A Single Payer alternative for a capitalist economy
We are often reminded that America is the only developed nation without universal healthcare coverage. America also has the most expensive healthcare system (by orders of magnitude) in the world, from which you would immediately conclude that the answer is obvious — implement a single-payer system. Many politicians have made it a career goal to enact a single-payer system, praising it as the obvious solution.
The phrase ‘single payer’ is really more a reference to a healthcare philosophy than a specific policy. Whether the U.S. adopts a full coverage single payer model where the government manages and pays for everything or merely pays for a minimum safety net is critically important.
Unlike car insurance, healthcare comes uniquely wrapped in moral concerns, with unique boundary conditions that must be designed to be upfront otherwise the system unravels.
Boundary Conditions:
- Everyone gets emergency care, regardless of their ability to pay
- Everyone must contribute to an emergency healthcare insurance policy
- Children, the poor, and the mentally ill require unique consideration
Design Goals:
- High healthcare quality
- Healthcare wait times are short
- Healthcare is financially efficient
Today, because the consumer is not a customer (i.e. makes payment decisions), the system is not optimized for consumer health. If you’ve ever received medical bills, you understand this.
The customer of the healthcare provider is the insurance company (i.e. the payer). The customer of the insurance company is the employer. Because no one is financially incentivized to improve health outcomes, America continues downward on a spiral of sickness.
Proposed Structure:
- Catastrophic Single Payer: Everyone contributes to a government insurance fund (i.e. single payer) covering catastrophic care.
- Mandatory Savings Plan: Everyone is required to save ~10% of their pre-tax income to be spent on routine healthcare procedures.
- Social Security: Everyone pays a tax to provide healthcare for the poor, children, mentally ill, and severely disabled.
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