sensible healthcare reform

Healthcare reform is called "complex". What makes it complex? For starters, there are multiple constituents, each with different needs and solutions. Then there are the multiple players, each of which have roles that are not agreed upon by society. BTW, this is called "healthcare reform" but it is really "sick patient payment or insurance reform". healthcare would include many elements of diet and exercise but it is what it is. Let's first look at the constituents and then lets look at the players.

Constituents
Sr citizens on Medicare

Poor citizens who have too few financial resources to be self sufficient in their healthcare choices.

Other citizens fall in several classes - those with high risk from pre-existing conditions, those with high risk because they do not belong to a risk pool, and everyone else

Players
Market based companies - these are the organizations who have a mission to provide care for ailing members of society in a way that they gain economic benefit.

Government - this is an agent of society that exists to meet needs in society when market based organizations cannot deliver their mission sufficiently to produce an acceptable return on capital.

Individuals - the consumers of healthcare services that initiate the use of the service.

Here's the plan -
1. Sr's on Medicare continue as is (approx 30% of pop)
2. Poor people (maybe 20%) have medicaid that is funded through block grants to States to apply as they feel they should for their citizens (this also creates competition between (States)
3. All other individuals obtain insurance as they choose from market providers. Market forces and other steps, such as eliminate govt mandates on coverage, competition across States, tort reform, and increase supply of medical professionals by govt sponsored scholarships, loans and grants, will lower overall costs resulting in more affordable insurance premiums.
4. States will use some medicaid funds to re-insure the market based suppliers for high risk clients of the market based insurance products that have conditions with the likelihood of unusual or catastrophic consequences. This allows Insurers to use the government funded capabilities to insure pre-existing conditions and keep their clients premiums lower. Private businesses can compete with the State to provide the re-insurance coverages.
5. Any citizen (not on Medicare or Medicaid) that does not have a sufficient risk pool from which to buy affordable insurance can subscribe to Medicaid for 5 years. The Medicaid premiums will be income and age tested just as insurers do in the regular market. Subscription is renewable in 5 year blocks at the choice of the client. The client can opt out of medicaid individual policy at any time they have opportunity for a more affordable option through a risk pool they can join.

The freeing of market based solutions for a majority of the population, the use of re-insurance practices to relieve insurers of high risks, and the govt participation in areas businesses can not cover profitably will allow each constituent and each player to best realize their needs and roles.

Feel free to pass this on to any politician who may wish to provide solutions rather than play power politics as usual. This is only a short blog post so I am sure when the lawyers get through it will be 100 pages of garbly goop :-)