First off, we agree that everyone should be covered. The debate is about how to do so within the constraints of the current system and budget.
“But someone having a heart attack can’t shop around.”
True, but 99% of all medical procedures are not emergency. You’re using an exception to make a rule. Bad logic. So, online marketplaces for health care services, which have been used in some European countries to control costs for over a decade, can have a major role to play.
Patients Don’t Know What They’re Doing
Again true, but their family doctor does. Resurrect the role of the family doctor and GP. The GP can then say (example) “you need to see a urologist”. Patient goes an online marketplace, shops around, picks one. Urologist says “you need such and such a procedure”. Patient goes to the online marketplace and shops the procedure. Easy Peasy.
“People Don’t Buy Healthcare, They Buy Health Insurance”
True today. We want to incent them to buy both. There are few greater incentives in life than the desire to turn a quick buck. Provide individuals with the ability to do so WITH their health insurance, and now you have a chance to bend the cost curve. Patients begin to self-ration (not always good, but not good to have no curbs on useage, either. See “medicare”) according to perceived need, hopefully guided by the same GP we discussed above.
What they don’t like — this won’t surprise anyone — are the provisions that pay for it: taxes and the individual mandate.
Bingo. However, how is this different from any marketing problem? Consumers are glad to pay money (look at how many middle income women run around with 200–1000 dollar handbags) for perceived value. If heart transplants were ten bucks, we wouldn’t be having this discussion.
First off, there has to be a mandate, but it needs to be smart. Buy every uninsured person in America a high deductible HSA with minimum coverages, small copay checkups. Pre-existing condition problem solved. Medical bankruptcy problem solved. Total cost? My SWAG would be 100–200B over 10 years based on costs BEFORE the ACA screwed the pooch. That’s pocket change for the government. People will want more, so let them buy riders on that to improve their coverage. If that idea sounds familiar, they use it in Switzerland. And since you’re using an HSA approach, you’re bending the cost curve by incenting people to shop services.
Now, what about funding. Here’s what’s really going to bite you in the butt. To pay for the ACA, the government decided to come up with a tax penalty for non insurance, and a complex host of other taxes levied on all sorts of things. Result? Insufficient funding and the perception in the public that the government had their heads up their asses.
Know what would have funded the ACA?
A ONE PERCENT TAX on adjusted gross income brings in almost exactly ONE TRILLION over ten years.
Think about that. Because the Democrats were too cowardly to stand up and say “we’re going to put on a new payroll tax of one percent, half paid for by the individual and half paid for by the corporation” we have a program which is about to be swept into the corner of a history book.
Now, of course, same problem for the GOP; because THEY are too cowardly to say the above, they’re agonizing on how to pay for it all.
But from the perspective of the citizen, what percentage of us would complain about a half percent tax levied on us that would solve our national health care uninsured problem? And that would be there as a backup for us if we happened to lose our jobs?
I’m guessing pretty close to nobody. :-(