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Thought I'd drop by my thoughts on replacing the current health care system in a way that seems to speak to many of the concerns from (almost) all directions.
Create two (semi-arbitrary; one feels too few, but best keep it not too complicated) basic levels of health insurance, well-specified. Perhaps one might be high deductible and one low. The premium would not be specified as part of the plan. Both should provide fairly complete basic medical coverage.
Divide the nations into large groups. Some larger companies might constitute groups, but on the whole the groups would be separate from companies. The goal would be to have everybody fall into at least two or three groups, and it should be structured so that everyone falls into at least one group (age range-based groups can ensure this).
For each group, have companies bid on providing health insurance to that group. The bids are in the form of the premium amounts, and the lowest premiums win (perhaps require the company to place a substantial but nominal bond in order to obtain the contract, forfeit upon not meeting the requirements of the basic insurance plans). The companies are required to offer the basic insurance plans for the period that was bid (perhaps two years), at the premiums bid (or less). They are free to offer additional insurance separately from or in combination with the basic plans.
People are free to purchase insurance from any company whose group they are in (or who will sell to them, of course).
Re: physicians, it will be the responsibility of insurance providers to bargain with physicians for prices of medical care provision. Winning a bid for a group will, however, require that care be available within a reasonable distance of residence for members of that group (reasonable not being a set distance for everyone, though in certain contexts, such as cities, distances would likely be set), and that anyone in a group being eligible to attend a particular doctor under that insurance means everyone in a group will be eligible, as well as that there are sufficient doctors available in an area to treat patients (determined by random samples of waiting times); this will lead to substantial medical care provider choice in most areas without requiring the insurance companies to fund any visit anywhere.
Obviously lots of details remain unsaid or unspecified, but that is the gist.
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quote: When you say "people", do you actually mean the healthcare system itself or do you mean you're going to poll people, or what? And by methodology, what system do you propose that the "people" decide what to pay for or not to pay for.
Everyone has a limit to what they are willing to pay for a service for that service's utility. If at some point people start paying too much for that service, they're going to start looking for ways to make that service cheaper.
A socialized type healthcare system is payed for through each person and businesses' taxes.
If a healthcare service pays for all illnesses or medical problems, and doesn't turn anyone away, then you might run into a situation like the article I linked to, wherein costs exceed what people are willing to pay. (This is not a conclusion the article reaches, but it is one that I think is a logical extrapolation of the situation.)
There would be no need to poll, as people would just say, we ain't paying for this.
People would determine this on their own, or by listening to others and then tell their elected officials to not pay for whatever service they deem inappropriate. I don't see that a methodology would be needed to uncover people as they would just communicate what they think themselves.
quote: Whatever system is proposed, it will almost certainly turn into a system which is ruled by political expediency and beurecracy.
posted
Ok, so you're saying that elected officials, not through polling, but through individual opinions of their constituents should dictate what medical coverage should be applied.
(BTW, that is a methodology)
So where do the penalties based on lifestyle choices kick in?
Or do you mean that individual constituents decide on their own what is a lifestyle choice or not, and then in an unorganised fashion tell their elected officials what the appropriate coverage is? Oh and where do the actuarial tables come in?
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