Here's an idea. There are many costs that are driving the need for reform - the costs of care for uninsured people, malpractice, and problems of economies of scale.
Uninsured People
Those without insurance drive up the costs for those who have insurance. Because hospitals are not allowed to turn away those who cannot pay, those costs are absorbed when hospitals charge everyone more for their services to make up the losses. Real reform should compartmentalize those costs.
People who are in the country illegally should not have their medical care provided at no cost. From a humanitarian standpoint, we should not allow people to die needlessly. My suggestion is that illegal aliens should be deported but in the meantime, whenever they receive treatment, they should be required to pay in cash. The federal government should pay for only the most essential life-saving care and then charge these costs plus any administrative expenses to the person's home country. If the host country does not pay, these costs should be recovered by siezing assets of that country and cancelling any US foreign aid to that country. Any income or assets of the illegal resident should be taken to pay for the cost of their care. Legal residents and citizens without insurance should be required to pay up to 20% of their income towards their Medicaid premiums and coinsurance. That percentage would be withheld in the form of payroll taxes. The uninsured who could afford health insurance but have chosen not to buy it should be restricted to selected public hospitals. Medical and nursing students who receive government funding (grants or government backed loans) would be required to intern at one of these public hospitals for six months to a year based on the amount of taxpayer funding the student receives. The uninsured would lose any right to sue for malpractice. Would the care they receive at these public hospitals be of lower quality than elsewhere? Undoubtedly it would be, but the inconvenience of long waits and less attentive care - which we all experience now at an emergency rooms now thanks to this burden - would encourage those without insurance to obtain it.
Economies of Scale - Buying goods or services in quantity allows a company to obtain them at a lower cost. Health insurance companies are only allowed to write coverage in their home state. This stifles competition because a company must go through the cost of establishing a presencevib each state, dealing with fifty different state insurance department regulations and administrative filings. The laws need to be changed to allow each company to write nationwide.
Malpractice - As with all tort reform, runaway jury verdicts and defending frivolous lawsuits drive insurance costs higher and those costs are passed on to the consumer. Punitive damages need to be capped at a multiple of proven economic loss. Contingent legal fees should also be capped to reduce the incentive of the lawyer to 'swing for the fences' for a large verdict.
These ideas seem more prudent than creating another federal bureaucracy.
