Today, I unveil my health care plan, available for presidential candidates as well as for adaptation by Oregon and Washington governors. Under my plan, everyone will think they are sticking someone else with the bill. Everyone will be happy. My plan will not only provide health care for all, it will also stimulate economic growth, create thousands of jobs, save the Social Security system, and fight global warming. It works by dividing us up into three groups of people:
- The privately insured: I will offer employers tax incentives to create health-care plans. Therefore, covered employees will think they are sticking their employers with the bill.
- The government-insured: I will create two government health insurance programs – Medicare for people over 65 and Medicaid for people too poor to afford health care. Those covered by government insurance will think they are sticking the government with the bill.
- The uninsured: Under my plan, 46 million people will have no health insurance. They will go to hospital emergency rooms for health care and think they are sticking the hospitals with the bills.
But don't worry about government, hospitals, and employers. Ingeniously, under my plan they will have opportunities to stick someone else with the bill. The government will try to stick doctors and other health-care providers with the bill by cutting fees, adjusting rates, defining procedures, and imposing price controls. Failing this, the government will simply stick the next generation with the bill. Employers will react by reducing coverage, increasing deductibles, and shifting costs back to employees, thereby sticking them with the bill. Or they could limit choice by forcing employees into HMOs. By paying a flat per-capita fee, employers hope to stick the HMO's with the bill. If that doesn't do the trick, employers can replace full-time employees with part-time employees with no coverage, sticking hospital emergency rooms with the bill. As for hospitals, under my plan there will be two types, for-profit and non-profit. For-profit hospitals will have incentives to increase revenues and decrease costs so everyone can make a lot of money. Non-profits, however, will have incentives to increase revenues and decrease costs so everyone can make a lot of money. Through clever cost accounting, creative interpretation of rules and definitions of procedures, ingenious allocations of overhead costs, and constant price increases, the hospitals will attempt to stick private insurers with the bill. So do the private insurers, doctors, and HMOs get stuck with the bill? Not under my plan. Insurers will stick
someone else with the bill by negotiating large discounts (forcing providers to raise their prices even faster). They can also employ a procedure known as downcoding to both deny valid claims and improperly lower the amount of money paid to hospitals and doctors. Lastly, insurers can stop selling insurance to people who really need it, marketing their services to the healthy and rejecting the sick. Doctors will avoid getting stuck with the bill by subjecting patients to rigorous credit approval, complicated forms, and endless waivers. (Doctors hope that in five years they will discover a test for poor credit using a DNA marker.) Doctors will also order unneeded tests and procedures to avoid malpractice suits. HMOs will try to stick their members with the bill through "denial management" techniques such as: determining that a provider is not part of their network; penalizing doctors who order long hospitals stays; requiring hospital recertifications and then alleging they were not advised in time; not recording the receipt of a bill and then denying claims because they were not filed in a timely manner. To make my plan
even more attractive, I will introduce a lottery for anyone unsatisfied with health care. Since lotteries are illegal in some states, my plan will also allow unhappy individuals to sue for malpractice and, on a randomly selected basis, collect huge awards. Under my plan, no one has any incentive to restrain spending, since everyone thinks they can stick someone else with the bill. However, everyone has great incentives to shift costs and deny claims. These incentives will stimulate economic growth, save Social Security, and help the environment. Start with the economy and jobs. Under my "Stick Someone Else With the Bill" program, the U.S. will spend an average of $7,000 per person. Other advanced countries – Canada, France, Australia, and Britain – will spend less than half that. In fact, if you add up all the spending (Medicare, Medicaid, veterans, government pensions, and subsidies to private insurers), the U.S. government alone will spend more per capita on health care than other nations. This robust health care spending will be a shot in the arm for the U.S. economy, creating new jobs and new wealth. We will spend more than $400 billion on the administrative costs of trying to stick someone else with the bill. This means jobs for tens of thousands of claim deniers, lawyers, guideline writers, cost accountants, form designers, complaint processors, price negotiators, reimbursement analysts, etc. Countries with single-payer systems lack this "Stick Someone Else With the Bill" infrastructure and will not create a single new job in these categories. Next, the benefits
to Social Security and our efforts to stem global warming are also quite wonderful to behold. Start with the fact that life expectancy in the U.S. will be lower than in the countries listed above. Under my plan, the U.S. will rank 24th in life expectancy among industrialized countries. Decreasing life expectancy is the most efficient way to save our Social Security system from bankruptcy. We will also rank 26th in infant mortality. Thus, we will have fewer adults to drive cars, use electric massage chairs, and leave large carbon footprints. Critics ask, "If we spend more than twice as much per capita as other countries, how can we possibly rank 24th in life expectancy and 26th in infant mortality?" I answer that we can and will accomplish all of this, so long as everyone involved remains focused on sticking someone else with the bill.