Remember, society as a whole bears the cost of providing, or not providing, healthcare to its citizens. The goal of healthcare policy should be to make this cost as transparent as possible, which will result in the most cost- effective care for the most people.
- All health insurance should be purchased by the individual on a tax-subsidized basis. Corporations should not provide health insurance to their employees. Health insurers will have to market their service and price to the actual consumers of healthcare, not to a third party corporation.
- The tax subsidy should be based on family size, to encourage consumers to shop for the best deal. The tax subsidy should effectively reimburse the lion's share of the cost of insurance.
- The tax subsidy should be "refundable" to encourage everyone to get health insurance.
- Health insurers must accept everyone. They may only vary their premiums based on the age and gender of the customer. Within this constraint, they can charge whatever they want. Health insurers should be regulated nationally, rather than state-by-state, to give consumers the most choices.
- Healthcare providers must charge the same to everyone, regardless of their insurance provider or lack thereof. They can set whatever price they want for a given surgical procedure or hospital stay, but it must be the same for all. They must publish their rates.
- The government will regulate all of these areas, but will not provide insurance. Medicare and Medicaid transfers will be turned into grants for the purpose of purchasing insurance as described above.
Liberals should like my plan because:
- It makes healthcare insurance affordable to all through tax subsidies for the middle class, "refundable" credits for the working poor, Medicaid transfers for the poor, and Medicare transfers for senior citizens.
- It is essentially redistributive: the tax subsidies and Medicare/Medicaid transfer payments are funded by the progressive income tax.
- It's not government-run single payor healthcare.
- Providers and insurers have freedom to set prices.
- Consumers have freedom to shop for the best deal.
- On a grand scale, supply and demand will affect market prices.
- It will be easier to buy insurance.
- There will be infinitely more transparency about the cost of healthcare.
- Despite all of the tax incentives and Medicare/Medicaid transfers, some people will still elect not to get insurance, and then expect to receive subsidized care when they need it. The only two answers are: "tough luck", or "mandates" that everyone purchase insurance. If there's no political will for "tough luck", then I'd rather have mandates under this system than under government-run healthcare.
- Health insurers will have to provide good service to retain customers. As a result, I would expect the cost of health insurance to increase to more accurately reflect the cost of providing healthcare to the population. I don't think the cost to society as a whole would increase; I just think less of the cost would be hidden in the government budget and more of it would be transparent in insurance premiums.
- In fact, the entire health insurance business model will need to change. Right now, it's based on collecting lots of premiums from employers for people who don't use a lot of care, and trying to avoid insuring really sick people. Under my plan, the insurers will have to accept the fact that they are bearing the cost of providing healthcare to a cross-section of the population, and charge for that care plus a reasonable profit.
- Providers will have to live with the fact that they cannot be like airlines that charge each passenger a different price based on when and where they bought their ticket. Yes, providers lose some of the pricing flexibility that typically characterizes a "free market." But, it's better than having the government run the market and telling the providers what they can charge.
