Q.  How does this differ from Health Savings Accounts and very high deductible plans on the ACA exchanges?

A.  We think our plan would be much better at lowering costs.  The Catastrophic Policies would be cheaper because they could be bought Nationally with no payment defaults and stripped of any mandatory additions such as birth control or prostate tests.  You tailor you account to your individual needs.  Everything else in healthcare should be cheaper.  If a huge market with no credit risk or no third parties to add costs and paper work doesn’t lower costs than nothing will.  One caveat, however, is in the beginning with so many newly covered even 2 1/2 years might not give providers time to gear up.  That might result in some bottlenecks that might result in some temporarily higher prices or waiting times.  We don’t think the market will let that go on very long.  In any case  providers are dropping Medicaid patients now at an alarming rate and that would never get better.  Because surgeries are a big part of the Catastrophic Policies, one other thing we would like to see is a policy option that would cover accredited foreign providers to lower the premiums.  According to the Oct./Nov issue of AARP  magazine a heart bypass in the U.S. costs $88,000, In Costa Rica $31,500 and in India $14,400.  We saw a brand new hospital in India and when we asked about the surgeons we were told that every one of them had served on the staff of a major U.S. hospital.  Additionally this would put price pressure on our hospitals.  In any case each dollar in your PSA would buy more health care than if it was put in a Health Savings Account or an ACA  very high deductible plan does now.  We believe that the differences could be substantial.  As people’s accounts grow and innovation kicks in over time the problem as a percentage of GDP would shrink.  You can’t say that about any other plan we’ve seen.

Q. Wouldn’t the Medical Credit Card ultimately be a national identity card?

A. Originally we never thought of it that way, but you’re probably right.  Because of the universal usage, the card has to be as secure as possible.  A Target or Home Depot experience would be unacceptable. Hence a chip and pin photo card would be would be a minimum.  In any case one of us just had a minor surgery and, you guessed it, had to show a photo I.D.  Because of the differing reporting and employment requirements between citizens and legal aliens, it would be easy to issue say blue cards for citizens and of course, green for legal aliens.  It does sound like it would be usable in practice as a national I.D. card.  We don’t see any downside to this.  Besides getting medical care, everyone could get on an airplane.  No more fighting over voter I.D.s.  We would be assured that everyone entitled to vote could and those that shouldn’t couldn’t  If we could lay that controversy to rest, so much the better.  One of thoughts about our plan was that it would bring more people into the mainstream.  This seems a step in that direction.

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