11.28.19 How Clark would fix healthcare; Americans are saving more

Clark promised recently to convey the key components for fixing healthcare in the U.S. He starts by asking how to align free market incentives with more efficiency and less cost. We have by far the highest % of national income going towards healthcare of any country in the world. It's shocking we spend 1/5 of our nation's wealth each year on healthcare. The next highest is 8 or 9% of a nation's output for healthcare. We must address cost first. How do we make healthcare more affordable? The industry doesn't think of patients as customers. The system is distorted with employer coverage creating corporate incentives. Big employers have a marketplace advantage, creating job lock. Employers being able to deduct employee health care from taxes should end right away. The best marketplace will happen when the customer is the buyer and chooses where to go for care. Healthcare cost will never come under control unless we get federally mandated price disclosure for any treatment in advance, to inform consumer decisions. Consumers should make the cost/benefit choice. In addition to requiring easy-to-read price lists - those prices must be guaranteed. No more surprise balance billing. The price is the price, period. ACCESS: Many American counties have no access to primary care providers. We need national law allowing Physician Assistants and NPs to set up their own practices independent of any doctor where needed. INSURANCE: More than half of all medical care comes through the government at federal, state and local levels, eliminating private marketplace incentives. The role of government should be providing reinsurance, after an insurance company cap is reached. This would get us away from insurers cynically manipulating the political process, selling fake policies full of exclusions and riddled with limits. Insurers could sells medigap like policies with clearly stated coverage and no requirement to buy. There could be no exclusions for any pre-existing conditions UNLESS the insurance was allowed to lapse for a period exceeding one year. Then they could exclude a pre-existing condition for a period of 6 months. This would create a marketplace incentive to stay covered. Selling insurance would be less risky if they capped it in the hundreds of thousands of dollars vs. the millions they now fear and refute. Having government in the reinsurance role would lower risk for the private market for routine healthcare. And allowing consumers to truly be shoppers changes the equation as well. There are many other elements to this including Rx. Know the arguments we've had in the prism of politics have looked at this as a zero sum game. Wrong. How do we make improvements to make healthcare more affordable and more predictable? That's the central question. 

The Commerce Dept. has issued a new report indicating Americans now save the most % of their pay in a very long time - 8%. Last decade, Americans had a NEGATIVE net spending rate, spending $1.01 for every dollar earned. Today, people on average are living on .92 of every dollar made - greatness. But it's not evenly distributed. We're of 2 minds about money. Some shiftied their thinking after the Great Recession and have become savers. At the same time, we have record credit card debt. There are many circumstances that lead to deficit spending. But for some, it's lack of planning. Take Clark's 1% challenge. If you're not saving yet, just divert 1% to savings and step it up another 1% every 6 months. If no employer retirement plan, set up a savings account or Roth and have money automatically put in every pay period. We build new habits over time. Slow and steady wins the race. Ideally, work up to saving at least a dime of each dollar. It changes your future and lowers anxiety in your life. 

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