Can we reform the American healthcare system to provide necessary care to everyone without destroying what is good about our system? I think we can.
Let's spell out my starting premises:
1) We don't want people to be financially ruined because of an illness.
2) Where possible, Americans will get as much as they can of whatever is free.
3) Competition and the profit motive have made the US healthcare system the best in the world.
4) Providing cradle to the grave full medical coverage of the entire population is impossibly expensive (c.f.: Medicare and Medicaid, Canada, Massachusetts).
5) What the Democrats want (trying to be charitable here): Universal coverage of every conceivable medical procedure for everyone in the country.
6) What the Republicans want (trying to be charitable here): A market based healthcare system that encourages healthcare providers to keep costs low without spending government money.
7) Neither 5 or 6 can happen in the real world.
Let's meet in the middle.
What is important to hard-core liberals is #5, but for most Americans the primary concern is #1. So let's take that and run with it.
1) Preferably through a private company, if necessary via a broadening of a Medicare type system, every American should have catastrophic health insurance. We're talking car accidents, heart attacks, and cancer, not a trip to the doctor to get a rash looked at.
We should expect people to foot the bill for this as much as possible. If an employer provides health insurance that covers this, fine. If not, every American should be able to buy at least a minimum insurance policy with pretax dollars. The premiums for this would be subsidized as needed.
2) This minimum policy should also cover preventative care to help keep catastrophic costs down in the long term. This includes annual physicals, pap smears, mammograms, and pre-natal care.
Failure to keep up with preventative care (e.g., more than two years without a physical) should raise premiums. (Otherwise, as we all know, men won't go to the doctor unless something is about to fall off.)
3) Beyond this minimum policy, everyone should be able to purchase more comprehensive coverage using pretax dollars (unless, of course, their employer provides it). This is the policy that covers rashes, colds, infertility treatments, and viagra. This is totally the responsibility of the insured, except for those on Medicare and Medicaid.
4) All federal laws that limit or prevent buying health insurance across state lines or require certain benefits to be covered by all health insurance (other than what is mentioned in 1 and 2 above) should be revoked.
5) Health Savings Accounts (HSAs) will be used to help people save for premiums and deductables. HSA savings beyond a certain point should be, at the discretion of the owner, transferable to any other legal HSA.
6) The federal government will oversee the creation of a cooperative program for those who have trouble getting insurance (due to their health conditions) for #3.
Think I'm way off base? Please tell us where and how.
Got other ideas? Let us know.
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