We have examined some of the difficulties of single payer healthcare. For some reason ( I would guess lobbyists) both the proposals of the Democratic (ACA aka Obamacare) and the Republican (AHCA) have nothing to do with healthcare costs. They both focus on regulating insurance and coverage. So how do we make health care affordable to the largest number of people? There are many ways, but lets talk about the few that would have the largest effect in the quickest fashion.
1. Get rid of the American Medical Association (AMA monopoly). In the United States, a myriad of laws create an unnecessary system where access to health care and medication is controlled by people licensed as "medical doctors." There are plenty of other health providers, including nurses, pharmacists, physician assistants, midwives and nutritionists who can take care of many health needs less expensively than doctors. For example, in some areas nurse practitioners conduct sports and pre-employment physicals at 1/10 the cost of using a medical doctor. Over the counter medications from a pharmacy are usually much less expensive than prescription medication.
2. Increase price transparency. There are two major problems with the pricing of medical services. The first is that they are not published. It is almost impossible to determine the cost of a procedure before it is performed. Costs vary greatly from provider to provider and patient to patient. The other problem is the lack of advanced agreement on price. Health care is the only industry in which people pay at the time of service, only to receive a bill for hundreds or thousands more several weeks or months later. Imagine eating a meal at a restaurant, then receiving a bill for $5,000 six months later. Isn't that insane? Yet it happens often with medical care.
3. Abolish government mandated coverage. Many people may remember when insurance did not cover pregnancy. Men, children, women over fifty and others who did not plan on getting pregnant did not have pregnancy coverage. Women of child bearing age could buy pregnancy coverage as a rider for about $30 a month. Now, everybody has the cost of pregnancy included in their coverage, whether they will ever need it or not. Many women bought such coverage, some didn't and some used a midwife. There are now dozens of these things which are mandatory. Since insurance also usually covers preventative care at the medical level, access to care goes through expensive medical doctors rather than less expensive health professionals. Because of the mandates, a select group of people pay slightly less for coverage of those conditions. However, overall they pay much more because they are paying for coverage which they don't need.
4. Insurance coverage for critical, not routine care. By mandating that insurance companies cover routine visits to the physician and screenings, many parts of the market are distorted. People go to the physician rather than a less expensive alternative. People do not know the true price of seeing a physician, so they do not shop for a lower price. Physicians can charge horribly distorted fees, because their patients are not the ones paying and won't complain. Insurance rates rise exponentially as people who would not pay full price out of pocket to see a doctor are willing to pay the smaller co-pay. Premiums for insurance that would to cover all serious conditions and prevent people from going bankrupt would cost almost nothing compared to the current structure of insurance which covers all sorts of procedures, needed or not.
These are just a few of the measures that would have a great impact. There are other measures, such as dealing with the cost of medical education and student loans. However, these are the issues that Congress should be debating rather than regulating insurance coverage. The issue is to lower the cost of health care, not create a government bureaucracy to insure payment of higher costs.
