derifatives

Separation of Issues, And A First Proposal

From thinking things through, it seems there are at least a couple of major issues here, and I'd like to separate them. People who are in favor of national systems of health care are really in favor of one or both of two different propositions.

1. The government should ensure that the poor can afford health care through some form of forced redistribution.


2. The government should take an active role in the provision and delivery of health care.

It is worth thinking about how you feel about these two things separately. For instance, I am opposed to both, but I think that [1] would be only a little bit bad, while I think that [2] is likely to have severe negative consequences for overall human welfare.

To give a bit more detail, under [1], everyone with income below a certain level would get money placed in a special account. They could use this account for any medical expense. They could buy primary preventive care, they could be catastrophic insurance in order to pool risk, etc. Just like the rest of us. The government would not mandate what procedures were and were not covered for who, and would not set prices for anyone.

If I were going to a propose a system, it would be some amount of [1], along with the government getting out of direct provision of care [Medicare, Medicaid, VA] and heavy regulation of insurance [no more corporate tax deductibility of insurance premiums, so your insurance would not be tied to your job, insurance could be sold across state lines, high deductible or "pay for performance" or any kind of plan the customer wanted would be allowed, insurance companies could charge different amounts to different people and don't have to take all comers, people are not required to buy insurance].

Questions for thought:

1. Would you find a system like this acceptable? Better or worse than the current system in the US?
2. Does your opinion change if the poor are ultimately able to decide for themselves whether something is or not a medical expense?

What would be a better system than this?