My response to Senator Bob Casey regarding health care reform

Dear Senator Casey,
There are several points in your reply that need to be addressed.   You state that "At its core, this landmark bill provides additional choices for Americans who need health insurance, while maintaining health insurance options that currently exist and that individuals may wish to keep.".  You know as well as I do that that is simply not true.  A public option will eventually eliminate the private insurance market as has happened in every other nation which has government controlled healthcare.  There are already over 1800 separate and different health insurance entities currently in the U.S..  We need additional choices?  What we need is the government out of the insurance industry so that it will be allowed to operate as a free market, thus increasing competition and reducing premiums while giving a higher quality product, (see solution 1 below).   The health insurance industry is one of the most heavily regulated industries in the U.S. today.  The government, through mandates and regulation, has forced them into a very expensive box that we all are required to purchase from.  As far as maintaining health insurance options that currently exist, a Community Health Insurance Plan funded by taxpayer dollars will certainly eliminate all other options in very short order.  When an employer looks at providing insurance to his employees, given the option between purchasing private plans and dumping his employees into the Community Health Insurance Plan, which do you think he will choose?  I can't imagine any employer won't jump at the chance to let the taxpayers foot the bill.  Since any insurance losses incurred by the Community Health Insurance Plan will be made up by printing more money to cover it, which private insurers cannot do, do you actually think that is a level playing field?  For both of those reasons, private insurance companies will simply disappear, and we will all be left but with one option, the public option.  Since at that point, the public plan will have millions of new subscribers, the gateways will then have to ration care to control costs, and you will simply have everyone basically on Medicare, which is already collapsing financially.   Every nation that has tried government controlled health care must ration, with a panel or board of faceless bureaucrats with actuarial tables rationing care to those it deems worthy.    The mechanism for this has already been installed via your vote on the stimulus bill in February which included the creation of the Federal Coordinating Council for Comparative Effectiveness Research, the purpose of which is to establish official criteria for denying reimbursement to less favored treatments, precisely like the triage done by the NICE committee in Britain, which blocks access to a certain expensive anti-blindness drug until the patient is blind in one eye.  Government run healthcare always has and always will be financially unsustainable for any nation.    For an example of this last point, we simply have to look at how our government has involved itself so far in medicine, Medicare and Medicaid.  
 Health care is a very personal issue that belongs between a patient and his/her healthcare provider.  The government simply does not belong in that relationship.   Health care decisions and control of the expenditures associated with it should be left for individuals and families, not a gateway or any other government bureaucracy.    
Additionally, you state that "The Affordable Health Choices Act takes strong steps to improve America’s healthcare workforce, making sound investments in training the doctors, nurses, and other health professionals who will serve the needs of patients in the years to come".  Let's be honest, there is only one thing that will attract the best people into the healthcare field, and that is financial remuneration.  This is true for any industry.  This bill, as with Medicare, will only serve to eventually reduce the compensation of our nation's healthcare workers.  We only have to look at Medicare to see that occurring. Only a truly free market will allow for compensation commensurate with the value patients place on the care they receive.  
Senator Casey, I also believe that our health care insurance industry, and the health care industry as a whole, does need some reforms.  But this bill is just the opposite of what is needed.  Regardless of intentions, anytime the government interjects itself into an industry, it skews the market and consequences that are not foreseen and untoward result.  The reforms that are needed are to get the government OUT of healthcare altogether, not more into it.  The following are a partial list of the reforms that are needed and should be included in the next bill that replaces this one. 
1)  Quit regulating the health care insurance industry and allow it become a free market.   Allow as many companies that can to offer as wide an array of products as possible so that beneficiaries can pick the plan of their choice—paying extra for richer health plans or picking less expensive health plans and keeping the savings.  The way it is now, regulations force us all to purchase only the most expensive plans that cover everything, weather we want it or not.  
2)  Eliminate the federal tax code chasm between employer provided health insurance and all other options.  The most regressive feature of the federal tax code is the existing federal tax exclusion for health insurance. This unlimited tax break for persons enrolled in employer-based health care coverage distorts health insurance markets, undercuts consumer choice and competition, and fuels higher health care costs.
     We also have a tax system that says if you find a better way of getting coverage, other than through your place of work, unlike getting health care through your employer, we will not give you any subsidy to actually get health care somewhere else because we have a tax exclusion for company-provided coverage, but not for other forms of coverage And so, people are skewed into that kind of system whether or not it is the best for them.  We should take concrete steps to transfer direct control over health care dollars and decisions to individuals and families.  This could either be done by providing tax credits to help Americans purchase health insurance that they would own, control, and carry with them throughout their lives regardless of their employment status,  or by enlarging and deregulating the HSA concept.  If you want to put money into a personal HSA, that should be deductible, and it should be unlimited.  That money could then be used to purchase health insurance if you choose to do so to cover catastrophic medical expenses, but it would not be required.  Many younger people may forego purchasing insurance and would keep the savings to grow via the magic of compounded tax deferred growth over a much longer time, growing it to a point that they could cover their own catastrophic expenses without insurance.    Those who feel more comfortable with insurance would be allowed to purchase it at much more competitive rates, since demand would be lower, thus lowering the costs.  
3)  Tax-favored premiums for those with pre-existing conditions.   This would make the premium revenues the insurance company receives to cover those with a pre-existing condition free from the 35% corporate tax rate.  This added value would encourage insurers to include those who they consider financial liabilities.  
4)  Provide a tax deduction equivalent to the hours donated to those health care providers who donate care to the needy and uninsured. 
5)  Tort Reform.  All that is required here is 2 rule changes.  A)  The elimination of contingency fees and  B)  Loser pays.  These 2 simple changes will eliminate 95% of all lawsuits filed, thereby greatly reducing the need for the outrageous malpractice premiums currently paid by healthcare providers that drive up the cost of providing care.  This would also stop the practice of ordering additional tests of questionable value just to ensure one avoids a lawsuit.  
6)  Eliminate state boundary restrictions.  Allow all insurers across the U.S. to compete in the market place, not limit the options and availability of possible policies to a single state of residence.  This will greatly improve competition among the various plans and thereby reduce premiums as well as allow the states to devise ways to help their insurers provide products that all consumers will like.  
7)  The U.S. has the 2nd highest corporate income tax rate among all developed countries in the entire world  This encourages companies to locate out of the U.S., and reduces the competitiveness of the ones that do remain.  Reduce the corporate income tax from 35% to 15%, if not for all companies and industries, at least, in as far as this discussion,  for the companies involved with healthcare.   This will encourage healthcare technology firms, pharmaceutical companies, medical facilities, (as well as all other industries) to increase expenditures on research and development so that they will stay on top, and we may continue to have the best health care in the world, as well as allowing companies in all of our industries to compete on a more level playing field.   
  Senator Casey, we simply do not want the health care reform you have proposed.  Please consider these alternative solutions in future legislation.    Thank you.

Cordially Yours, 



Thane S. Farmer.