Politics: Repeal and replace?
But as a thought exercise, what would a "replace" look like in my opinion as a pajama wearing blogger?
But that presumes a solution from DC is the best solution. The problem is that too much power is consolidated into the hands of a few regulators in DC.
Realistically, the health care system in very rural North Dakota is going to be somewhat different than a more urban state like New Jersey. As such, right now, health insurance is regulated at the state level.
So, how does one develop policies that help the people in the upper right quadrant of the matrix?
What about block grants to the states for the states to use in any combination of the following manners:
(1) To expand their current Medicaid program
(2) To expand or create government run hospitals and clinics to provide care to the underserved, uninsured and underinsured
(3) To expand or create a voucher program to help people buy health insurance who currently can't afford it.
Thus, the people of rural South Dakota (less than 1,000,000 people) can look at their situation and decide which of these methods actually helps the most people. Their solution might be very different than California (38,000,000 people with ginormous urban areas).
How to fund?
The just passed health bill has a mix and match of taxes and fees that essentially picks winners and losers among various industries and groups of people. More fair and effective is a broad based tax since any general public good should be paid for by the widest possible tax base. The tax could be indexed to income groups so higher income groups pay a bit more and lower income groups pay a bit less.
The problem of the bottom left group!
Initially, I was hesitant to support the idea of an insurance mandate. But I'm beginning to shift my view on that especially if the mandate is imposed at the state level much as the auto insurance mandate is controlled at the state level. The state governments already have records of companies licensed to sell health insurance in their states so they are in the best position to verify compliance.
And finally, the most radical reform ... in exchange for lower over all income tax rates remove the tax sheltered status of insurance premiums. Companies will still offer a menu of insurance plans but employees will now have a more complete understanding of the cost of the coverage they buy. Competition works best when the true cost of something is more apparent. With the lower tax rates they have more money in their pockets to decide which plan they want to enroll in.