Notes on Health Care Reform for My Congressman

I accepted an invitation from Congress Dutch Ruppersberger (2nd District, Maryland) to stop by his office and comment on health care reform. The following are my talking points for him. I hope my readers will share what moves them with others in Congress and let their Representatives and Senators know that the screaming mobs at public meetings do not speak for the majority of this nation’s citizens.

Dear Congressman Ruppersberger:

I fully support President Obama’s efforts to provide access to health care for all Americans. While I personally support a single payer plan, I understand that it is not a politically viable option; therefore, I want INSURANCE REFORM that meets these criteria:

• Require everyone to have insurance coverage.
• Do NOT rely on a tax credit – people with limited funds cannot wait for the Tax Fairy – they must be covered immediately!
• Provide a public option that is a default for everyone. For people who do not acquire or keep private insurance and can afford to do so, apply a surcharge—make it like MAIF! (Maryland Automobile Insurance Fund) or Worker’s Compensation — with penalties collected through the income tax system if a person is above a given level of income.)
• No discrimination for pre-existing conditions.
• No exorbitant out-of-pocket expenses, deductibles or co-pays.
• No dropping of coverage for seriously ill.
• No gender discrimination.
• No annual or lifetime caps on coverage
• Guaranteed insurance renewal

MEDICARE REFORM:

• Make this the default plan for the working uninsured and use their premiums to support the insurance trust fund.
• Raise premiums and increase means testing to insure that those who can afford to pay cover a fair share of their costs.
• Medicare should not replace private coverage for people who are still in the workforce. Tie it to the age of Social Security eligibility, which does not pay anyone on their 65th birthday anymore.
• End the “Donut Hole” in Part D.

MEDICAID REFORM

• This program cannot afford to be the nation’s nursing home plan.
• Shutdown the fraudulent “estate planning trusts” that are designed only to help affluent people shield their assets so that they qualify for Medicaid coverage in nursing homes while passing on significant estates to their heirs.
• Encourage younger people to purchase long-term care insurance. Make us want this by giving everyone now under 60 an increasing “lookback period” for asset disposal before Medicaid will cover them in a nursing home. Add one year for each year under age 60 up to 10 years from the present five year period.
• Require the new plan to provide at least 5 years of coverage, including in home benefits so that it is meaningful for people who need more care near the end of their lives without bankrupting them, their children or the nation.

INCREASE SUPPLY OF PRIMARY CARE

• Pay off the school loans for doctors who complete residencies aimed at primary care.
• Increase Medicare and Medicaid reimbursement rates for primary care so that it is a financially
attractive option for new doctors.
• Create a training program to retrain foreign doctors in English; see the New York Times of August 4, 2009 – enclosed. (Doctors in Cuba Start Over in the U.S. — http://www.nytimes.com/2009/08/04/health/04cuba.html This will also increase services available to immigrant communities.

I believe these modest proposals can help move us to a position of universal coverage and fair access to health care for all.

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