People ask me, as a Physician, whether or how I would reform healthcare. (What they mean, it turns out, is not to reform medical care but to change how medical insurance works. Nobody really wants medical care in the US to change because it is the best and most caring in the world, by far, thanks to our free choices, national prosperity, brains, and freedom in general.)
It's become clear to me that people are divided into two basic camps on medical insurance: those who want to insure cheaply against major expense and those who want what amounts to pre-paid medical care. In any event, it is stunning to me that 85% of Americans were content with their medical care situation pre-Obamacare so I'm not sure that represented any crisis requiring massive Federal intervention and control.
As someone whose bias is against government getting involved further in our lives, if I were King here's what I would do about medical insurance - free it up:
1. I'd permit medical insurors to create national markets for insurance, like MLS does with real estate. They would be happy to do so were they free to do that.
2. I'd make medical insurance portable across state lines, and detach it from employment. If any employer wants to chip in, or if a union contract requires a business to chip in, fine. They could offer vouchers as a benefit, if they want to.
3. I'd demand that insurors insure everybody who wants to buy some, creating high-risk pools just as they do for auto insurance if needed.
4. I would permit the freedom to sell any kind or style of medical insurance people might want with whatever sort of coverage they want to buy. Or not to buy, if they want. It's a free country, and people are free to be foolish or to trust in the benevolence of others.
5. Regarding Medicare and Medicaid, I would fold them together somehow as means-tested charities for the poor, run by states or municipalities.
(As an off-topic aside, let me tell you the problems with many government-paid Medicaid patients and charity patients: they miss appointments, they are not appreciative and treat you like a servant, they will not make morning appointments, they resist advice, their fees do not pay the rent so docs have to limit their numbers - and they are prone to lawsuits against you. I know about this, because I do around 10-15% charity work in my office as my form of tithing, volunteer one day/week in a charity clinic, and teach for free 1/2 day/week. Just another greedy doc. )
Addendum: A reader asks about tort reform. Good question. God knows how much of medical expenses are CYA by docs and hospitals. The reality is that medical care is an art, and that any medical decision can be challenged or questioned if somebody wants to sue their doc.
What would you do if you ran the world?
