While I know that most of the work has been done on the HCR bills, I just had a thought on how to make an OPTIONAL single payer system work and be affordable. Don't laugh at my ideas, because sometimes the best ideas come out of crazy half baked schemes. That being said, here goes...
First of all, we would raise the level of elegibility for Medicaid. I'm not sure if it changes with COLA, but It definitely needs to be done.
Second, if you are unemployed and receiving UI benefits, you may request an additional 1 per cent tax be withheld to pay for the AmeriCare Plan (gov't option). You may also choose not to take the withholding and continue with your COBRA. When your UI benefits and extensions expire, you will automatically qualify for Medicaid. Once you find another job, the Medicaid will drop after one month, if the projected salary is greater than the Medicaid cutoff.
Third, if you are employed, making over the Medicaid cutoff, and wish to choose the AmeriCare option (basically buying into Medicare), you may CHOOSE to withhold 1 per cent of your gross income as your premium. So, on your paystub, you'd have Fed and State withholding, FICA, Medicare, and Americare. You have the option of changing with every W4 form filled out. For instance, if your partner gets a great job with super benefits, you can go to your employer and change your W4 to opt out of the AmeriCare plan. So, if you make $30,000, you only pay $300 per year. Dependents as listed on the W4 are automatically covered.
Fourth, an optional National Prescription Drug plan. For those on Medicare and Medicaid, you will present your card. For all others, a valid driver's license or other state recognized identification will be what is presented. The price plan will follow the Medicare guidelines, with the maximum price for a prescription to be $30. There will be no limits as to costs. Special considerations will be given for certain drugs, such as Cipro. This is the "closing the donut hole". Once again, if you have a prescription plan with your employer or private insurer, you may use that one. Hence the DL instead of the national card.
Fifth, ALL childhood immunizations will be free of charge. A parent taked their child anywhere, badda-boom badda-bing, immunized. This is a cost everyone should eat.
Plan requirements include ALL care, just as in a true single payer system.
Insurance providers will compete for percentage shares of patients. for example, lowest bid would get say, 40% of the market share, next lowest, 25%, and so on. Percentages may vary. This will help keep costs down and foster true competition.
Establish tax credits and grants and other incentives to recruit GP and Family Practice and Pediatrics and Primary Care physicians.
I'm sure there are other things relating to cost controls by providers/hospitals, etc to be added, but this is just a general idea. if you all like my ideas and thoughts, send them to your congresscritters and then who knows?