At the current rate of health care cost inflation (which, contrary to common belief, was not affected by the ACA) it doesn’t matter what type of public insurance scheme you come up with. Any and all will become unaffordable over a moderate period of time.
There is only one known way to control costs of anything, and that’s to put free market elements in play. The profit motive, in other words. All actors in the system (payers, providers, patients) need to have some sort of incentive to control costs. With fee-for-service, no one has any incentive at all.
The GOP has the right idea on the patient side with the HSAs, but because they’re the GOP, they refuse to put enough money into it. The Democrats, who would be glad to put enough money into it, reject the HSA idea, for various reasons, all of which are either ideologic or petty.
So, we’re back at square one.
On the provider side, we should be talking about how to nationally implement integrated care, a la the Kaiser or Cleveland Clinic models. Make it financially advantageous for doctors to work for an integrated care provider which can act as both the payer and the provider.
If our doctors were part of large integrated care providers, and our insurance policies were all HSA’s that were offered by those providers……now you’re getting someplace.
None of the above forces you to raises taxes a penny.
What forces you to raises taxes is that now you have the HSA’s in place, there are certain groups of people, specifically low income and those with chronic needs, which are going to have to have their HSA accounts “goosed” with government money on a regular basis according to some formula. That is not going to be easy and it is not going to be cheap; but it will be a helluva lot cheaper than single payer, and now you have built-in cost control.
The lefties will hate the HSA part, be ambivalent towards the integrated care part, love the “no more insurance companies” part, and although they’ll love the taxes part, they’ll hate the fact that it will have to be an across the board tax increases that includes EVERYONE, not just the “hated rich”.
The righties will love the HSA part, be skeptical about the integrated care part (but not opposed), be critical about the no more insurance companies part (but not totally opposed), and hate the taxes part.
So, it’s a perfect bed of compromise: everyone has a part they like, and everyone has a part they hate.
All we need to do now is tell them to go do their jobs, and that failure is punishable by death. :-)