Maybe it's better

I think our current system is about the worst possible, but maybe it's better that the health legislation will have to take a detour. Why? Because the legislation passed by both houses simply piled on to a bad system. Let us count the ways the current system is flawed: 1) layers of administration (sales reps, account manager, employer staff, benefits brokers and consultants, state insurance departments, etc. etc.) 2) poor use of talent --- why should a person with a good business idea be saddled with thinking about healthcare --- some people with great ideas and skills have medical conditions, 3) adding layers of rules to coerce people into purchasing insurance, 4) the current employer market is not efficient at controlling costs

Now let's talk about a single collector plan. Under this plan, the federal government would collect taxes and private health plans would agree to provide services for a capitated fee. Medicare Advantage is a version of this idea. I propose that we "cover" all our citizens under this plan. I know there are a lot of details, but there is an army of people who figure these things out for a living. What should the benefit plan be? How much should the insureds pay as premium vs. out of pocket at the point of service? I would leave it to the private plans to figure out and make a proposal.

Details:

1) Let's make it a pay as you go system just like employers do today. The health plans and government would need to project costs of the plan(s) and the government would have to collect tax dollars to cover. Do not allow deficit spending. This would force tough choices.

2) The government would pay the health plans a fixed fee per member per month. The fixed fee would be risk-adjusted so that health plans do not have an incentive to avoid the sick.

3) The health plans would compete for business based on service, price and variations from the base benefit plan. For those who believe in the free market, true competition should help control costs. For those who don't believe in the free market when it relates to medical care, the health plans are not going to go away without a fight so we have to start here.

4) All participating health plans would need to be transparent in their reporting of dollars spent on direct care, marketing, etc.

Walking through the model:

1) The health plans and government agree that every citizen in the US can be covered for $3,000 per year in a base plan (just throwing out a number for illustration purposes), including a reasonable fee for the health plans

2) The government would pay actual per capita fees based on who enrolls in the health plan

3) The health plan would either directly provide care or pay a provider network to provide care with coinsurance from the insured.