Just curious what people think is a logical fix to the current healthcare system. I think Trump was on the right path during the campaign when talking about "getting rid of" state lines to create competition among the insurance providers to drive prices down, but not sure how feasible that is right now. Perhaps the real threat of a single payer government controlled system will make the insurance come to the table with new ideas.

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You ask a valid question. And it's a difficult question to answer. I think you could look all over the world and see various answers.
That you think Trump had any kind of insight on answering it, at all... sigh. Most states are already a large enough risk pool that going larger is not going to unlock any value. All that "eliminating the lines between the states" would do is cause all plans to re-organize into the states with the lowest levels of regulations.
If state level regulations were actually driving up costs, then each state's government should double-check their own. It's telling that the people selling that line never specified which states had excessive regulations or what those regulations were.

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My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

When the ACA came out, I was convinced that was the answer. Not colored at all by the fact that I was working on a product that needed the ACA to be viable or anything, of course. The ACA has kind of gone belly-up because that's what happens when participants in price fixing get tired of having their prices fixed. Single payer would be ideal, but that money has to come from somewhere, and at last count it would cost anywhere from $2-3 trillion per year for the first ten years. You want to talk about a deficit? Because it's either that or a huge tax spike for everyone. I mean, dumping the easy to manipulate income tax system in favor of a flat consumption tax that's much harder to avoid would help. So would ending Social Security, but that's a different discussion. Point being, if the US wants to find it, there would be enough money out there to go for single-payer.

Assuming that's off the table, because Democrats will throw a hissy-fit about Social Security and amending the Constitution to do away with income tax takes years, something close to the ACA involving vouchers is probably the best we can do right now. I do think that basic health coverage should be extended to all residents in a country as advanced as ours, and I don't think it should be the responsibility of employers to provide it. From there, it gets into all kinds of messy contingencies regarding income level, employment status, family size, and how the hell those things would be verified in a post-income tax society. So let's just go with "the open market has proven that it can't be trusted and single-payer would be a decade-long disaster to implement, so vouchers are probably the best we can do for right now."

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Single payer, or a voucher system that covers everyone, can be paid for with payroll tax increases.
When you consider that we already pay out gobs of pre tax money on health premiums, most people's take home pay would not change.

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My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

Single payer, or a voucher system that covers everyone, can be paid for with payroll tax increases.
When you consider that we already pay out gobs of pre tax money on health premiums, most people's take home pay would not change.

So, employers should subsidize it?

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Tough one to answer. All I know is that any method must remove borders. Then there must be a way to share data across the spectrum. It also cannot be government run. Sure, there could be subsidies but control, no thanks. Perhaps vouchers or Health Savings accounts? Outside of those thoughts, I don't think there is an easy answer or perhaps there just isn't one specific way to do it.

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Tough one to answer. All I know is that any method must remove borders. Then there must be a way to share data across the spectrum. It also cannot be government run. Sure, there could be subsidies but control, no thanks. Perhaps vouchers or Health Savings accounts? Outside of those thoughts, I don't think there is an easy answer or perhaps there just isn't one specific way to do it.

HSA's are great, and I do one myself, but the one negative is that if something catastrophic happens before you are able to accumulate a decent balance, you are stuck with a 10K deductible.

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Doctors forming and managing risk pools.

The cure for scarcity is less bureaucracy not more.

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Single payer, or a voucher system that covers everyone, can be paid for with payroll tax increases.
When you consider that we already pay out gobs of pre tax money on health premiums, most people's take home pay would not change.

So, employers should subsidize it?

Employers subsidize the current system.  Should they? I don't know.  But they do.  Keeping that part the same would minimize the shock of changing. One thing that stinks about our current system is, changing jobs means changing insurance plans for most people.

If instead it was a bigger payroll tax, and it funded a voucher for your family, your family could keep using the voucher for the plan they like even as employers come and go.

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My fellow southpaw Mark Brunell will probably always be my favorite Jaguar.

I think that at least part of the answer is to get government nearly completely out of the picture.  Eliminate the barriers and allow insurance companies to compete across state lines.  For that matter, get rid of social security in it's current form.

Also eliminate it being tied to employers.  Companies shouldn't have to offer a health insurance plan, retirement savings plan, etc. as part of compensation.

Have an easier and better menu of options and incentives for HSA's along with a high deductible catastrophic insurance plan.  Health "insurance" shouldn't pay for routine medical care, checkups or minor visits much like auto insurance doesn't pay for oil changes or a flat tire.

Give better tax incentives to people to save money for health issues that is able to grow tax-free and is able to be given to beneficiaries upon death.  In other words, get rid of the "nanny state" and allow people to do for themselves.

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There are 10 kinds of people in this world.  Those who understand binary and those who don't.

Can't we just give it away for free like Cuba?

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

There is no middle ground, if you have government subsidized payments you'll always have inflated cost. It's one of the two options free market that depends on simple supply and demand laws to regulate cost or public funded healthcare with cost controls dictating the price of goods and services. So long as you have an endless flow of cash from the government without any cost controls the system will inflate prices sky high.

At this point I fear we've gone to far to go back to a private insurance system. With Medicare and Medicaid anf then the ACA covering so much of the population to pull the rug out from under them isn't realistic. So at this point you almost have to go all in and use the state to restrict cost which is essentially a single payer system.

I don't like single payer systems and believe they eventually lead to higher cost with worse healthcare but we've almost gone to far at this point.

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If I had to do a national healthcare, I would make health insurance like car insurance, where it only covers catastrophic health costs. This would drastically reduce the amount of interference between insurance companies and doctors, and allow the free market to help shape pricing. The premiums would be tied to a base salary. People could choose to pay more or less base percentage to reduce or increase their premiums. For example, if one chose the base rate of 5% of their salary, a person making $30,000 a year would have to pay $1500 out of pocket before being able to claim catastrophic health insurance. If they had a good HSA, they might opt to increase that amount to 10%, which would reduce their premium.

