I am a totally ignorant housewife with experience of the British NHS, the British BUPA system of private supplementary health insurance, the German Health care system (limited) and the American system.
So... this is the way I think it ought to be.
1. Private Pay. Walk-In clinics.
If anyone wants to see a doctor in the walk-in system for cuts, scrapes, colds, flu, bronchitis, drug testing, rashes, broken toes/fingers, flu shots, prescription refills, (the sort of things that the uninsured take to the Emergency Room, and everyone else "walks in" and claims on their insurance, which cannot possibly be efficient in terms of paperwork time in relation to face-time with the doctor)
Flat rate of $10 for up to 10 minutes. (Or whatever AMA deems reasonable, given the following... Obviously I think general practitioners ought to earn a great deal more than $60 an hour. Perhaps tax CREDITS could be an answer.)
Cash payment before being seen (on the spot).
Sign medical waiver, so there is no insurance/malpractice issue.
No insurance forms to be filled out, or claims to file. No exceptions. Just like walk in flu shots.
This will save doctors a lot of paperwork.
This will put the onus on patients to turn up at the clinics with all their own records and a list of their symptoms.
Health Care Spending Account. Would that be VEBA for everyman?
Everyone (even children) may set up a tax-free, personal, individual Health Care Spending account, on the same principal as a college account. Possibly, the state could match savings for the lowest income individuals. The dollars would "roll over" and never be lost (unless spent.)
Employers could "buy out" existing health care, by tranferring cash into their employees' Health Care Spending Accounts.
This would be a private pay system. Those who keep themselves in good health would not be subsidizing those who have unhealthy lifestyles.
Private Insurance. (Like the British BUPA)
Individuals could opt to buy private, annual, term insurance for operations and other expensive procedures. This would be for patients who did not wish to wait for hip replacements, and other elective procedures, or who wished to have annual physicals at "resort" hospitals such as the Mayo Clinic instead of in their local physicans' offices with "participating providers".
It could work like car insurance, with cash back for people who do not make claims, and reduced premiums for those with clean health records. Premiums (at the Health Care Account owner's sole discretion) could be paid out of the Health Care Savings Account.
Everyone is covered (for everything requiring a referral from the $10 walk-in clinic and upwards). Everyone waits their turn. Only prescriptions that are necessary for pain, life preservation, functioning of tests, etc would be provided. (No self-esteem drugs, no birth control, no viagra, no fertility drugs.)
Catastrophic care would be covered, but there would be NO ability to sue for medical mistakes where the care was free.
On the other hand, there would be an ombudsman, and doctors who made horrendous mistakes could suffer penalties (but the penalties would not enrich lawyers.)
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