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Healthcare: Look anywhere you like for answers, just not the US

America’s healthcare Clusterf**k offers no solutions

Inclusive, financed, and diverse

Equity also tells us that we almost certainly don't want this insurance (as we don't with unemployment insurance, or with disability insurance as viewed through the veil of ignorance of John Rawls fame) to be based upon any ability to pay.

Sure, we can let the rich top up their treatment if we wish, but we do want everyone scraped up off the roads, bones fixed, cancers treated to whatever extent they can be. So, that's an argument for state financing, through taxation, of that healthcare insurance.

TB treatment isn't done so as to treat the TB patient so much as to make damn sure that they don't infect others

We also obviously want public health measures to be so financed: TB treatment isn't done so as to treat the TB patient so much as to make damn sure that they don't infect others. And the US system is particularly bad at this, breeding drug resistant strains through incomplete treatments of the indigent. Just really bad policy (I did say the US system is God's Own Clusterfuck, didn't I?).

Assurance is a little different. Here we would like the price system, the market, to come into play. Sure, we don't want to be bidding on which A&E stitches up our jugular. But there's nothing wrong with a bit of consumer pressure to get the people who take blood tests to up their game. But we'd also like to make sure that people really do do those assurance things, and have their check ups.

So, we're not at all sure that we want people to be paying directly out of pocket for them. Much to easy to skip the $100 doctor visit for a nice meal out until something that triggers that insurance system happens. And we really don't want to be paying an insurance company to provide those assurance things. That's just madness, offering them a profit margin for what is essentially a prepayment plan.

On the supply side, we'd like to have something of a market, at least for those assurance things. A&E not so much, in that insurance part of the system. Although we could of course get all sophisticated and point out that competition is really the way that we decide who we're going to cooperate with, and so there's nothing wrong at all with various hospitals competing to be the provider of whatever emergency service it is that the insurance system needs.

So, possibly, a rich and diverse ecosystem of providers. Like just almost everyone except the NHS has. France (number one in that WHO listing) has for-profit, charitable, government-owned and coop providers of pretty much all medical services dotted around the system.

They've a state run (OK, unions and business really) insurance system with co-pays (thus bringing some consumer pressure into it) but really bad stuff is 100 per cent insurance paid (cancer, etc).

The NHS has a near monolithic provider, the NHS itself - together with that state-run insurance but absolutely no out-of-pocket for that assurance part.

Multiplicity of providers

The US manages to have a multiplicity of providers. For-profit (and, to be fair, not-for-profit) insurers, almost no control over that assurance part for the insured, and yet manages not to cover a significant part of the population.

It's because that insurance is job and income related, not state. And just to put the icing on the top of God's Own Clusterfuck I was astonished this week to find out that Vermont has split the state into non-competing districts. So, they've managed to create for-profit monopolies in each district, not cover everyone, no control whatsoever over those assurance costs and then are surprised when it has the second most expensive healthcare insurance in the US. Blimey.

The Affordable Healthcare Act (aka Obamacare) means a medical IRA (individual retirement account) is not a viable option

It was Brad Delong, a professor at the not-right-wing-at-all Berkeley campus of the University of California who suggested what might be a reasonable compromise among our three desires. For that assurance part, a tax-favoured savings account, perhaps fed by a mandatory part of wages.

For any medical treatments that took more than 10 per cent of annual treatment it would be entirely state paid. And run it over the diverse and as free market as can be US medical system (meaning get rid of those monopolies in Vermont and elsewhere).

Something that could actually be cobbled together in the US through a Medical IRA (individual retirement account), a catastrophic-only insurance policy. But then of course the Affordable Healthcare Act (aka Obamacare) means an IRA is no longer a viable option. God's Own Cluster ... eh?

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