Monday, January 11, 2010

Instituting Fee-for-Service

As the monstrosity nicknamed "ObamaCare" nears reconciliation of the House and Senate versions, I'd like to revisit my support for a market system in health care. In short, my ideal system is fee-for-service, except where it is unaffordable, then the government could offer loans for necessary health services and procedures.

We could ditch the "loan" idea in favor of a full subsidy, but wherever free healthcare is given there will be abuse, fraud, and waste. There will be growing pains as our current system—already broken by what socialism has so far instituted—adjusts to market realities, but the efficiencies of a competitive system will quickly pay for themselves. The cost of insurance premiums is borne by both businesses and employees, and we would be free of that. What cannot be paid, such as a catastrophic event, will be assisted by government subsidy if needed.

Its institution will take two simultaneous steps: (1) Remove all mandates for employers to buy health insurance for their employees. If insurance companies want a free market system, this is what it will take. Of course there will still be medical insurance available for people who want it, but it will be optional, rather than coerced. Then (2) formation of a program that reviews whether a procedure in question is necessary, and whether the bill is affordable for the individual or not. If it is necessary and unaffordable, then the government pays it by loan or subsidy. It would be funded by what already exists in MediCare and MediCaid; their focus would switch from general health coverage of certain populations to "necessary and unaffordable" coverage for everyone.

What I am suggesting is a comparable system to food assistance: if you want to go to the fanciest restaurant you can. Otherwise you buy what you need at the store, and if you can't afford that, there would be food banks and food stamps.

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