Here is my idea for an alternative Healthcare plan that could theoretically pass Congress. In other words, a compromise that could theoretically attract support from both parties, if the Republicans could pass a plan that they weren’t unanimous about. And, of course, if Democrats liked the plan enough to support something that Republicans (especially Trump) would take credit for after the GOP spent Obama’s entire term sabotaging the ACA, refusing any compromise, and being colossal dickwads. It’s not single payer (GOP nonstarter), and I’m not saying it’s better than single payer. I can’t say it’s better than the ACA either, except it might be for some, and it’s designed with the same goal of making Healthcare affordable to all.
My compromise is rooted in the idea of providing more options. In short, to give both sides a version of the system they want. Envision two suburban neighbors, Bob and Sue. Bob has a cheapo catastrophic healthcare plan from a national corporation with a very high deductible, but it cannot drop him and it has to cover his kids until age 26. He also has a Healthcare Savings Account to cover at least half of his high deductible. These measures provide him some measure of protection from medical bankruptcy, as long as he’s managing his HSA responsibly. For routine medical needs, however, he pays a concierge practice about $150 a month, which doesn’t bill his insurance, but comes out of his HSA and counts against his deductible. They cover his checkups and routine visits and offer considerable discounts on testing and other services, for which the prices are published in advance. They also have an upgrade option which includes a number of additional specialists including mental health. They don’t cover prescriptions, but Bob can now buy them online more cheaply from reputable Canadian or European pharmacies and still use his HSA. Of course, Bob could also just buy a low deductible private health insurance plan (also from a national corporation) if he’s healthy enough to qualify and can afford the higher monthly costs.
Sue prefers the security of a public option. She pays the government for Healthcare and her monthly fee is determined by her income bracket. All medical services are provided for an affordable co-pay. The government pays medical providers on a salaried basis, not per-procedure, so they have no incentive to recommend unnecessary procedures to some, nor to avoid treating low-income patients out of fear they won’t pay their bill. The size of the program gives the government leverage when negotiating with drug providers, and its negotiations include MediCare, MedicAid, TriCare, and all federal employees. The government reduces costs by consolidating functions across those programs I just mentioned, especially MedicAid which is partly federalized. State spending on MedicAid is sharply reduced, as they have a much smaller role in administering it, and one federal MedicAid program is cheaper than 50 state grants. As for government medical practitioners, they make less annually on average than concierge docs (depending on patient volume) but they don’t have to worry about malpractice suits or paying someone to handle insurance stuff. They can be doctors instead of businessmen, if that’s what they prefer, and still be relatively highly paid.
People like Bob can have problems if they fail to manage their HSA wisely or if his concierge docs try to make up for a temporary shortfall in revenue by recommending tests that are probably unnecessary (“but hey, aren’t you glad we’re now 100% sure it isn’t cancer?”). Some will pay less for more, and some will pay more for less. It’s traditional capitalist medicine, but with fewer administrative costs, and with fewer opportunities for price gouging. And you can always opt out of having to make healthcare decisions based on finances by taking up the public option.
Seeking treatment from any government salaried provider without having any public or private insurance will require immediate enrollment in a public plan for a minimum of one year (MedicAid if eligible or otherwise), but will not require payment upfront. Those who are unable to mentally or physically consent (such as a drug overdoser dropped off at the hospital) will be given the option of being charged full market prices out of pocket or being enrolled in a public plan (including MedicAid if eligible, as above) for a minimum of one year. And enrollment automatically renews unless you cancel it. Non-payment will be applied to your taxes.
Obviously, the biggest loser in this compromise are the drug companies. Perhaps federal grants for pharmaceutical research and development, including cost-reduction research, could alleviate that. And the health insurance industry loses a lot of customers, though some of those include loss leaders. They also get to cross state lines, which is likely good for profits but at the expense of laid off workers.
Layoffs are unfortunate but that’s what happens when you take on an industry that is making big bucks from making people sicker and/or poorer. Taking on big tobacco leads to layoffs. Taking on pollution from coal leads to layoffs. And if you’re looking at this as a Republican, taking on “government spending” leads to… guess what? Layoffs. How to help laid off workers is another topic entirely.
Like I said, not better than single payer, not necessarily better than the ACA, and it would require willingness on the part of Republicans to actually compromise and put forth something compelling enough to get Democrats to forgive 8 years of absolute obstructionist bullshit and risk making Trump more popular. But workable? I think so. I could live with it.