explain to me the cruelty and brutality of actually trying to enforce our current immigration laws.  While immigration is at a 95 year high, one must not discuss the "illegals" in public.  How dare these rouge Police and ICE officials try to actually arrest, hold or deport these folks who's "only crime" is to have violated the promise they made to us when we let them in.  While Obama was certainly not shy at deporting folks, when Trump speaks out loud what a problem it continues to be, all of a sudden enforcement is a GOP or Trump act of inhumanity.  

We continue to see Governors, Mayors and even a few Police Chiefs openly declare that they will not do their sworn job and assist the Federal Government in doing their job in this immigration area (all while their entourage and voter support base cheer them on).  These sound bites and press conferences remind me of that scene where Queen Amidala comments so this is how liberty dies...with thunderous applause.  Our tolerance of tolerance is preventing opportunity and promotion of the general welfare and in some instances creating a national security risk.  In addition to being generally unAmerican, our failure to follow our laws even with empathetic intent, will create a negative result long term as others use the same defense for their failure to follow the law (I stole to feed my baby or I raped her because of her outfit).  As I recall President Regan legalized 3 million of these folks once and now we have 12 million.  I guess that tact did not really solve the problem.  I am here to propose an actual solution.

And while we can argue all day on whether the current laws are fair and just (most immigration in 95 years), I would hope we would all agree that elected and appointed officials should follow the laws and regulations they were put in place and swore to follow.  Failure to do that and follow the Rule of Law makes us every bit as wrong as the dictators and communists we preach against daily.  Hypocrisy thy name is Immigration Tolerance.

But the first thing we always have to do in solving a problem is to clearly state the problem.  Here goes:

In America today there are 12-15 million people in our country who are not accounted for under the immigration laws of the USA (entry/exit status).  These are the folks that are referred to as the illegals or more politically correct as the undocumented.   These folks represent 13-14% of our entire population.

Before we can go any further we all have to agree on that statement above.  This is not a commentary on whether these are "family and friends" as the media allege or possibly "bad hombres" as our current POTUS warns.  This is just a summation of the facts we know from sources we hope to be reliable.  I believe this number to be accurate so we can now press forward to my solution.

Sources: Pew, National Review, USA Today, CIS Org

IMMIGRATION SOLUTION 101 - State the Problem and the Need for a Solution
IMMIGRATION SOLUTION 201 - Propose Solution that Addresses the Problem and the Need
IMMIGRATION SOLUTION 301 - Clarification of Birthright Citizenship