Again, I think the feds should allow states to experiment, should consider state or local results carefully and should always be sensitive to local conditions and concerns. Stay out if they're not needed.
But they should not be enslaved by local demands and shortcomings. Somebody has to be the umpire.

If we were innovative we'd escape the constraints imposed by the reality of how our states are today and proceed more often with regionally oriented policies.

Just a quick clarification before this highjacked thread crashes.

All fees and charges would be set by the market – no government interference. Prices would be driven down by pure market forces.

I stomped the halls of congress with this plan back in ’92 when Hillary came up with her proposal. It was pitched to Jack Kemp while standing next to him at the urinals of a country club restroom. The time was just not right for a plan to make it. Maybe that time has come.

The devil is in the details, however, and this is but one of several ways to arrive at universal health care through a mix of public-private funding and service mechanisms. We have the same goal,and I suppor the mix approach.
It will take a very careful cost/benefit analysis AND an analysis of how much of this plan is actually deliverable before any decision could be made.

Will doctors and clinics settle for guideline fees, for example, or will they simply opt out?

Your fraud catching idea is something I've been talking about for some time.
There is no doubt that it could be done. That it hasn't been reflects the misguided aversion to making an iinitial nvestment for the sake of reaping huge benefits down the road.

In fact, that's the hurdle to implementing any plan: the initial investment that's required.

I don't want to hijack Pete's post for one side topic. I still disagree with you on some details, and I think you are overly optimistic about results, but I appreciate your broad angle of approach.

We should go to Washington and haggle out a deal.

I suppose the main innovation I'd like to add to Pete's plan is to not get locked into states versus national government as the two options. Some issues will be best handled at those levels. But perhaps others would be better handled on the county or municipal level. Or perhaps others would be better handled by a regional group. Finally, other aspects of life might be better handled through private enterprises or independently operating governmental agencies. It's hard to come up with examples for all of these, but I will give it a go. Educational curriculum is often best left to more local units; healthcare might indeed be best handled at a state level; environmental policy might be best handled at a regional level, such as all states with a vested interest in the Colorado River; …. Hopefully people get the idea. The executive wing of our government needn't necessarily be a binary state or federal decision.

That would keep all the insurance companies in business and would balance the budget.

Using the broken arm scenario above, think of the benefits of having a system where everyone has the purchasing power of an individual account.

Aside from having the dignity of being a paying customer, access to quality healthcare would be vastly improved. Investors would immediately pour money into building rapid care clinics in high-density underserved areas knowing that money would flow immediately as service is provided. Doctors would be more likely to practice in areas they previously avoided if the accompanying hassles of collection were eliminated.

Along with this system is a web-based mechanism to capture medical information so that it is immediately available to healthcare providers. Because there would no longer be traditional health insurance, the main reason to prevent medical information from being disseminated would be eliminated. Medical researchers would benefit from having all this information available (without names) in order to track areas of concern like cancer clusters.

You seem to zero in on some of the benefits before they are even brought up.

The growth aspect of the accounts is a part of the plan and is also tied to a variation of tax reform. But I was trying to present this in baby steps.

The beauty of the program I’m advocating is that it brings the same purchasing power (along with the resulting dignity of being treated as a welcomed, paying customer) to all, regardless of their income.

Funding the individual accounts for the poor/low income would be done on approximately the same scale as the earned income tax credit. The money would be available only to licensed healthcare providers and outlets. If the individual exceeds the federally mandated minimum in one year, the catastrophic Medicare benefits would kick in. If the individual didn’t use anything out of their account in a year, the person would be able to transfer 10% of the account balance for their own use.

On the broken leg scenario, the savings would be substantial along with the service being far better than any low income person would be accustomed to. With this system, the person would look (quickly) on the internet or in advertisements in the yellow pages for immediate care clinics. The clinic would have every incentive to treat the person quickly, professionally and at a good price using the same basic theories as any business – they want to have happy satisfied customers who will come back.

The clinic owner would have minimal overhead because he would be paid immediately after the service is performed. No arguing with insurance companies, no months of screwing with the government. Fraud would be easy to catch, due to the software monitoring of procedures per location/doctor etc. If a typical Medicaid fraud perpetrator was on this system, he would receive a visit from the authorities the day after he claim to have performed 8 hip replacements in one day. Also, the person who was charged for the hip replacement would have received a call, just like credit card companies spot check unusual charges.

Why not just make the expenses tax-deductible? (No income-percentage threshold or other gimmicks.) Or do you forsee using the accounts and their potential as savings or investment vehicles (which can grow in value beyond what is put into them) as a form of “leverage” increasing the ability of people to pay for health care as well as make their own choices about it?

