OK, I figured I'd throw my non-politically correct 2 cents into the ring. Note, my thoughts are my own and do not reflect the opinion of my employer.
1) Problem - Lack of portability. It doesn't seem right that people who loose their employer sponsored insurance may not qualify for an affordable individual plan. Or that people who buy individual insurance and then develop a condition cannot shop around because they can't pass underwriting. I would change the law so that all insurers who offer individual plans would have to accept any person who had any type of medical insurance coverage in the past 60 days (similar to current HIPAA rules, but expanded to individual coverage and at rate levels the rest of the market pays).
This would have the effect of encouraging people to stay in the insurance market and would reward them for doing so by giving them freedom of choice in return. I estimate (very loosely) that this would add about 10%-15% to current individual market rates.
2) Problem - Individual rates are high (plus I just added 10%-15%). I have several ideas in this realm:
a) Simplify the individual insurance market. Idea #1 goes a long way toward simplification. I think some of the things the government has done in the Medicare Supplement Market make it a very simple market for people to understand. Maybe have a set of standardized plans that all carriers have to offer (but they are not limited to). I would also keep the plans simple. Something like deductible, coinsurance. Period. This would enable easy comparison of plans.
b) Eliminate broker fees on individual plans(or at least put severe limits on them, and require them to disclose what they are being paid). I guess brokers provide a small service to members who can't figure out the Internet and they help people navigate the confusing world of individual insurance. But...if my simplification plan were in place, we really wouldn't need them. Eliminating broker fees would save 5%-10% depending on the company. Some companies run promotions like, sell 30 contracts in a specified period and get a $10,000 bonus! This is not a joke, do you really think a broker with that kind of incentive is going to be unbiased? What a waste of money!
c) Start charging rates based on lifestyle. 90% of health care costs are caused by preventable illnesses. Why should the people who work out, eat healthy and don't smoke pay for the costs of those who chose to live other wise? This is America, you're free to live however you want, but you should have to pay for it. Higher rates might give people an incentive to change.
d) Turn health insurance back into insurance instead of health care. High deductibles designed to protect from large financial loss. The problem with this is many American's can't save enough money to take the risk of a $100 Dr visit.
e) Increase cost and quality transparency so that patients can be turned into consumers.
3) Problem - The 18% of Americans that are currently uninsured. I think the uninsured fall in to several categories:
a) Uninsurable - those who are too sick to qualify for coverage. All states should have high risk pools for these people that have slightly higher premiums than the individual market and are subsidised by a tax on insurers or hospitals. Most states already have one. They could also be used for the high risk people in #1 in order to spread the risk over all carriers selling in a state.
b) Can't Afford - Have community based care centers to provide care. I agree that in America we can afford to provide basic medical care for the people in our communities. I would not call health care a right though. It's a privilege that we enjoy in our rich nation. I wouldn't mind chipping in to help out others in my community, but it should be kept at the local or state level.
c) Won't Afford - If they want to take the risk of not having insurance then they should face the risk of bankruptcy when something happens.
OK, so maybe this is more like a random collection of rants, but this is where I would start...
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