So, in your opinion, how would a system work to include everyone with no mandates and still be affordable?
Not arguing, just wondering.
I don't think you'll ever get everyone covered, even with a mandate. So, let's change the goal to get as many people covered as possible and as early in their life as possible.
We need people to get away from the entitlement mentality that they're going to get health care insurance provided for them at work and get them back into the mindset that health care insurance is something they need to buy for themselves. That means we need to level the playing field between work-based insurance and individual insurance, and that means equal tax treatment and equal group buying power. As such, individuals should get a tax deduction for buying health insurance equal to the tax break that businesses get for providing health care insurance. (Think about it--businesses get to write health insurance off as an expense against profits and they don't have to pay FICA or Medicare as part of the compensation package they pay to employees.) The ACA is somewhat trying to get people to buy their own insurance through the exchanges but they are using a stick as an incentive and not a carrot.
A couple of by-products of individuals buying their own insurance is:
* The insurance is portable--they don't need to stay at a crappy job for the insurance. The earlier you get them on insurance, say in their 20's, the healthier they will be meaning they will use less health care over the years which will contain costs.
* They become savvy shoppers and will become informed consumers, which will create real competition for their money.
I could go on for hours on this subject but I'll quickly list some things. Basically, it means giving individuals more choices and getting them to be educated consumers. We went through something similar when the traditional pension plan was phased out in favor of 401k plans and IRA's.
1. Give individuals a tax deduction for buying their own insurance. Quite a difference from taxing them for not having insurance, isn't it?
2. Finally, (finally!) allow individuals to form groups to purchase insurance at group rates.
3. Encourage HSA's. Have a PR campaign touting their use.
4. Allow across state border selling of insurance. (This will work for awhile, until a select number of states give incentives and become tax havens for insurance companies.)
5. Allow Medicare patients to spend on private health care services if they desire.
6. Make insurance portable from job to job. You could do this by allowing businesses to give employees the money needed to buy their own insurance without having FICA or Medicare taxes attached. Then the employee would have real choices in insurance rather than choosing the plan from the sole insurance company the company contracted with.
7. As Bro. Curtis said, TORT REFORM. There are too many lawsuits nowadays. These create defensive treatments and therapies (read, unnecessary CYA treatments). And the lawsuits themselves drive up the cost of health care.
8. Shorten the length of patents on new drugs. Not drastically, because pharma companies have the right to profit on innovation, but if it were shortened by a couple of years, patients would benefit by paying less for generics.
Probably the best way to do it would be for patients to be able to pay cash for services, bypassing the insurance company altogether. I can imagine ads by clinics for MRI's, or colonoscopies, or cardiovascular stress tests with a cash price listed. I can also imagine the patient negotiating prices.
