Let's start with preventive medicine. On the whole, it is grossly expensive and ineffective. Yes, certain aspects work, but on the whole it is a waste of money and resources.
Contrary to conventional wisdom, it tends to cost money, but it improves quality of life at a very reasonable price.
www.nytimes.com
So, we should use preventative medicine sparingly and judiciously, not just spam it as some panacea because it isn't.
You'd be wrong about where I came up with my ideas on this. They are my own.
What I propose is totally different than virtually anything the talking heads have proposed.
First, I'd implement a national catastrophic health insurance plan. Everyone gets enrolled and these are administered by the current health insurance industry backed by government, sort of like FEMA does with flood insurance. The plan would have a very high minimum deductible, but once met everything beyond that is paid for in full. I'd have the deductible today at somewhere around $10,000 to $20,000.
This insurance is for major medical emergencies, those rare, once or twice in a lifetime things most people might experience. What it is not is for routine healthcare. For those with chronic conditions, once they meet that deductible for the year, the insurance takes over. For most people, that deductible would be no worse than what they're paying out-of-pocket now yearly for such conditions and could be met without bankrupting them.
For routine care, you set up a medical expense / savings account. There'd be options on how to do this for a personal one, and you could have one through your employer. It would work similarly to an IRA or 401K except you'd be able to withdraw funds as needed to meet medical expenses. All money put into the account would be pre-tax (tax free), and all medical expenses 100% tax deductible. That makes the money put in go further in terms of your total earnings. There'd be a yearly maximum you could put in tax free, after that amount anything in the account put is after tax but you could still contribute more than the maximum. Accounts might earn interest depending on who you set it up with and how. That money remains tax free too.
The expectation would be that you have ideally, $10,000 + in your account so you have the deductible met for catastrophic care if that's necessary. The idea of this is you contribute more early on when younger and healthier, and then when you get older and have issues, the money is there to cover the costs of care. But it is YOUR money not the government's or an insurers. The only restriction is that you spend it on healthcare. But you get to choose what healthcare you want and need.
For those on government assistance, an account is set up for them and some of their assistance money goes into that account for healthcare. If you get an EIC (Earned Income Credit) tax refund, that instead of going to you goes into your healthcare account automatically.
For employers, they can set up such accounts with employees and use matching funds or simply put funds into employee accounts. The employee could present a medical expense and have it covered from their employer plan. Unlike personal plans that can grow over time, the employer one is yearly with a cap on total funds equal to the catastrophic deductible.
Funds left in a plan at the end of each year would automatically, by law, be split 50-50 between the employer and employee. That is, each could potentially get up to a $5,000 bonus for the employee being healthy during the year (taxable). The employer could choose to roll over their returned funds into the plan for the next year meaning after several years of paying out these bonuses, the employer's contribution becomes essentially free since they are just reusing money from year to year.
The exact amounts for account size and deductibles is open to debate. I'm just giving rough numbers here. But this plan is pay-as-you-go for most health care with insurance getting involved only when the medical cost is astronomical or massive. The big expense in health insurance is covering routine care. That takes a massive amount of administrative effort. Here, most or all, of that is gone.
