It is time for you all to solve many things that have been bogged down by partisan posturing, including health care. I am afraid that the extreme of one-payer health insurance will overcome the other extreme of everyone for themselves. It is time to build on the middle ground of the ACA and construct a plan that provides complete medical care for all within a true insurance structure.
I haven’t abandoned the idea that I am a liberal thinker. I believe this is a progressive position because it is moving forward from where we are. The United States government cannot run health care. Our country is too large, and we have too many people. Various regions of the country have diverse health care challenges. Depending on the federal budget, with its ability for deficit spending, is asking for unrestrained cost and fraud. That is not to say, however, that the government should forgo the costs of income-relevant subsidies of insurance cost, medical education, research and, especially, rural infrastructure. Because of the strategic necessity of having a healthy population, government has a requirement to set standards for the health care of the nation.
The health insurance business model uses mathematics to assess risk and puts a dollar figure to the shared cost of that risk. Most of the insured population will not use all the care which is covered, but they can be sure of having health care with no or minimal cost whenever they need it. Insurance has been a market-driven sustainer of freedom from risk to life and property for centuries. It stabilizes our society at our most basic need for security.
We cannot trust government to run an insurance company. Just look at Social Security. It started out with a realistic actuarial basis, but a growing accumulation of money, which a private company would hold for reserves to pay claims, was seen as a surplus which could be used for other government spending. The spending may have been worthy, but the money was not actually available.
My vision is for an insurance exchange that covers everyone plus a requirement for mandatory insurance. If you don’t sign up, we will tax you. I want to do away with Medicare, Medicaid, Chip, children who are not dependent on their parent’s policy; everyone. People would choose and sign up for their coverage. Employers would choose the amount they would contribute to each employee’s plan with the same tax structure now in place. The government would set the subsidy for people with less-than-adequate income and the disabled. The truly indigent could sign up for a plan with a small premium or a small co-pay, which would be significant for a non-life-threatening emergency room visit. Perhaps states would cost share with the federal government.
Small business and the higher-income self-employed would not be paying the premium they are now because of the fact that their risks are assigned over a small pool. Medicare recipients would have more choice. They could pay higher premiums for less cost share; their prescriptions would be covered without the need to visit SHEBA counselors every year or the dread of significant changes mid-year.
The crucial point is, there would be market, not political, drivers in place. The insurance industry would incentivize healthy living and work with providers to lower costs. Companies might find that a not-for-profit model would give them marketplace advantage. With a regulatory cap on the ratio of claims paid to premiums collected, there would be no incentive for companies to collude in price fixing. There would, however, be an incentive to work year over year to minimize risk by encouraging better health and lower costs.
I remember, in the ‘90s, as Communism was breathing its last, that people who had lived under those regimes had the most problem with the freedom of choice. It is important, I think, not to take away the privilege of having to figure things out. Health care is a participatory process. We cannot buy health, but we can buy the means to make ourselves as healthy as possible. Things that are free of cost have no meaning. Keeping the insurance model in place makes sure that everyone has skin in the game.
As always, I invite discussion.