The path to universal coverage for a nation is potentially a long and arduous one. Under the current, multi-payer, centrally planned medical system, we have seen an increase in overall cost, and a decrease in overall delivered care. Centrally planned healthcare systems attempt to “fix” or standardize costs to achieve a cohesion. This process can lead to unintended consequences such as incentivizing ineffective therapies as well as increasing administrative cost, which generally add little to no value to the consumer. In this paper, we will attempt to lay out a plan to achieve as close to universal healthcare while also balancing personal freedoms, decreasing overall cost, increasing purchasing transparency, and minimizing taxation of the consumers.
Free market healthcare is one in which healthcare is considered a commodity instead of a basic right as defined by the Constitution (Goldsteen, et al 2021). A shift to a free market healthcare society would be a drastic change to our current structure and being a free market alone will not solve our healthcare needs as a society. Additional considerations include tax reforms, insurance reform, and limiting the government’s role in healthcare. Benefits of shifting to a free market healthcare system ultimately will shift more power to the consumer. One of the mechanisms that will empower the consumer would be regulations requiring upfront, transparent pricing by the healthcare provider. When consumers are able to make educated decisions on the pricing of their care, the market will naturally become increasingly competitive to gain market share.
Decreases in overall government intervention in healthcare will also be necessary in order to ensure increased and more equitable delivery of healthcare. Governments role would be impacted in a few ways. First, regulation in what portion of healthcare the government can or will provide as well their involvement in adjusting how healthcare is taxed could increase overall access to care. Minimizing the financial burden consumers face when they need to access care can be achieved by effectively litigating that all healthcare purchases are completed tax free. Removing additional and unnecessary tax burden on the consumer provides another avenue to reduce the overall cost burden on the consumer. These tax burdens could be lifted at the daily healthcare needs level. This would include removing the tax burden from daily health care items as well as activities that promote a healthier lifestyle such as gym memberships. In states where this may not be feasible, an increase in the overall limits to privately funded Health Care Savings funds could provide a relief to the consumer of increased taxation, reducing the overall costs to ensure they have additional funds to spend where needed. Federal, state and local government involvement in providing direct healthcare would be limited to safety net facilities meant to serve our underserved and lower socioeconomic citizens who may lack the ability to afford healthcare. Safety net facilities would be able to provide limited services, and could be approved and funded by millages voted on by the community. This provides additional power to the consumers to determine their needs as those needs can vary greatly from state to state and when comparing rural vs. urban communities.
Health insurance would require reform to better serve the population’s healthcare needs. Health insurance under a free market would be limited in its usage and coverage. Currently, health insurance is being used to cover events ranging from general checkups to surgery or cancer treatments. In order to mitigate costs, insurance companies currently attempt to spread the cost of bills amongst the entire group insured, which ultimately requires that the healthier individuals be more financially responsible for the care of the sicker individuals. This model has been a major driver of increased healthcare costs while also seeing a decrease in care delivered. By reforming health insurance to cover major life events, i.e. cancer or surgical interventions, this could have a dramatic impact on the health cost of the more minor events such as a well check. Similar to other types of insurance, the individual would have the option to opt into purchasing these added coverages of insurance. Policies adopted at an earlier age would carry lower costs as a benefit to the consumer. Insurance is a commodity by definition and should not be considered a requirement. Requiring the young and healthy individuals of society to carry costly insurance carries a financial burden that they should not be shouldered with. Increases in overall income levels has been shown to have a more positive impact on an individual’s overall self-reported health (Larrimore, 2011). Greater financial growth, particularly in younger years, could in theory lead to greater health outcomes as the population ages.
In conclusion, the debate on the best approach to achieving “universal” healthcare coverage will be one that lingers and most likely will not be solved with a silver bullet approach. The ability to have increased financial control of how your health care dollars are spent can have a large impact on how health care is delivered. By adjusting the tax burden faced by consumers when purchasing healthcare, the community as a whole would see an increase in transparency in health care cost as well increase their overall purchasing power. The community would be able to “vote” with their dollar by knowing the upfront costs by providers, thus creating a more competitive environment for the consumers business. Reforming the use and application of health insurance could potentially reduce the overall financial burden of health care cost, especially in our younger population. This could, in turn, lead to greater long term self-reported health effects as the population ages. When trying to determine our most optimal path to increased or “universal” healthcare, there will always be a division. Political division will always have our community divided on this topic. One aspect that most would agree upon is increased transparency into how our health care dollars are spent. With increased transparency, power could shift back to the consumer to determine how their dollars are spent, thus forcing the health care market to adjust to the consumer and not the other way around.
Citations
Larrimore J. (2011). Does a higher income have positive health effects? Using the earned income tax credit to explore the income-health gradient. The Milbank quarterly, 89(4), 694–727. https://doi.org/10.1111/j.1468- 0009.2011.00647.x
Nation, G. A., III. (2016). Healthcare and the Balance-Billing Problem: The Solution is the Common Law of Contracts and Strengthening the Free Market for Healthcare. Villanova Law Review, 61(1), 153–190.
Raymond L. Goldsteen, D., Karen Goldsteen, P. M., & Benjamin Goldsteen, M. (2021). Jonas’ Introduction to the U.S. Health Care System, Ninth Edition: Vol. Ninth edition. Springer Publishing Company.
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