A few things are clear:
1) The status quo is unsustainable. Healthcare costs are skyrocketing and insurance profits keep going up. We're the ones getting hurt.
2) Our administration is failing miserably to enact anything beneficial. Even the few good ideas they have get picked apart in committee by Senators who have been outright purchased by health insurance companies.
This will probably end up as incoherent rambling, but oh well, here's some ideas. It's a big topic!
-- Pre-existing conditions
You can't ban insurance companies from not covering these without an insurance mandate to offset the revenue loss. I can't come up with a way to make a mandate fair, so instead I'd open up Medicare to people who have been denied insurance due to an existing condition. They'd have to pay premiums to Medicare, as I'll discuss below.
-- Medicare improvements
One of Medicare's problems is the per-person costs are so high. The elderly are the most expensive to care for. I would try out one of the Senate ideas: make Medicare available to those under 65 to opt-in, but they'd have to pay premiums. Per-person costs would go down because you'd have some young, healthy people in the pool. I don't expect too many people would sign up, but if the premiums were even a little lower than private insurers, you'd probably get some much-needed revenue into the system to better care for the elderly. Worst case, nobody likes it and Medicare still just covers the elderly.
Another (probably one of the largest)problem is Medicare's poor oversight has led to large amounts of fraud. This needs to be curtailed. Additional personnel dedicated to fraud prevention would easily pay for themselves.
Boost the payouts for Medicare. Doctors aren't given much incentive to participate these days. Hopefully the above fraud prevention measures would pay for this.
-- Streamlined billing practices and patient records.
Every time you see a new doctor you have to give medical history from memory. This wastes time and causes errors. Electronic patient records and electronic billing methods save time and money, and improve the accuracy of the information your doctor has to work with. Make this mandatory.
-- Tort reform and per-procedure pay
I lump these two together because they have the same effect: unnecessary testing.
We're bleeding money and, more importantly, talent from the medical field in the form of malpractice insurance. Doctors spend absurd amounts of money to protect themselves from lawsuits and many of them give up entirely. To this end, doctors perform expensive, wasteful tests that they don't feel are necessary. Cap malpractice settlements and make the standard be "gross negligence" rather than "it didn't turn out like I wanted."
On the other side is the financial incentive. Doctors who perform more tests get paid more. We need to push the standard back towards salaries rather than per-procedure pay. Tax incentives for operating on salary instead would encourage this.
Combine the two and you have billions of dollars wasted on tests that the doctors, in their professional judgment, think are unnecessary.
-- Encouraging healthy behavior
Not often talked about is just how unhealthy Americans are. Our rates of heart disease and diabetes are astronomical, because we as a whole just don't eat right or exercise enough. Early education is key. Push more health education at an earlier age in our school system, and continue that education throughout their development. One class in fourth grade and another in eighth just isn't enough. Keep kids exercising in school. Gym class builds character! Good habits developed early are more likely to stick.
Unfortunately, a lot of this falls on the parents. You can't just ban every unhealthy food item or mandate people go jogging daily. Parents need to be encouraged to keep their kids eating healthy and exercising, but how do you do that? We can tax unhealthy products, but such taxes are invariably regressive. The poor are hit hardest when you tax cigarettes, soda, or cheeseburgers. On the other hand, you want to discourage eating nothing but cheeseburgers! Unhealthy people cost more to care for, it only seems fair to make them pay more, right? Salt and high fructose corn syrup go into everything these days. It is literally killing us.
So how do you curb that without disproportionally hurting the poor or taking away our right to choose?
-- Improving the free market
Competition breeds efficiency, and right now we hardly have any competition. 90% of the population is stuck with whatever their employer uses. Even if you can afford individual insurance, it's going to cost more for the same product, especially if you have any sort of bad medical history. Worse, we have little way of judging the quality of our insurance company until we NEED them. After years of paying premiums, you finally get sick only to be dumped immediately for some typo on a form you filled out long before you got sick. Insurance is nearly monopolized in some regions, so you might not have many choices no matter how much money you have.
