Turn it upside down.
FIRST collect the necessary cash, a tall order, by making a legal ‘grab’ of all medical insurance monies paid by employers. A clever lawyer and his brother, a clever ad man, can figure that one out.
SECOND keep all of the medical care / insurance establishment businesses going. HOW ON EARTH? It’s simple – just make their front line staff, people I’d like to call Deniers of First Resort, into Facilitators of First Resort. You’ll understand why once we get to the bottom:
THIRD Pool the actuaries of all the insurers (they figure odds of loss per demographic etc.) and get them to develop a universal table of risk. Everyone’s prior health history, life habits, DNA, race, income, parents’ income, hobbies, occupation, – – and a hundred fifty more details yada yada – to derive a table which has as many discrete buckets as the actuaries need to cover all of the corner cases.
FOURTH Assign, by choice or by lottery, assign a provider company to every person – including the under-the-table “guest” workers and their families, plus, as a favor to Europe, all of their citizens who visit the US. That company has a very important reason to remain your choice because your premium, which is pre-funded by the employer and employee Medicare tax payments all rolled together into a fifteen trillion dollar pie. And yes, that’s what we spend on medical care in this country, so the dollars DO exist. (And by the bye, we have better care, except for the fact that medical emergencies tend to bankrupt people, and lots of people aren’t in any of our systems.)
FIFTH Your premium, pulled from the table, reflects your real risk.
SIXTH Funding: Your medicare tax is graduated to your income. Today low wage workers can’t possibly afford good care, but now that worry is gone.
SEVENTH The sicker folks, end-of-life people whose medical bills in the last two years of life exceed all prior medical bills for years 0 to whatever, bring in huge bucks as premiums, and the providers know that if they fight hard to retain your loyalty today, they’ll get to manage those funds that go along with your annual risk.
EIGHTH You get to fire your provider at will. And every year on your birthday you need to re-up, so the provider will do whatever it can to make that happen.
NINTH Are we there yet? Europe does this in a much more pedestrian way, with some great differences. Holland’s government writes one medical care contract, and its insurers abide by it. In France every little country doctor is part of the whole medical complex.
T R Reid wrote a great book on how the rest of the world handles medical care, and it is great reading.
VERSUS Nowhere else does a medical emergency pose the rest of bankruptcy.
VERSUS Nowhere else does a homeless person pray to be delivered to the ER entrance of a Charity hospital – and most big cities do have those.
VERSUS Nowhere else do you have to choose between a low cost insurer who provides shoddy care, vs a great insurer who costs a lot.
ARE WE THERE YET?