Health Care Debate

It seems that all politicians want some health care change, but no one has a good idea of what their goals are. For Democrats, who have long been primarily about providing health care to all (or at least as many as possible), they seem to be more interested in changing the policies of those who already have care. (They want to apparently want to get rid of the high deductible plans, of all things, which are purchased by the most financially savvy among us.) This is dangerous, as most Americans agree their is a problem in general, but most also like what they've got. Republicans have always wanted to introduce more competition to lower overall costs. But then they criticize ideas to tax employer paid plans, which would likely push people out of the big group insurance and into shopping for it themselves.

Frankly, I'm not sure what's so difficult. The simple way would be to have a basic public plan that is free to the public...GASP. Publicly funded hospitals, clinics, etc. It wouldn't nor shouldn't be great service, but it wouldn't compromise needed care. Then allow anyone else to buy their own, including the existing employer funded care, but eliminate any tax breaks. But if you can prove you own your own insurance, you receive a credit equivalent to the average per person full cost of the public plan. (If after you take the credit and subsequently show up at a public ER, you or your insurance will pay the bill back to the government.) And unlike members of the public plan, the government can make no mandates on you as far as healthy living, which they could for those on the public plan. Hey if you want taxpayer funded cancer treatment, you can cut back on the smokes.

But the one issue with this is the cost. First, I'm not sure there will be that many more people taking this than currently are on Medicaid or Medicare combined. Frankly, I think some older folks would prefer to go out and get their. The credits would be expensive for sure, but you will also collect more in taxing employer provided medical benefits. The remainder can be funded through a VAT-like tax, which I actually believe should be the only non-tariff revenue for the feds, but that's another topic.

In the end those who truly need more care than they can afford will take the public plan, and we can all be assured they will get the coverage they need. Others of us can pay a reasonable premium for catastrophic coverage, get a credit for not burdening the public system, and then buy our day-to-day care from pocket. When doctors start posting prices of routine procedures, you'll know we have competition, and like all other truly competitive services (LASIK is a great example from the world of medicine), prices will not go wild.

One footnote is the AMA. Every time I hear someone from this group, they continue the mantra of needing to invest more in prevention and less on treatment. That's probably very good for helping people live longer and may have some small cost benefits. They talk about medical malpractice BS. I know that's a good chunk of costs. But they never talk about the need for doctors and hospitals to compete with one another on price. And that's where the real savings are.