A few reforms would make it much closer to one and it would greatly reduce costs. These reforms wouldn't socialize medicine, but you could add socialism a lot cheaper if you had these reforms:
1. Price lists - health providers MUST have and PUBLISH them, and MUST follow them ALL the time. No negotiated rates for anybody. If you want an operation done you can comparison shop from a catalog.
2. Up-front cost disclosures. If the patient's name isn't on a piece of paper disclosing the cost of a procedure, then the service provider doesn't get paid, in general. Acute emergency procedures can be handled differently, but should be the exception. They could probably be socialized as well with regulated prices (which would of course encourage providers to avoid calling everything an emergency).
Just those reforms alone would greatly lower the cost of healthcare by commoditizing much of it. Those without insurance would also get fair prices, and if this care was socialized then the taxpayers would save money as well.
I think that other changes could be made more opt-in, so that people can choose from a number of different insurance options. I think that catastrophic coverage is something to consider - there is no reason that people should need insurance for routine care unless they have a serious chronic problem.
I very much agree with the tenure of you arguments. Is there a thinktank, set of articles, or a blog that articulates you idea in greater detail?
I have two concerns. Firstly income in the USA is very unevenly distributed at the moment. For a family of 4 earning $120,000 it's totally affordable to be financially responsible for most health care needs (in a cheaper commoditized market). But what about the bottom 50% who are earning less than $50,000. And what about the bottom 32% earning less than $30,000 a year. And what about people earning $8.00 an hour? You may be able to bring the cost of seeing a physician down to $25. But what about an MRI? It currently costs between $900 and $5000 depending on what is being done. Because of the significant capital costs you are not going to be able to bring the cost below $500. So how do you deal with the fact that $500 is simply money that the bottom 30% does not have?
They may run up bills of $2000 in a single (unlucky) year and be financially ruined. Or they may simply may be shut out of getting care. Or what about a hernia repair operation? If you include all docs fees, hospital fees, drugs fees etc the whole thing costs between $5000 and $13,000. Even if you could get the price down to $2000 that is still very high for the bottom 50%.
Secondly how do you deal with the cost of prescription drugs. The generics are cheap. But the non generics and even a few generics can cost between $200 and $800 for a 1 months’ supply. Again this is money that the bottom 50% simply does not have.
So I could go with you plan with the following adjustments:
1. Nurse practitioner’s have similar patient outcomes to GPs. In other words doctors are over qualified and over trained. And it costs us a fortune as a result. This is a consequence of the fact that you need an undergrad degree, normally 2 years spent in addition to getting a long list of pre reqs (and the list keeps on growing) + getting volunteer experience. The average age of just starting med school is 26. Then 4 years of med school. Then 3 - 10 years residency. It’s a huge waste if resources.
http://pt.wkhealth.com/pt/re/jcn/abstract.00004471-200902000-00016.htm;jsessionid=LvVTpv7L1qJW3Lgt2D62GJ6bhy9Sv6pTCM9HnYWJ7PPMmgL2Wmpr!713630137!181195628!8091!-1
Too maximize efficiency I would suggest 2 levels of physician:
Level i – This would involve a 6 year undergrad degree with internships and residencies during the summers. It would be a competitive program (not as much as med school is, though) and provide the equivalent of a nurse practitioner’s degree and would be paid for upon graduation so such people would not graduate with college debt. They would also choose a specialty within their program. You can think of it as similar to a physician’s assistant.
Level ii – This would be essentially what we have now except that medical school would get rid of silly pre reqs that waste people’s time like organic chemistry and be more scientific. (So for those in med school the anachronistic step 1 exam would be entirely rewritten and evidence based medicine would be brought to the fore). Also there would be some rigorous education in the use of statistics and engineering techniques. Again med school (and undergrad) would be paid for by the taxpayer so doctors would have no debt to pay off.
You would first see a level I doc. For 90 – 95% of patients – that would be enough. The difficult cases would be to level ii. And there would no silly laws requiring only doctors to carry out certain procedures when a nurse is just as good (because the AMA lobbied the state legislature). Some types of surgery would require only level ii. Other more common types could use a level I with another 2 years of additional training.
2. For those in the bottom 30% (those households earning less than $32,000 a year) there would be some program that would significantly subsidize the cost of most health care. Eg – so that an MRI which now costs $2500 and with the private market would in the future cost $650 would have a $550 subsidy so that the out of pocket cost would be $100 (and an even higher subsidy for those earning $8.00 an hour).
For those above the 30th percentile there would be an out of pocket limit of 15% of income after which some kind of government program would kick in.