On Sunday, July 5, Paul Krugamn laid out his argument that affordable health care for everyone was an achievable goal.[quote] Many people would be surprised to learn that I agree with him on that. He correctly argues that we already cover the bulk of the most expensive health care patients by covering the elderly under Medicare. He also argues that the uninsured already receive much care that we are already paying for so we are already paying much of the costs for their care. Finally he argues (as a corollary to the first point) that many of the uninsured are generally young and healthy so that insuring them would cost less per person than our current per-person cost of public insurance (bringing down the average cost per person and increasing the overall cost only slightly).
His conclusion is that “extending coverage to most or all of the 45 million people in America without health insurance — should, in the end, add only a few percent to our overall national health bill.” He would be right at the beginning but eventually the nightmare spiral of skyrocketing costs would take over because the fundamental problem in our health care system would not be addressed – overuse and the disconnect between the source of payment and the subject of care.
I agree with Krugman that the system can be reformed and that it is possible to provide necessary health care for essentially everyone (some people will always fall through the cracks no matter how good the system gets) without a dramatic increase in costs. I go a step further and argue that we can do it with a substantial decrease in health care costs if we will correct the fundamental problems of our current system. My goal would be to get private insurance and government to each pay no more than 25 percent of the cost of health care (they currently pay 35% and 46% respectively) and let citizens pay for the other 50 percent or more. In order to drive the system in the direction of that goal – and correct the fundamental problem – I would propose changes such as the following:
- Tax company health benefits as income but make private health insurance premiums tax deductible.
- Make government health plans only cover emergency and preventive care (preventive care should be covered 100% without any copay for all legal residents).
- Reduce the requirements for private insurance plans so that they need not cover more than public plans.
- Have all out of pocket health expenses tax deductible (not including elective procedures like liposuction and hair removal).
[quote1]These moves would encourage people to live more healthy lifestyles and leave them responsible to pay for their own choices if they don’t. At the same time, all basic health care needs would be covered privately or publicly without an individual mandate. Private plans could be as extensive as people are willing to pay for while basic emergency and preventive care would be avalable to everyone. I’m confident that such a system would achieve a much lower cost to society than what we are currently paying.
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