I haven’t been too happy with the Republican proposals I’ve seen, especially when it comes to pre-existing conditions, but here is a possible solution. Why not give Democrats single-payer universal coverage – but only for catastrophic care, while basic care would be covered exclusively by health savings accounts that could be rolled over?

The universal catastrophic insurance could be paid for with a new payroll tax, that employers pay half of, while requiring the dollars employers currently spend on health insurance to be transferred to people’s salaries. The health savings accounts could work just as they do now, except allowing the money to be rolled over. The same companies that currently manage such accounts could also manage when the catastrophic deductible has been reached and bill the government when it is exceeded.

The deductible itself could be means tested, lower for people with lower incomes and higher for those that are richer. The lowest income people could even be given a tax credit to help pay part of their deductible. The point is to let people spend their own money and allow the market to truly function. Competition for each patient’s dollars is essential to lowering costs. But the catastrophic insurance guarantees that no one will ever worry about pre-existing conditions again, and very few people would face bankruptcy due to medical costs. And think of the savings of getting rid of the middle man — the health insurance companies.

If you eliminate insurers, how do costs go down? If the payor is the gov’t (us), money will still get extracted from us to pay providers. Sure the profit part comes out so there may be some reduction in costs but look at Medicare. It is going broke much faster than Soc. Sec. and there is no profit motive there.

Doctors and hospitals already shift their unrecoverable costs from Medicare to the private market now.

If we require coverage of pre-existing conditions, that will drive up costs as well. The problem in health care, as it is with most other issues is…US. We as a society spend too much on health care because we don’t eat right, we don’t exercise enough and yes, we don’t “ration” health care. 85 year olds that need hip replacements should pay for it themselves.

The “young immortals” have no incentive to participate because regulations do not allow for plans tailored to them to be sold.

Eliminating insurance companies only solves one piece. Until we slow down the “demand” side of the equation, health care “reform” still results in higher costs.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

http://www.guardian.co.uk/theguardian/2009/aug/15/simon-hoggarts-week#