Goal: Affordable healthcare

As a libertarian, leaving most decisions to the market and to the patient makes sense. With a market, capital expenditures are made that do not make sense in a managed care system. Natasha Richardson, after sending the first ambulance away, may not have survived, but a 2.5 hour ambulance ride from the ski area to the hospital, when no helicopter was available, may have made the difference. Sioux City, population of 50,000, has a life flight helicopter. Why? because a helicopter ride can be paid for by charging the customers who need it.

Here is my simple plan:

1. Every year, the income tax system can mail a pre-paid cash card with $2500 to each family funded:
   
   a) from the taxes submitted or
   b) supplimented similar to Earned Income Tax Credit, or
   c) for the truly needy, funded totally by welfare.
2. A cash card can be limited to healthcare, much like food stamps are limited to food, but the unused portion at year end transfers to a 401K for the family,
3. Require a high deductible policy (called a major medical policy MM) covering catastrophic costs during the year from $3500-$5million. Premiums are 1/3rd to 1/4th of a commonly used co-pay policy because most years, these MM policies are never used.

When the cash card has used the full $2500, and the costs have risen above $3500 only then does the insurance company get involved.

Everyone gets healthcare at an affordable cost! Office visits include close to 50% non-medical costs so immediately costs begin to drop (which is reflected in lower premiums again). Most families will not use the full $2500 in a given year or file any insurance claims. The debit card does keep track of spending.

When a mother has access to the pediatrician’s office for $50 or the emergency room for $1000 for her child, market forces kick in. Price starts to matter again. For individuals who abuse the system or who are incompetent to manage their care, we have either family guardianship or social services just as we do today.

Is a mammogram $88 or is it $188? No one asks now but spending their own money changes that. Overhead, like shiny new offices, increase costs, but may not increase quality so the patients will become better consumers.

Drop Medicare, Medicaid, VA health care and Government employees insurance, as well as, all employer-based insurance and let the insurance companies vie for private group major med policies for unions or associations and require longer coverage similar to life policy contracts. Give the federal government responsibility only for the major medical policy of pre-existing conditions, the very needy and Veterans. Drop all other insurance mandates passed by states and DC.

A centrally located database with all health care records can still exist but it can be voluntary and the cash card charges are linked to procedures and can be used for medical studies without individual information.

At the most, even if the fed had to fund 1/2 of the cash card accounts, it would not exceed $100 billion -- and remember, with medicare gone, the VA and government employee spending gone-- it would beat anything proposed to date.

It’s too simple and it gives citizens way too much choice in the matter to catch a bureaucrats’ eye but I would love the freedom it would allow me. Call me a rebel!