Healthcare is one of the only industries where the product is considered a “right” by some. Unfortunately, this creates some problems for the delivery of that product, because as soon as one considers it a “right,” it is necessary to force someone to provide it, which removes liberty (which is definitely a right). Rights are not supposed to be things, they are supposed to be states of being. You have the right to life–meaning the right to not be killed. You have the right to liberty–meaning the right to not be falsely imprisoned or constrained. You have the right to pursue happiness–meaning the right to not be forced to do anything you do not want to do, the right to not have your property taken from you, and the right to attempt, but not necessarily succeed, at any venture. This is what the Founding Fathers meant by “negative rights.” Positive rights, on the other hand, are things that must be provided to you by someone else. There is a debate as to whether these actually exist.
But aside from that debate, and aside from the question of whether healthcare is a right, it is plainly demonstrated by the skyrocketing costs of health insurance premiums and healthcare in general that government involvement leads to healthcare being out of the realm of possibility for the majority of American citizens. I personally know a family that would lose 90% of their income if they went from part time employment to full time employment, simply because of Obamacare. The ACA is a disastrous piece of legislation, but it is just the latest in a long line of pieces of legislation that have hurt the healthcare industry. Control of healthcare belongs in the hands of the doctor and the patient, not any third party, whether that is an insurance company or the government. The ACA has moved care further away from that control point, and any reform should focus on putting it back where it belongs.
We can’t take away government-provided (ie, taxpayer provided) healthcare or insurance-provided healthcare all at once, or people would start dropping dead in the streets. Instead, it must be done incrementally so that we can wean ourselves off of other people’s money and rehabilitate our economy. Here are some ideas.
1) Remove the individual health insurance mandate and deregulate the medical device industry:
Basically the first step should be to get rid of the individual mandate of Obamacare and deregulate the medical device industry and allow an independent regulatory board to manage the device quality. For instance, UL manages the quality of AC adapters for most electronics, to ensure they don’t blow up. Criminal action is still prosecuted by the government but people know to look for that UL stamp before buying a charger because they know that is the stamp of quality. A similar board could approve things like CT machines, walkers, and hearing aids, which would cut costs considerably. Getting rid of the individual mandate would lower the premiums of pre-paid healthcare and make it affordable for the middle class to purchase, once again.
2) Deregulate pharmaceuticals, begin weaning people off of government-run health insurance, and remove corporation/group discounts for insurance:
Next, we need to move on to deregulating pharmaceuticals, which will cut down the costs of prescriptions. Again, criminal activity should be prosecuted by the government, but they should be out of the business of deeming what is “medicine”. Poisoning someone is a crime. Fraud is a crime (giving someone something that you did not tell them was in the package or not giving someone something that you told them *was* in the package). Other than that, let people buy what they want.
I think weaning people off of government-run healthcare should follow a similar path of weaning them off of social security and other bankrupt systems. The people who have no recourse should stay on completely, with no change to their coverage/benefits. The people who are about to go on the system (let’s say they’re 63 or 64) should have no change. The people with 5 years to scramble, get a “retirement job” secured (like a lower-paying, part-time job), or save some money to offset their deficit, should have lower benefits than they thought but not have everything cut. People with 10 years or more to figure this out should only be able to get out whatever they put into the system. At a certain point, no one will be required to put anything else into the system (though they can if they want to), and the rule will stand that you can only ever take out what you put in.
Getting rid of employer-provided health insurance will at first make costs go up, but as we already dropped the cost of many things (pharmaceuticals and medical devices), many people will stop getting insurance unless they really, really need it. Over the long term, costs will fall because individuals will stop buying insurance, which will make prices go down (supply and demand). Providers will charge less because people will have to pay cash, so the market will drive the costs of care.
3) 100% tax-free health savings accounts, tiered tax deductions up to 100% for charitable healthcare contributions
Government incentives can drive behavior. In this case, reducing the amount of money forcibly taken (taxed) from individuals will really help drive spending behavior. Agreeing not to take money from individuals if they put that money into a health savings account and only use it for healthcare is one way to drive people to save. Additionally, anyone who donates to charitable healthcare not only takes care of the problem of indigent individuals who can’t pay under this new free market system, but incentivizes individuals to essentially ‘tax’ themselves — if they put *all* of the money they would have had to pay in taxes into a healthcare charity, then they pay *nothing* else in taxes. If they put half of what they would have paid in taxes into a healthcare charity, then they only have to pay half of what was left in taxes. If they had a 25% tax rate and they put 25% of their money into a local healthcare charity to help the needy, then they are totally done with taxes for that year.
4) Catastrophic health insurance mandate
Since most “prepaid healthcare” (what most people know as ‘insurance’) would go away under the free market, the only thing that would be left (that the market would demand) is catastrophic health insurance. Like the insurance you have with your car, citizens 18 and older would be required to purchase yearly catastrophic health insurance for themselves and their dependents, which would almost never be used. It would only be used if they happen to get into a car accident, get cancer, or have some other massive problem that costs more than they could ever pay. Many individuals would end up using it for end-of-life care, or for that one surgery they have to have in their life. The healthier they are, the less they pay. There would be a government ban on insurance companies turning people away from catastrophic insurance because of any pre-existing condition, but there would not be a ban on charging unhealthy people more. Parents would have the option of purchasing catastrophic health insurance for their unborn children once a pregnancy is confirmed, to avoid paying a higher premium for a child with congenital deformities. And again, charity would be available for people if needed.
This is not an exhaustive list of ideas, but it is a good start, I think. Please comment below with constructive criticism or additional ideas!