The U.S. Health Care Debate

[Don Corleone]

At the moment, I am not really seeing much coverage of constructive alternatives in the press to which I have access. The proposals seem like a muddle and mess because real reform is being shied away from in favour of the minimum possible politically - and, it must be said, some startling level of cowardice being shown by Democrats if real reform is what they believe in. However, all I see of the other side is yah-boo scaremongering.

If I may, could I ask Don Corleone and Seamus to explain the kind of system that they would like to see in the United States? As far as I understand the numbers, something of the order of 46 million fellow citizens of the US are uninsured, many more part insured or vulnerable to redundancy, and there are 18,000 unnecessary deaths due to lack of medical insurance each year - and many more bankruptcies. (These are figures widely quoted in the papers here, so I am open to them being challenged with other evidence).

You two gentlemen are deeply Christian, wise and caring individuals who also believe in a conservative solution to most social issues. I may not always agree, but your opinions are always thought-provoking. Your thoughts on the best, even ideal, reform (given that the existing system, if the above figures are even remotely accurate, is deeply immoral and close to barbarism for a wealthy country) would be very valuable for me to understand the direction of the ongoing debate.

Thank you much for the high compliments, sir, and for your confidence in me to propose a free market solution. I'm not certain I can, but I would argue that our current situation is not a free market system either. Some practices/guidelines I would adopt for cost savings:


I believe we have numerous problems which overlay to form the quagmire that is our current medical system.

1) We do not incentivize doctors to make people healthy, we incentivize them to "do something". I would recommend altering the way doctors are compensated to more of a fixed payment schedule, where they get paid the same whether they recommend you for additional procedures or not.

2) Costs are best controlled when the decision maker is well informed of the costs of their decision. This is why I am so strongly in favor of high-deductible plans (level of deductible based on your income, to make it a sliding scale... such as 0.5% of your gross income or some such). I myself just went on a a high-deductible plan, and I'll tell you, you learn to ask questions like 'And how much will this procedure cost?'

3) We have to nullify all the protectionist laws enacted on behalf of the pharmaceutical companies. They are anti-competitive and are a big part of how we got to where we are. End Medicare Part D (at the very least, the no bid requirement) and allow for competitive sourcing of drugs from other markets.

4) We need torte reform. I don't believe in limiting the ability to sue, or the damages rewarded. But I do believe that if the judge finds your case to lack any bearing, he can refer you to a judicial oversight committee. If they find your case to be utterly without merit, you (or your attorney) have to pick up the legal costs for the defense. That should end those "WhoCanISue.com" and late-night Robert Vaughn ads that run "IF you win, I get 1/3, if you lose, you don't pay a dime" shticks.

For the coverage issue:

I like the way Germany, Japan and the State of Massauchusetts are set up. Require insurance from a government approved medical insurance provider. However, as part of this:
-Remove tax incentives for corporations to provide coverage, put everyone into the open market.
-Allow the formation of buying groups or co-ops (which are currently illegal in the US....well, they are and they aren't... large corporations buying for their employees are allowed, but I'm not allowed to form one).
-On an evaluation of an individual's ability to pay, the government will subsidize medical premiums. Families that make less than 40K a year will receive 100% of the money they spend in insurance premiums back at the end of the year. 50% up to 80K and so forth. Once your family hits 6 figures, you pay the whole nut. But, if you violate the law and do not get insurance, you don't get one red cent.

And one more thing I would do, to incentivize the insurance companies to cover everyone...

Set their income tax based on a new figure I would call their coverage index.

A 24 year old male with no family history gets assigned a +20. A 79 year old woman with Crohn's disease, diabetes and early stages of cancer gets assigned a -20.

The index is the sum of all individual ratings of everyone you covered for the entire year, pre-existing condition cases not included (if you don't cover them, you don't get their index points). At the end of the year, when your accountants calculate your taxes, they add or subtract your index from your corporate income tax. If you go out and cover a bunch of end-of-lifers, you'll be rewarded handsomely by the taxman. If you insist on dropping coverage on all risks, you'll be taxed heavily for that policy.

Edit: Edited to add cost reduction measure number 4.