This is my new compromise between advocates of government provided
health insurance and those against. My earlier version may have had a
flaw incentive wise so I am changing it. This version moves close to
that put out by the Niskanen Center see
here.
The state would provide insurance to all Americans but the annual
deductible would be equal to 60% of each family’s trailing year adjusted income
minus the poverty line income (say $25,000 for a family of 4) + $300.
Why 60%? Because some research by the Democrats has shown tax revenues
are maximized at 70%, meaning most people will not hugely cut back at
working at up to a 70% marginal tax and the current top rate in some
states is about 50% already. I took the mid point between the two at
60%.
So a family of 4 with a trailing year adjusted income of $30,000 would
have a deductible of $5,300 * .6 or $3,180.
A family of 4 with a trailing year
adjusted income of $80,000 would have a deductible of $33,180.
Middle
class and rich people could fill the gap with private supplemental
insurance but this should be full taxed. This would encourage the
middle class and rich, who are generally capable people, to demand
prices from medical providers and might force down costs. They could
opt to pay for most health-care out of pocket while the poor often less
capable would be protected.
It is not a perfect plan but it might help. Some deregulation of
health-care would also help the poor gain access. The gauntlet that
Doctors have to run these days to get to practice seems like an
anachronism in today’s world. Let smart people get to practice medicine
after on the job training. Let the medical businesses decide who is
qualified to practice medicine. 12 years of training to tell if my
child has an ear infection is overkill and reduces access to health-care
for the poor. It appears that medical care could much cheaper than it is, see
here.
Another benefit of my plan is that it would encourage capable Americans
(the rich and middle class) to be a counter weight politically against
the providers.
Also it seems worthwhile to me to maintain
flexibility in the system. Our slightly more freedom oriented medical systen
looks not so great right now because we spend more than the other
developed countries but things are still changing and our more
flexibility may start to pay off at some point.
Here are some possible avenues for that flexibility to pay off:
One, all or none of these things might workout and others not mentioned
but it is worth maintaining some level flexibility and freedom.
Here
is an article that makes a strong case for a system similar to the one
that I propose. His plan suggests a insurance for catastrophic events
that cost more than, $50,000 combined with a large health savings
account.
In addition since Government provided health insurance is paternalism it
should provide insurance that experts would recommend and that means
among other things insurance that only pays for care that shows a
significant margin of cost benefit. So it should not cover procedures
that the
UK's NHS does not cover. There would be huge savings there.