Bernie Sanders has come up with a health care plan, actually the same one he has promoted for a while now, that he wants to introduce to congress. This plan is for a single payer plan funded by a payroll tax. He calls it Medicare for all.
Let me first say that I really do like Bernie. I voted for him in the Democratic primary in Georgia. I think he has a lot of good ideas but, honestly, his implementation of these ideas into working solutions basically suck. Medicare for all falls right in there with the rest of his half-baked ideas.
Medicare is funded by a payroll tax just like Social Security. And just like Social Security it looks to the people working and having an income to pay for those people who have reached a particular age and (mostly) retired and quit having an income. It’s health insurance that we pay for on the front end of our lives to have coverage on the back-end. It isn’t set up to be a pay as you go system like every other insurance policy out there. Trying to force it into that model will only break it and it’s somewhat fractured as it is today.
What I’d really like to see in trying to insure medical care for the most possible people in the U.S. is for us to continue to use the health insurance companies that we use today and a trick from the ACA, mandate that everyone have a “high deductible” health care policy with the “high deductible” and the premiums being relative to income. The lower your income the lower the deductible and the lower the premiums, the higher the income the higher the deductible and premiums. Yeah, the rich ends up subsidizing the poor under this system but that’s how our tax system works and it seems that we are stuck with this model. Besides this model seems to be the moral and ethical standard for us.
With this system you would pick your approved policy from the company of your choosing but it would be paid for with a payroll tax. The unemployed would be picked up by a standard unemployment policy that would be as generous as the budget would allow with no choice of who supplies it. If the unemployed person is independently wealthy and doesn’t need an income some special case can be worked out for them.
Now let me be clear, this would be for catastrophic coverage and most people would want to supplement it with a private or some sort of group policy and they would be able to. The personal policy would have a deductible of your choosing but would also have a ceiling of coverage based on the deductible of your government-funded policy. This policy could be personally funded or employer funded and the policy could easily be written to be seamless with your government-funded coverage. Remember, when I say government-funded I’m talking about that payroll tax that the government is going to withhold from your paycheck for your insurance.
This is a general framework in what I see could work for everyone. There are details that need to be worked on even in the abstract of what I’m suggesting but overall I can’t see a problem with this. It keeps government out of totally controlling our healthcare solutions while protecting people from catastrophic health issues having to declare bankruptcy.
This plan also keeps the patient in the loop as the customer and gives the patient an incentive to keep costs low. They are on the hook for some of the bill too.