I can't imagine another way out that will not draw us into the disastrous slippery slope that will be co-ops or "expanded Medicaid" or other euphemisms...we need to privatize, make portable and drive down costs by opening a free market that means that the 3 companies selling insurance in MD would have to compete with the 46 in PA.
Performance based outcomes will propel the better providers to the top and the market will sort out the lesser programs. 25% of the "uninsured" are "the invincibles" (the 18-25 year olds) that feel no need to buy insurance...if they do not buy insurance they can contract with private fee for service firms that will compete and possibly make loans or give them credit for procedures.
The higher risk 50-65 uninsured (uneligible for medicare, but struggle with no coverage, low income, job loss or pre-existing conditions) get assigned to a "risk pool" that better performing insurers will ultimately compete for, because they are able compete for them at reduced rates, giving them good coverage and reasonable rates.
The elderly will be covered by medicare and the indigent will be treated pro-bono by participating hospitals. I would like to see THAT pool covered by University Hospitals, many of whom have billion dollar grants behind the universties and should make use of the interns and younger doctors to keep the indigent covered, much as many law firms do.
Wow. Looks like you have given this a *lot* of thought. Very well stated.
I like the equation. Does “Individual Policies” mean “If you don’t want psychiatry, podiatry, chiropracty, maternity coverage you don’t have to buy it”? Because the loopy laws that have been passed on behalf of various medical lobbies forcing inclusion of these and other un-needed benefits have really driven up insurance costs.
Years ago when I first started my own business, we had something called “catastrophic health care coverage”. It paid for extended, serious illness, but we self-insured for discretionary stuff (doctor’s visits for the flu for example). It was VERY affordable, true INSURANCE. I bet you can’t even get that kind of coverage any more, most places.
Currently we use a HSA and high deductible health care policy. It works well but the cost of that for fiftysomethings is going up-up-up like everything else, and in five years of having it we have never collected a dime in benefits. If possible, I’d go back to the catastrophic insurance plan if I could. The HSA/HDHP is the next best thing for our situation.