Much longer answer given elsewhere. Shorter answer:
A) Formal payments by employers and some copayments by employees, plus copays given to providers, plus private health care premiums, plus medicare taxes and post-retirement contributions for Parts A, B, C, D etc. form a sum $S.
B) While $S is less than what is spent annually on medical care in the U S, it’s very large.
C) Invert the rules (laws) which today permit insurers to void and re-write their contracts of care on an annual basis. Make it say, “Committed until the patient chooses another vendor.” Period. Let patients opt out on birthdays, e.g. vendors get one year not patients.
D) Acquire embarrassing, invasive data from every patient – full history, hobbies, associations, criminal and driving record, DNA, age sex race parentage sexual proclivity and tons more. All under HIPPAA privacy, but acquire it.
E) Have all current health insurers pool their collective actuarial wisdom to develop a cost table capable of defining, to within some target percentage (single digit, greater than 90 % accuracy) the likely cost of care of anyone. See D above.
F) All patients, via fingerprint / SSN / retina scan / you-name-it, CHOOSE THEIR INSURER. Insurer receives, from central taxing authority empowered to collect all of $S, their projected cost. Of course we’ll need to make $S come out in the black, but consider this: medical care in the rest of the free world keeps everyone reasonably healthy, and at 65 to 75 cents on the dollar relative to what we spend here.
G) As needed expand $S by setting medicare taxes such that anything under $15/hr pays nothing, and graduated up such that professional salaries where employers shell out as much as a thousand dollars a month hit the employer with an appropriate share of that amount, and no salary cap. Employers may get to burden their employees with a minor share via a cost split., but that’s in the details.
H) CONSEQUENCES – high-dollar end of life patients get fought over, because optimizing their care provides a good return on their very high care remuneration. Keeping them in good spirits becomes a primary goal. If in-home care saves money, it will happen.
I) Managing health, not injury, leads to better return on care dollars. Insurance companies still exist, still run in a capitalist manner, but have profit motives connected in equal harness with good outcomes not cheap ones, via C) above.
J) As providers compete for improved outcomes, medical costs should also decline because everyone will receive care, meaning expensive emergencies due to delayed minor care will tend to decline. People without doctors today cost a ton of money when they show up at the E R. They get care there but it’s late hence very expensive. Heading those problems off via regular maintenance care will put us in line with the rest of the free world.
This version of “medicare for all” subsumes today’s medicare bureaucracy, sadly, but gets everyone covered (yes even folks who cross the border without a formal invitation) and does so in a “Republican cloth coat” capitalist fashion. Just let someone slip this idea into the White House and NeoCon headquarters, so they can take credit – the important thing is, just do it.
Oh, and Another Thing 