Ronald Bailey at Reason offers an outline of what market-based health care might look like. Here's part of it:
The typical American might purchase high-deductible insurance policies that cover expensive treatments for chronic diseases such as heart disease, cancer, AIDS, diabetes, and multiple sclerosis, as well as the catastrophic consequences of accidents. Coverage would also include expensive treatments such as heart surgery, organ transplants, dialysis, and radiation therapy. In addition, we'd be able to buy health status insurance that would guarantee that we could purchase insurance at reasonable prices in the future.
Such policies are available already. The online clearinghouse eHealthInsurance pulls a quote of $131 per month from Anthem Blue Cross Blue Shield for a single 55-year-old male with a $3,000 annual deductible, no co-payment after the deductible, reasonable pharmaceutical benefits, and lifetime maximum benefits of $7 million, with an option for health savings accounts. (With such accounts, consumers make annual tax-deductible contributions, then take tax-free withdrawals to pay for uninsured medical costs.) That was the cheapest plan, but more than 80 other insurance policies were available. As deductibles went down, of course, the prices went up.
A lot of routine care could be handled through retail health clinics located in shopping malls, drug store chains, and megastores. Such centers would be staffed not with physicians but with nurse practitioners or other qualified personnel. Consumers generally would pay for routine, everyday transactions directly out of their health savings accounts.
As has been suggested by others, perhaps health insurance should be more like auto insurance. We expect our health insurance to cover everything from prescription drugs to doctor visits for the flu, but we don't expect such routine maintenance for our car to be covered by our auto insurance. We buy auto insurance in the case that we have a catastrophic accident, not to cover state inspections or to have a fuel pump replaced.
By placing the responsibility for purchasing insurance on the individual consumer rather than on employers the employee could be given the cost of their insurance otherwise withheld in their pay check, they would have portability since they wouldn't lose coverage if they switched jobs or lost their job, and employers would benefit by having more money available to them to hire more employees.
Ideas like this are at least worth looking into, but they're not going to be popular in Washington because they wouldn't allow the government camel to get its nose inside the tent of our health care.
RLC