A comprehensive reform bill (should; should not; should with an exemption for people who can't afford it; should with an exemption for people with religious or moral objections; should with exemptions for people with incomes lower than 133% of the poverty level or for those individuals who would have to pay more than 8% of their income to buy the lowest cost plan available to them) mandate that all (US citizens; citizens and legal US residents; legal and illegal residents) carry health insurance. Individuals who violate the mandate (would; would not) be assessed a penalty of (0; 2.5% of adjusted gross income; up to $750 a person per year) that will be phased in gradually over the next eight years.
Employers (should; should not) be required to contribute (100%; 50%; 25%; 8%; 0%) of the cost of coverage (under all circumstances; under no circumstances; if their annual payroll exceeds $250,000; under all circumstances unless the company can demonstrate that paying for health insurance would lead to job losses or have other negative effects; if they employ more than 25 people). Employers who fail to comply (should; should not) be assessed a penalty of (0; $750 for each full-time employee, and half that for each part-time employee) not covered.Health insurance (should; should not) be brokered through a (national; exchange; state-based exchange; private insurers). In addition, a (government-run insurance plan; nonprofit cooperative) (should; should not) be set up to compete with private plans.
Employers (should; should not) be eligible for tax credits (under no circumstances; if they have fewer than [25; 50; 100)] workers; on a sliding scale based on the size of the company and the level of worker pay, with larger companies and better-paid workers receiving few or no credits; if they are considered a small business).
Health insurance (should; should not) include (a basic package of preventive services, mental health, dental, and vision benefits; at least ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance-abuse services, rehabilitation services as well as devices, laboratory tests, preventive and wellness services, and pediatric services; four levels of coverage, with an escalating number of services and increasing percentage of costs covered as one ascends the levels). In addition, insurers (should; should not) be prevented from denying coverage to individuals with pre-exising conditions. Plans (should; should not) include prescription drug coverage, and if a public plan is put into effect, the government (should; should not) use its purchasing power to negotiate lower drug costs. In addition (government; private; no; all) plan(s) (should; should not) take into account comparative-effectiveness research when constructing their formularies. The plan (should; should not) also take into account follow-on biologics and (should; should not) provide (0; 10; 12; 14) years of data exclusivity for innovator drugs.
This plan will cost ($1 trillion; $829 billion; not so much as to add to the federal debt) over the next 10 years. The plan will be paid for by (slowing the growth of health spending in the long term; income surtaxes on families earning over $350,000 and individuals earning more than $280,000; surtaxes on families earning over $1 million and individuals earning more than $500,000; fees on insurance companies, medical-device manufacturers, and drugmakers; limiting tax deductions on charitable contributions; mortgage interest for families earning more than $250,000; taxing money spent by drugmakers on advertising; tax money for direct-to-consumer advertising; raising taxes). Additional funds (can; cannot) be raised by trimming Medicare payments to hospitals and subsidies through Medicare Advantage. Hospital associations (should; should not) give up some proportion of Medicare and Medicaid payments to offset the cost of insurance, and drugmakers (should; should not) reduce the costs of drugs for individuals who fall into the Medicare "doughnut hole."
Now wasn't that was easy? Next month, we'll tackle the economy. (For more information, the New York Times website has an interactive graphic on healthcare proposal comparisons.)
Michelle Hoffman is editor-in-chief of Pharmaceutical Technology. Send your thoughts and story ideas to [email protected]