I would give every citizen $1000 that went into an individual HSA. This would be used to help pay insurance costs and basic healthcare. That's 350 billion, annually. This is a number that could be manipulated based on the data. I started with $1000 as a random number, but I am not sure what number would be optimal. This would primarily be used to cover basic healthcare and rollover each year. This would allow people who were healthy to form a surplus of money and give them flexibility in their premiums. I would also consider adding an ability for communities to pool money, though that adds a layer of complexity that might cause problems (but could also help drive down insurance costs).

I would not mandate health coverage, but I would allow insurance companies the right to deny pre-existing conditions. This threat, combined with the HSA, should be enough incentive for a majority of Americans to pay down insurance. To further drive down insurance costs, I would open up competition across state borders. Also, I'd give companies a tax credit based on how much they help with their employees premiums.

People born with major disabilities would have the option of enrolling in medicare/medicaid. The NHE is up to 3.5 trillion, and I believe my plan, only using 300 billion of that, would take a lot of people off medicaid and put them into this new system. Medicare costs wouldn't change.

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I would not mandate health coverage, but I would allow insurance companies the right to deny pre-existing conditions.

See, as someone who lives with something that falls under the "pre-existing conditions" umbrella and has been boned for it in the past, I disagree with any notion that an insurance company should be able to say, "Well we're not covering you because you're already sick." You want to experience hell on earth? Try being diagnosed with a condition on Tuesday, losing your health insurance on Wednesday, then having to figure out creative ways to treat it yourself for the next six months because you're self-employed and insurance companies keep saying, "We'd love your money, but we're pretty sure you're actually going to use healthcare services, so no thanks." It sucks, and it's not right to do to someone. If anything, certain "pre-existing conditions" should get you priority and discounts, not get your application for coverage trashed.

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I would not mandate health coverage, but I would allow insurance companies the right to deny pre-existing conditions.

See, as someone who lives with something that falls under the "pre-existing conditions" umbrella and has been boned for it in the past, I disagree with any notion that an insurance company should be able to say, "Well we're not covering you because you're already sick." You want to experience hell on earth? Try being diagnosed with a condition on Tuesday, losing your health insurance on Wednesday, then having to figure out creative ways to treat it yourself for the next six months because you're self-employed and insurance companies keep saying, "We'd love your money, but we're pretty sure you're actually going to use healthcare services, so no thanks." It sucks, and it's not right to do to someone. If anything, certain "pre-existing conditions" should get you priority and discounts, not get your application for coverage trashed.

Hey, I wrecked my car yesterday so I want to add Collision to cover it.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Correct me if I'm wrong, but as long as you have the condition diagnosed prior to losing your healthcare, it should be able to transfer. Pre-existing conditions is a way of making sure people don't only sign up for health insurance once they need it. It shouldn't be a tool used by insurers to keep from paying what they should. The theory is that by having that as a risk, people will pay for insurance while they are healthy, which will allow the insurance companies to profit and/or build up a savings for the unhealthy years.

I wouldn't speak poorly of your situation; it sucks you are dealing with that. However, the goal is to keep people on insurance. Pre-existing conditions should not disqualify you from being insured as long as you keep an active policy (or within a few months of it expiring). Without a pre-existing conditions clause, how do you keep people from signing up only when they need it? If you have a better solution, I am all for it. I just haven't thought of one.

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See, as someone who lives with something that falls under the "pre-existing conditions" umbrella and has been boned for it in the past, I disagree with any notion that an insurance company should be able to say, "Well we're not covering you because you're already sick." You want to experience hell on earth? Try being diagnosed with a condition on Tuesday, losing your health insurance on Wednesday, then having to figure out creative ways to treat it yourself for the next six months because you're self-employed and insurance companies keep saying, "We'd love your money, but we're pretty sure you're actually going to use healthcare services, so no thanks." It sucks, and it's not right to do to someone. If anything, certain "pre-existing conditions" should get you priority and discounts, not get your application for coverage trashed.

Hey, I wrecked my car yesterday so I want to add Collision to cover it.

I'm being compared to a broken down car. Awesome.

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Hey, I wrecked my car yesterday so I want to add Collision to cover it.

I'm being compared to a broken down car. Awesome.

Hey, my house burned down yesterday, so I need some home owners insurance.

Hey, I was diagnosed with cancer yesterday, I need to add a rider to my health insurance policy.

Hey, I died yesterday, I need some term life insurance.

The subject doesn't change the logic and it's not personal.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Correct me if I'm wrong, but as long as  you have the condition diagnosed prior to losing your healthcare, it should be able to transfer. Pre-existing conditions is a way of making sure people don't only sign up for health insurance once they need it. It shouldn't be a tool used by insurers to keep from paying what they should. The theory is that by having that as a risk, people will pay for insurance while they are healthy, which will allow the insurance companies to profit and/or build up a savings for the unhealthy years.

I wouldn't speak poorly of your situation; it sucks you are dealing with that. However, the goal is to keep people on insurance. Pre-existing conditions should not disqualify you from being insured as long as you keep an active policy (or within a few months of it expiring). Without a pre-existing conditions clause, how do you keep people from signing up only when they need it? If you have a better solution, I am all for it. I just haven't thought of one.

The goal isn't to keep people insured, the goal is to create the conditions for a free market. The question is not the middle ground between today and total government control as the title suggests, the question is how do we free the market to best serve everyone. Do that and we dont have to worry about keeping people on insurance, which isn't attainable anyway.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Eat the poor

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