Here at Crank Crank Revolution, we don't write a whole lot of policy papers. Mostly because we don't have time, but even if we did the policy papers would have titles like "A Cost Analysis Of Making As Much Glue and Dog Food Out Of One Horse As Possible" and "Researched Talking Points On How To Get The Arrested Development Movie Out Alfreakinready." While such things would have high social value, we understand that it's not something everyone is looking for.
That said, recent developments (of which I have been actively avoiding) have made me think more about the health care issue. So much so that I went through and developed the C2R Patented Two-Step Solution To Solve All Health Care Problems In America (tm).
To be fair, the C2R Patented Two-Step Solution To Solve All Health Care Problems In America (tm) is not--despite its clearly inaccurate title--going to solve all of our health care issues. But it will go a long way into solving huge swaths of it, and could easily get bipartisan support as well.
There are, as the name of my C2R Patented Two-Step Solution To Solve All Health Care Problems In America (tm) suggests, two parts to the plan: Everyone Gets A Coupon Or Most Likely A Plastic Card You Will Immediately Lose, and Don't Sue Your Doctor.
1) Everyone Gets A Coupon Or Most Likely A Plastic Card You Will Immediately Lose
Vouchers are a free marketeer's version of a wet dream. Throw a voucher at pretty much any social ill, and all of society's problems disappear. So it is with health care. The first thing we do is scrap the existing programs. I mean everything--throw Medicare, Medicate, COBRA, CHIP, and the VA Program all in the trash. That's right, even the veterans. Then, you give everyone--I mean everyone--a voucher. This voucher is good for any health care provider. You get to choose the insurer you want, and with the type of coverage you want. You want to make lots of visits with a high deductible? You want to go once a decade but never pay a dime? You want/don't want birth control? There's a plan for you, somewhere.
Employers would no longer provide your health care, so no worries if you lose your job and employers aren't spending as much on wages. You'd no longer pay a Medicare tax on your own wages, as everyone does now. Those two things, of course, would be replaced by whatever the cost would be to provide that voucher. Employers and/or individuals could elect to get a better plan if they so desired by spending more money--but they'd get taxed on it (unlike now) and would have to come up with the cash themselves.
Of course, what sort of coverage are you gonna get with the bare minimum? The government could mandate that every insurer come up with at least one plan of coverage that could be paid for with just that voucher. Additional stipulations, such as pre-existing conditions or maximum deductibles, could also be tacked on, but the less of this the better. If an insurance company doesn't want to offer any voucher-only plans, then they're not allowed to trade in any vouchers--their customers have to be cash only.
Now, liberals would love this plan because everyone gets covered. Conservatives would love it because there's still a market mechanism for insurance companies to make money and be competitive. The moral issue of what does and doesn't get covered (such as abortion or birth control) disappears, since it's up to the individual to choose. Insurance companies would like it because there's a vast new pool of money waiting for them, they are guaranteed to get paid, and they have a lot more leeway in providing care as needed. Medicare is no longer needed--it's an insurance plan, just like everything (and for everyone) else.
The only sticking point? Two, really: cost and that pesky minimum coverage. Cost we'll get to in a minute, but the important thing to realize is despite what you think, we're all paying for everyone's care now. Hospitals can't turn people away, so anyone who doesn't have insurance (or goes bankrupt) has those costs eaten up by covered individuals anyway. We're still paying in higher costs, so presumably individual costs would be lower and thus the cost of covering everyone would be lower as well. Unfortunately, the restrictions placed on the "minimum coverage" would always be under intense pressure by politicians looking to force companies to provide more and more coverage for the same amount of money. This is a real problem, but hopefully one that could be legislatively managed. In addition, there can still be VA hospitals and the like to cover legitimate issues, but their insurance would be done just like everyone else.
The important thing is that insurers can play with different price points, just as consumers can choose the plans that work for them. You don't mind waiting two weeks for a doctor? This plan may work for you. You like seeing your specialist same day? You'll pay a higher deductible, but there's a plan for that, too. There are so many variations (and incentives for meeting the needs of customers) that people will be overall happier with what they have.
2) Don't Sue Your Doctor
Cost control is another huge issue. In fact, I believe that cost control is more important than getting people covered--because the less expensive health care is, the more people can be covered without any other reason required. Employers would be more likely to offer health insurance if it costs them less to purchase.
Now, I'm under no illusions that malpractice lawsuits are a huge chunk of health care spending. In and of itself, malpractice insurance and outrageous jury awards are pretty minimal in the overall scheme of things. But there's more to it than just that. Lawsuit avoidance eats up so many resources that aren't really calculated in. Right now, if test A and test B would cover 99% of your ailment, doctors also order tests C through Z just to make sure you can't sue him for missing it, even though it's prohibitively expensive to do so. Not only does the direct cost of the test or treatment come out of these expenses, but all the staffing, resources, and need for other patients gets thinned out as well.
We could go through the normal motions of how to reduce malpractice lawsuits, but that's not really the point--there are legitimate reasons for malpractice lawsuits, nor are those so-called "jackpot juries" necessarily evil. But it does present a unique way of capping these costs: let patients decide.
When you sign up for a health insurance policy, you have the option of capping any malpractice costs. The chance anyone will ever be legitimately injured due to malpractice is extremely small. But it's your choice. If you waive it, insurance companies have an incentive to drop your cost. Your doctor won't waste any time running a hundred useless tests. And the health care system will no longer groan under the strain of needlessly covering phantom ailments. Of course, if you want to retain that right as patients have now, you certainly can--at a cost of a higher premium/deductible. You'll still have the right to sue your doctor--doctors still need an incentive to give quality care, and wrongs still need to be righted. But the amount you could get would be capped at a certain level; since you've been paying less each month (and the chance of any one individual ever suffering from malpractice in the first place is small) society will come out ahead..
Obviously, these aren't the only major issues with health care. We still have an ugly patchwork of competing entities to deal with; patient record-keeping is a joke; and Americans still spend too much on care that is extremely expensive and has little chance of success. Part of reforming health care is going to be painful: Americans are going to have to come to terms with the percentages. No one wants to think about writing off the .01%, and we can no longer pretend like it doesn't cost the system millions extra because people would rather go to the ER than wait three days to see a doctor. But hopefully the C2R Patented Two-Step Solution To Solve All Health Care Problems In America (tm) is a step in the right direction.