A - Set up a simplified insurance exchange. Essentially an Orbitz.com of health insurance. Make it available to everyone, and any insurance company can advertise on it so long as they meet certain criteria. Only a few plans per company to minimize "spam," and the plans offered must offer standardized benefits so that people can compare apples to apples. **The regular market would still be available for the thousands of other plans and companies out there.** Also a requirement for joining the exchange: full disclosure on practices. Every denied claim or dropped policy must be tagged and public, so that people know who they're signing up with. Pacificare in California has a nearly 40% denial rate. Until recently, nobody had a clue. I bet their enrollment rate has dropped off after this came out!
B - Open up the insurance market across state lines. Competition, competition, competition. If those non-profit health insurance co-ops in Minnesota can operate better for less, they deserve a bigger share of the market.
C - Encourage startups. Right now the barrier to entry is enormous. I'd suggest tax breaks on startup loans for new companies.
-- Extend medicaid
Thousands of people die every year because they don't have insurance. People die for lack of money. It's unacceptable. I would extend medicaid to a larger segment of the population. Those who can afford insurance but choose not to get it shouldn't be rewarded, but many people just can't afford it after they buy food for their family. How would I pay for it? We've got to get money somewhere. The military budget is out of control thanks to a broken appropriations process. There are probably wasteful pork projects being worked on. Getting our asses out of Iraq would save a bundle, but that's not something we should rush. Our nuclear arsenal is due to be replaced, I'd say the vast majority of it is completely unnecessary. We can deliver nukes via aircraft, cruise missile, ICBM, artillery shell, or submarine. Surely at least one of these options is redundant, and we have hundreds of the city-crushing ICBMs. Maybe dozens would do?
The point is, there are places in the military we could trim and not endanger the safety of America or its troops. Same goes for nearly every other government department. TSA, anyone?
-- Fair practices for insurance companies
Stricter regulations on when an insurance company can drop your policy or deny a claim. "Failure to disclose past medical history" is a catch-all for big insurance. Hey, you didn't tell us that you had frequent headaches six years ago, we're not covering that kidney transplant! Once an illness starts, the insurance company shouldn't be able to drop your policy. Period. So long as you pay your premium (which gets frozen the moment you get sick). They had their chance to "review your records." They just didn't because at the time you were profitable.
-- Death panels
I've never been so disappointed in the GOP for not only failing to refute this nonsense, but for actually promoting it.
People should talk to doctors at the end of their lives to make a plan for their wishes to be met. Do you want to be kept alive or do you want your pain to be shorter? If you don't have a written order, this horrible decision is dumped on your family, your doctor, or even the hospital administration. Doctors should be paid for this consultation. There was a clause in HR-3200 that would allow doctors to bill Medicare for such a consult, and then some moron called it a death panel. Now that clause is gone. Sickening. What nobody mentions is that a Republican senator co-sponsored a nearly identical bill in 2007. Every state has an end-of-life directive provision. If you write the order, it must be followed. That's the opposite of government deciding how your life ends!
-- Prescription drugs
We pay too much. We're allegedly shouldering the "R&D" costs, but pharmaceutical companies have a way of lumping marketing into R&D. They also don't like to mention that the bulk of the research - finding what drug works and what doesn't - is actually funded publicly already. Pharma companies just do the finishing touches. They've also got shady practices like rebranding identical drugs for a new use to extend their patent beyond its expiration, or making minor variations in formula and calling it something new.
One reason Canada and the UK pay so much less is that they have the bargaining power of a market covering 100% of the population. If you want to sell drugs at all in Canada, you have to negotiate with an extremely powerful body. If you aren't willing to negotiate, your competitors would be jumping at the chance to secure such a huge customer base.
Collective bargaining would improve our odds. Allow insurance companies to enter joint negotiations on behalf of their collective insurance pools, perhaps? Allow them to join in with Medicare's negotiations? I don't know enough about the process to say something firm.
I await the inevitable serious flaws to be pointed out. What are some of your ideas?