“national catastrophic Medicare program”

This would be true insurance. Note that rather than cover anything that happens inside hospitals (using hospitalization as a criterion for coverage) there might be less use of hospitals in the future and more out-patient services to reduce costs.

Here's an interesting take on the ever increasing deficit.
http://www.greenfaucet.com/hanlons-pub/obama-mc…

I do have one observation, however, and it's about private health care accounts.

To have a broken leg set costs the same minimum amount whether you are rich or poor. To put aside the money for potential broken limbs, however, is much more difficult, and sometimes impossible, for families whose income barely covers the price of the roofs over their heads and the grocereis in their kitchens.
What happens, then, is that the broken leg will be set in an emergency room, and everyone pays anyway. and pays a higher total price.

Let that be a model for a general observation about health care. Any plan that doesn't examine how it actually works for different sectors of society has an inherent fatal flaw, which will bring us back to the arguing table faster than you can say health care. The reason; what may look like savings at face value can result in much higher costs in the long run.

???

What does anything standing in front of you in real life look like? Is it as distorted as anything on here must be in order to explain your frequent illogical and untrue statements?

For starters what does 'minimalist' look like when it stands in front of you in real life? The whole argument is an attempt to determine the minimal amount of government involvement necessary to deliver a fair and just system of governance. Everyone is a minimalist. as no one wants the government to intercede where it's not necessary , so we have to determine where it is necessary.
Everyone is against taxes, as no one wants to pay taxes that are unnecessary, and so we have to determine when they are necessary.

Catch word arguments (taxes, minimlist, nanny state, markets) just distract from the effort to define what and when something is needed and how it works.

Using individual accounts puts the decision making process into the hands of the user. It allows total freedom as to how this money is spent on healthcare. A debit card would access the owner’s account for immediate payment for services, which would greatly reduce the estimated 28% of healthcare dollars now going to administration. The less fortunate in our society could receive funds for their account through a system similar to the earned income tax credit.

Standard fees for service would be available on the internet. Each time a debit card was used, it would automatically update a website that tracks medical charges by zip code. Displayed for any area would be a list of providers (sorted by cost) with the average of what they charged for the last 10 similar procedures.

Specialization would explode. A doctor who specializes in lancing ass boils would be able to develop cost and time effective methods that would bring the cost down substantially. Just as you wouldn’t want to pay a skilled surgeon to do a simple procedure, you don’t want the director of “Boils Are Us” performing heart surgery on you.

To accommodate specialization, advance degree nurses would fill the initial contact role. Less expensive and more convenient, these diagnostic nurses would be able to devote more time and compassion to people, knowing not only your personal history but that of your family. By delivering the initial stage diagnostics in the home, environmental factors, diet, etc. could be taken into account in the early stages. Using portable equipment, vital signs, fluids, etc. could be collected and if not analyzed on the spot, be sent expeditiously to a lab. Once all the data and impressions are correlated, the nurse can communicate with the right doctor quickly and effectively.

Of course, there is much more. I just thought you could use a break.

Ya remind me of a guy I had in Kuwait when we was putting out oil well fires. He would analyze the situation, discuss it, call his buddies overseas and while he was doing all that crew number two was just putting out fires.

I perfer answers to talk. Weve been talking for 200 years and we still havent answered the question.

If we want health care. How do we do it?

Actually, that's not true because markets are not usually left unchecked, and whatever you may believe about the effects of commercialism and poor quality programming is separate from the fact that they're responding to what too many people prefer and that may be bad in this example, but it is in no way truly wrong.

And with insurance, actually it leads to…

“a system based on choice leaves out the many (most) whose choices are either limited or nonexistent”

Yes. “If there's great demand, let the price rise in response to the demand, and then those who value it more highly will pay more to get what they want” is itself an ivory tower approach and could be accused of being a variant of “Let them eat cake;” an elegant alternative the British economist Vickrey used is succinct: “Willingness to pay implies ability to pay.”

In addition to (physical) disaster relief, what about (I doubt modern politicians in Washington could be trusted with it, though): a general-purpose “rainy day” fund, i.e., a contingency reserve, funded by a fiscally prudent government running a small but significant surplus?

2) that markets don't work well if left totally unchecked has been demonstrated in numerous areas, the destruction of the credibility of media being one glaring example and the dissolution of a viable health care system being another.

That worshippers at the 'markets' altar never look back at the consequesnces of their tenecious beliefs reveals a 'let them eat cake' attitude that cost Antoinette her head, and can cost democracies their future.
Let's just get back to the real world and the BREAD and butter issues important to the commoners comprising the majority.
Markets( a tool) should work for us; we shouldn't work to sustain markets as a specific tool when that tool doesn't work.