Being practical idealist, I am both socially liberal and fiscally conservative.On health care, I believe that America needs three things: access to coverage for all; the end of dirty tricks on the part of insurers; and affordability.
On coverage, I would have America step up to the plate and say, "Yes, we do care about the least among us. Yes, we will cover their health care needs." And yet, I think there should be a quantitative target on the wall because sound objectives are measurable and dated. When JFK told us to go to the moon, he also said to do so within ten years' time. I think that we should cover all uninsured Americans and do it for no more than $100 billion per year.
Let's face it. There are 47 million Americans without access to health coverage, and that leaves 260 million Americans who *do* have coverage. The problem of access to coverage is affecting the former group, not the latter. Hence, access help should target the former group, not the latter.
As a result, my answer is not single-payer, universal health care. When the private sector can get the job done correctly, it should be free to do so. Above, I mentioned two different groups. The access problem affects 47 million (let's say 1/6 of the population), and the dirty tricks problem affects 260 million (let's say 5/6 of the population). Instead of one health reform plan and bill, this should be two -- one for public sector reform and one for private sector reform.
I happen to think that the simplest answer to add coverage for 47 million people is to raise the threshold of eligibility for Medicaid. Medicaid can and should be made free to the bottom 1/6 of earners (based on household earnings rather than individual earnings). And, the prescription drug benefit that now accompanies Medicare can and should be extended to those on Medicaid.
For 47 million people, that means "problem solved," and I bet that the cost will fall within my $100 billion target. (Disclaimer: The government can always escalate costs to an insane level. I thought the Iraq war should have been fought for $75-$90 billion, but the government made it cost over 10 times that amount. So, I refuse to be blamed if a Medicaid adjustment costs more than $100 billion. How I would do things is one matter; how *they* do things reflects brain damage about which you should ask them.)
The next problem is that of dirty tricks on the part of insurers. The U.S. Congress has the power to regulate the insurance industry. A bill should say that we're changing the ground rules for insurance firms. New rule: "No price - nor coverage - discrimination for sick people and those with pre-existing medical conditions." That simple rule would stop insurers from denying coverage and/or jacking up rates for people with pre-existing conditions and for those with coverage when illness strikes.
The cost of extra Medicaid is to be borne by the public sector; the cost of the rule changes for insurers is to be borne by the private sector.
After access and dirty tricks are addressed, the next problem is affordability. The private sector reform bill should have additional rules for insurers. "Co-pays may not exceed $200 per month, and deductibles may not exceed 10% of the patient's actual household income last year. For whatever reason, patients may not be burdened beyond the amounts implied above."
One more interesting boost for health, the government should require landlords to remediate toxic mold conditions in all rental units. That mandate would actually create some jobs, along with providing a more healthy environment for renters -- some of whom are immune-compromised and have massive health complications arising from unhealthy buildings.
Some wag will read this far and say, "Well, John, how is it paid for? You haven't specified the source of $100 billion annually." Personally, I think that it is easy for the USG (US government) to find $100 billion annually. Since I favor means-testing entitlements, how about means-testing Medicare? And if that doesn't produce an entire $100 billion, then how about a haircut for the military? The military spends more than six times this amount annually these days, but I think that they should be able to keep the lights on (in peacetime) for a "mere" 3.25% of GDP. If the USG changes its priorities, it can find $100 billion. Q.E.D.
Note that my plan, above, has no new mandates for employers, and no requirement for individuals to buy anything. Medicaid would simply be there for people when they need it. Government and insurers would change their ways, but not doctors or hospitals. All that I advocate is simple changes to the existing health infrastructure. The insurance industry would be reformed, but it would dodge the bullet of a prospective single-payer, universal health system. I have called myself a "practical idealist" and I think the above shows a practical side and eschews the single-payer magic bullet that some progressives (or idealists) would prefer to read in my advocacy.
For a postscript, I would be able to write an article about how to fix the economy for "only" $300 billion. However, they've already wasted more than 10 times that amount, so I really think that our political leaders ought to be perp-walked into jails for crimes against America and the American worker.
Also, here's an idea to boost health for civilians in other nations: Discontinue land mines, cluster bombs, and weapons with depleted uranium. They should be taken out of the American arsenal, and in the absence of same, I think that American leaders should also be perp-walked into the Hague for crimes against humanity.
Do you suppose that I should write those "postscript" articles, or keep that stuff to myself? ;)