I try not to get into my own politics to much, mostly because (a) I like having a broad audience that isn’t angry at me about something and (b) because by nature I’m uncertain about pretty much everything softer than physical chemistry, which makes political pronouncements tricky.
But, I got to thinking about this problem we have in the US, where (ruling out idiots and assholes), we have two arguably reasonable factions – one group that thinks healthcare would benefit from a market in which prices are known and insurance functions like insurance in other markets*, and another group that would like a European style socialized system where you’re taken care of regardless of your wealth or condition.
*That is, insurance should insure you against something rare or risky, as opposed to just being a pass into the hospital like it is now.
I like the idea of caring for everyone, but I also think it’d be good if people knew the cost of the care they were getting. People then might make better choices (for example, purchasing generic drugs) that would drive down cost over time. That is, socialization sounds nice, but I can see the value in a market.
So, why couldn’t you come up with a market that worked like this:
1) Once a year on their birthday, each person gets X$ deposited into a personal “healthcare account.” This would be an inverse parabola based on average medical cost per person per year. That is, a typical 1 year old needs more medical care than a typical 20 year old, and a typical 80 year old needs more care than either. So, the money deposited reflects that.
2) The money may *only* be spent for healthcare. There might be some fringe cases on what constitutes healthcare, but this could be managed by using pre-existing certification systems.
3) When people want healthcare, they can buy it with regular dollars or healthcare dollars.
4) Healthcare institutions may trade healthcare dollars for the equivalent amount of dollars. This would stop the healthcare institutions from preferring “real” dollars over the healthcare system.
5) Anyone else can trade healthcare dollars at an agreed upon price with anyone else. Presumably, healthcare dollars would be worth less than regular old dollars, so people in need of more healthcare could buy up healthcare dollars cheaply.
6) In the case of catastrophic health conditions, where extremely expensive care is required, some sort of separate federal insurance system kicks in.
By this means, the system is essentially socialized, but at the point of purchase the buyer is in a market. This incentivizes the purchaser to pick what they actually need. For example, it’s been shown that robotic surgery doesn’t necessarily give better results than conventional surgery, but it certainly costs more. A buyer who has to pay (even in fake healthcare dollars), might be more likely to choose the cheap but effective option.
On the seller side, the one big downside I see is sellers would try to push product onto buyers, which may not be desirable in the case of drugs and surgery. But, this already happens, unfortunately, so it wouldn’t necessarily be worse. Plus, sellers would be obligated to offer the same service at a better price, which might allow individuals to consume more overall, if that’s what they want.
So, that’s my pitch. Probably a terrible idea, but it was kicking around my head, and I’d love to hear your thoughts.