An Alternative to State-Run and For-Profit Healthcare

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Affordable Healthcare and Full Coverage for Catastrophic Illness

A civilized society does not allow people to die or suffer unnecessarily just because they are poor. We need some kind of public health care system, but we don’t want a system in which decisions about our health are made by bureaucrats.

Moreover, any public benefit must be available to all, not just for the poor. Therefore, I suggest that the US Treasury issue Greenbacks (such as President Lincoln issued) to build and maintain state health center infrastructure: hospitals, labs, emergency care centers, and doctors’ offices. (Or the US Treasury could purchase existing infrastructure from the private, for-profit health industry.)

Such centers would be cooperatively-run by the local community/stakeholders, not by top-down control from the Federal government. The Federal government’s role would only be to provide the funds for the physical infrastructure.

As non-profit cooperatives, these health centers would offer quality service at low or reasonable costs and free care after the patient pays a sliding-scale deductible that would be about equal to or less than what people pay in yearly premiums now.

With such a system,-- in which people pay out-of-pocket for routine care – those who take care of their health would not be expected to subsidize those who do not take care of their health. And no one would suffer economic hardships as a consequences of illness.

No citizen would be forced to buy insurance nor pay a Federal or state tax for this health care program. Businesses would not be required to provide health insurance for employees. The public health system would be greatly simplified.

The money that US citizens would save not having to buy health insurance and not having to contribute to the profits of stockholders in the health industry would be huge. Yes, it would wipe out a very lucrative industry, but so be it.

All government employees and elected representatives should be covered through the same plan as the citizens.

Individual states should have the option of levying consumption taxes to further support catastrophic health care program and the option of including charity-run health centers in their programs.

Such a public health care system could operate alongside a private health care system, and citizens would have a choice to use one or the other.

This idea of using Greenbacks to fund public infrastructure supposes that the Federal Reserve system would be finally ended, after its 100+ year long disastrous experiment that has given us boom and bust cycles, during which those with cash are able to buy up assets, concentrating wealth more and more with every cycle. Instead of debt-backed currency, we could have public infrastructure-back currency.

A society with high-quality health facilities available to all for reasonable fees is a wealthy society.

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The primary question that came to my mind while reading this policy is that of payment for the medical staff, especially those who are buried under mountains of student loan debt.

How could the medical staff be incentivized to forgo private practice to pursue this alternative?

To take this a step further, given that this system would be national in scope, covering every citizen, a solution to this problem would not only need to incentivize existing doctors, but an immense amount of medical personnel - which our nation is already in desperate need of.

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I like your mention of “Full Coverage for Catastrophic Illness” - somewhat like an inverse lottery (there’s a reason lotteries aren’t privately run)

But you didn’t go into much detail about it

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Good questions. Currently, with the largely private for-profit healthcare system (plus Gov supported health insurance through private third parties) a lot of money is going to administration, stockholders, pharma patents, contractors, insurance industry, and etc. If all that waste were eliminated, more money could go to those providing the medical care.

I imagine local health cooperatives making the decisions about salaries together with local stakeholders, that is the community that uses the centers plus the medical staff.

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Thanks for your question. Many decades ago, it was common to buy health insurance that covered you for catastrophic illness, but not for routine care or minor illnesses. People used to pay out of pocket for routine care, and that helped keep the costs down: the patient was the one checking that he was not being overcharged/and was getting good service.

Then came HMOs, an idea which is like getting car insurance to cover oil changes and car washes and everything else.

I don’t like the idea of for-profit health insurance. Cooperative health insurance is more reasonable and efficient. I like the idea of the government acting as insurer for catastrophic illness, because, frankly, some people get very unlucky with accidents or illness, and if they don’t happen to have insurance (a lot of young people don’t), we can’t allow them to suffer. We used to expect charities to step in and that’s okay too, but too iffy for many, especially the middle class.

The idea that people would pay about what they pay now in annual insurance premiums, before the catastrophic coverage kicks in, would keep the costs of the program low. If the health insurance industry can manage to rake it huge profits for stockholders and CEOs, surely a well-run government catastrophic insurance program could meet the needs of the people.

Families making around 35K or less don’t currently pay any annual health insurance premiums. Perhaps some families at the higher end could pay around $500 tops per year. Others could pay very minor fees, much like a co-pay, $10 or $20 per office visit.

Eventually, we want all patients to be responsible for some payment. Right now income disparity is too great. And some people are just too poor and too unhealthy. But that’s a larger problem. If people were paying less for housing and transportation and grew some of their own food, they could afford to pay something for medical.

I developed this idea when I ran for Congress in NY as a Libertarian. I managed to convince many Libertarians that this would work. No small feat. The key is that the insurance program is available for all, not just the poor and the individual is made to take some responsibility for maintaining health.

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Agreed, I’m on the same page

The only part where it does get slightly tricky is there is somewhat of a link between “caring for their health” & “catastrophic illness”

Cancer is a great example - sometimes it’s bad luck, sometimes it’s unhealthy lifestyles (like smoking)

But I’m in agreement that for the super-expensive stuff that can make you go bankrupt, there should be government coverage (like an inverse lottery, a pool of money)

For the other stuff, people should just pay for it

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Dear God, a recipe for another monster bureaucratic nightmare which we need like hip pockets in our underwear. NO !

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I also do not like bureaucracies. That’s why I am proposing the health care approach that does not rely on bureaucracy.

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My preference would be that there is a push for Direct Primary Care where you pay a monthly subscription fee and you can see your doctor as many times as you want or need in a month. This often includes some basic labs and prescriptions, though not always. I think it varies between practices, but the free market could even that out.

Additionally, it would be great if you could purchase stand-alone catastrophic health insurance. Currently you can only buy it if you have high-deductible insurance or under extremely restricted circumstances. I don’t know why you can’t just purchase it on its own, but you can’t.

My ideal would be to have a DPC for everyday illnesses and catastrophic insurance for the big stuff. I’m also looking into medical sharing as that seems like a promising possibility for major medical events.

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We’re on a similar page: subscription versus pay-out-of pocket for routine care. How about the people are able to choose between these options and we can see what works out best?

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I understand where you’re coming from. My husband has an insurance premium through work where they pay part of his premium, leaving him to pay $150-200 every 2 weeks as long as it is only him on the policy. If he were to add me onto it, it was calculated to be $500+ more per month, and that does NOT include adding my daughters to the plan. So for the two of us alone it would be $900+ each month just to have insurance that will only pay after a high deductible is reached and then dictates what tests and procedures are performed. It’s likely cheaper without the insurance!

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It is a very strange custom that we have that our employers decide our insurance. As if we are their cattle, or something. Non-profit cooperative insurance makes more sense. But governments seem to think they are charged with the duty of making corporations more powerful.