"...please sleep soundly knowing that despite the best efforts of my head my heart cries out for you, your voice, your body, the touch of your lips, the touch of your finger tips and an even deeper connection to your soul." - S.C. Gov. Mark Sanford (R) to his Argentinian mistress, Maria.
I find it quite odd that in just the past week or so, two top 2012 contenders have ruined their respective careers. Is this just a hint of the fallout to come? The first, Senator Ensign, was a stalwart against marital indiscretions and has called upon many to resign - including his colleague Larry Craig. Sanford may not have been so outspoken, but he certainly shows what he believes through his record - a 90% lifetime score from the American Conservative Union. In the wise words of Shakespeare: "Thou doth protest too much." Who's next?
How Do You Solve A Problem Like Maria?
Healthcare
I'll begin by describing, as I see it, the fundamentals and inadequacies of the market based private insurance system:
Companies - usually - need to turn a profit in order to survive the market. In the health insurance industry a provider must service a sufficient number of individuals (who each pay an equal nontaxable sum monthly) to cover the costs of operation and company employment in order to turn that profit. The problem with the system is that these companies are able to turn away individuals who live at excessive risk. This is kind-of like stacking a deck. The companies are guaranteed a profit because the majority of their clientel live healthy lifestyles and typically will not need to draw from the pooled monthly dues.
Unfortunately, the people who are left uninsured are disproportionately unhealthy risk takers or those that had prior conditions that health insurers refused to cover. This creates, through market based incentives, a two-fold increase the costs of medical care. First, because doctors and health facilities treat the uninsured that require medical attention when ill or injured, they must raise prices elsewhere to cover the costs of those operations or prescriptions in order to maintain a functioning business: remember, these are businesses also - they must profit or they risk closure or bankruptcy. Second, when treatment costs rise health insurers mimic that rise in order to maintain similar levels of profit. This creates a burden on the entire system: a perpetual loop of rising costs.
The solution, therefore, is to run health insurance as a not-for-profit organization.
Unfortunately, no private entity is ever going to do that. It then falls to the government to create such a system. A singular national organization will obviously be better than multiple, scattered, regional, smaller health insurers. This will allow everyone to get better care and care more often because the pool is substantially larger (this holds true even when accounting for the increase in individuals of sicker dispositions).
The organization should be run essentially the same way that a current business is run - excepting the practice of turning away potential costumers. The government should mandate that everyone purchase health insurance (not necessarily that run by the government). The government should also guarantee nontaxability when done through an employer and give a tax deduction if purchased personally (this will eliminate any discrepencies between employer purchases and individual purchases).
The health care industry excepting insurers should all continue to function as private market based entities that are regulated by government agencies. These businesses are logically meant to be for-profit. If one doctor gives better care than another, he should get more business than his inept colleagues. This should still drive innovation in medical care as well because a business that creates more viable treatments than other businesses will still make a bigger profit and will still outperform their competitors.
Next: how do we eliminate the profit portion of the government run entity? The answer in simply this: divide the end of the year excess (minus a certain percentage of that excess to cover any immediate or anticipated dues and costs) into checks made out to every individual being covered by the insurance. The amount to each individual should be indexed to the amount of money they drew from the pool to cover their medical expenses during the previous fiscal year. Therefore, someone who used a higher percentage of the pool than another will by reimbursed less than someone who used propotionately less of the fund.
The argument against such checks is this: someone might utilize the insurance less if they knew that their yearly check would be less because of it. Well, that is their fault. They had the insurance and they CHOSE not to use it... Behavior is not something the government should try and regulate.
Finally - a private health insurance industry should still be encouraged simply out of ideology. If a person, for whatever reason, does not want to purchase government run healthcare they should feel free to purchase it from their chosen insurer.
This is basically single-payer healthcare but with a few minor alterations...
EDIT: This system would potentially do away with both Medicare and Medicaid - ostensibly saving us billions over the next fifty years because fees and operations would be consolidated and there would be no overlap in the system.
EDIT 2: For those that are excessively poor and cannot afford to purchase the required coverage (remember that health insurance would be mandated) the government would issue a non-refundable non-taxable voucher that could be used to purchase insurance with any insurer (public option or not). If the recipient choses the public option, he or she would be exempt from receiving the end of year disbursement of excess funds.
EDIT 3: After a conversation with someone close to me who is of a different mind than me on this, I continue to support what I've written. I agree with Obama when he says that if private insurers truly do believe that they will offer the better and cheaper service, then they should not be afraid of competition with a public option. There could possibly be a few extra incentives established for people to chose a private option over the public option. How about this: if someone is getting their insurance through work (the payment for insurance is non-taxable at the moment), the business could possibly get a tax deduction equal to the sum being paid for all employees (this should be capped at a reasonable level). This will allow businesses to thrive by having extra money and will encourage them to pick the private option. The reason the public option needs to be there is as a back-up for those who can't get realistic or reliable insurance elsewhere.
EDIT 4: I also forgot to mention that I do believe that allowing people to buy insurance across state lines is a very good idea. This allows the pool to grow which in turn reduces the premiums that people have to pay to get their health care. It's a great cost saving measure. Notice that in my idea there are best of both sides: from Republicans I've taken a voucher to be used on the market, I've taken the idea that state lines must be opened, I've maintained that open competition must be there to ensure honesty and quality of insurance, and I've maintained that other facets of the health care industry - such as primary care, pharmaceuticals, hospitals, etc. - be kept solely private market based entities. From the Democrats I've taken the public option and maintained health benefits as tax free (notice that the people who have called for taking these benefits are mainly Republicans - McCain comes to mind...).
EDIT 5: Another point comes to mind... The argument over health care, as it seems to me, is not "will this plan save money"? It is instead "will this plan save more money than my opponents plan will save"? Well... If you know that both plans will save money, why not consolidate those plans??? Just stating the obvious here. We know that both sides plans will realistically save us trillions. Who cares if one plan is better than another, won't it save us even MORE if both plans are implemented?