The following are my thoughts on the current healthcare crisis in the United States, and is based on my 10+ years of experience in the industry from the insurance side.
We all know the United States is expensive when it comes to healthcare - not a shock there. What has always disturbed me is the lackadaisical way in which the legislative and executive branches of our government operate regarding this subject. The Republicans often say "limited government is the way to go", yet their hypocrisy is ragingly rampant by their continued eyes in people's bedrooms (gay rights), on women's bodies (pick a topic, there's no shortage) and on robbery (tax cuts for the rich and multinational corporations, among others). Democrats are no better. Their equally hypocritical conversation about how "they're not socialists" (check yourself on all of the social programs we have, inducing social security and Medicare), their bend over and take it in the butt strategy for dealing with Republican agenda (do you really need context for this one?) and the run-around-in-circles perspectives has essentially served no one.
Plainly put, neither of these groups is competent enough to deal with our most pervasive issues of the day, most notably healthcare.
So the obvious next question should be: who does? I'd raise my hand, but that would be self-serving and sanctimonious... so I'm going to anyway. 😅 While I'm halfway kidding, I think that a lot of answers could be hashed out by average folks from different walks of life by having a rational and real conversation about the challenges and what we should do about them. An individual's health is so subjective and personal that it cannot be addressed in a wholly blanket way. We need to openly and honestly look at what we can do now, and perhaps, what we can do as time progresses.
Let me attempt to address a standard healthcare question here:
Q. Is healthcare a right or a privilege?
A. Both. I believe that everyone should have access to preventive / wellness care for free via the government (expanded Medicare paid via our taxes) for both adults and children. That means annual screenings (the labwork should also be free), physicals, dental and vision checks. Children particularly should be covered under Medicare until they are school-aged (up to age 6). Senior citizens should continue to have coverage under Medicare akin to what they have now.
This is what the uncapped 1.45% on wage income and 2.9% self-employment deductions are for, and would be accessible to everyone regardless of your household income bracket. To cover the additional expenses, I would increase this deduction and a small percentage surcharge on individual capital gains income. Basically, everyone pays into it.
As for the rest, here is where the privilege comes into play.
First, remove the employer responsibility for maintaining health insurance coverage. Why do this? People stay in jobs they hate because they need the coverage. Think of the innovation and entrepreneurship that could result when coverage becomes portable. It's tied to the individual, not your job. Employers would still contribute, just to a state pool instead of to an individual plan(s) based on their payroll numbers.
Why a state pool? We love states' rights so much in this country. It only stands to reason that the state should be responsible for fully coordinating these deductions and the methodology by which people select a health care plan. (Accountability is OF COURSE required because... well, you can't trust folks with THIS kind of money.)
Under my system, EVERYONE is required to choose a health care plan. This process is can be done online, over the phone or at designated community centers. There is no "individual mandate" where you pay a fine - you CAN select a "preventive-only" and/or "emergency-only" plan. Under my solution, "preventive-only" plans would be free and automatically enrolled for every American. You literally have to do NOTHING. But in choosing to keep just those plan types, you are accepting responsibility for ANY costs that result OUTSIDE of those terms of coverage. End of story.
The most important concept to note is that individuals choose the plan components they want, but don't have to deal with insurance companies directly. It all gets "white labeled" under the state Medicare plan to keep the experience seamless for members. They deal with the STATE, not the insurance company IF they are involved at all.
If you need a plan with special coverage types - cancer, chronic illnesses like diabetes, hereditary diseases, etc - there's a plan for that too. You can also choose dental and vision beyond your normal annual checks and teeth cleaning. The idea is just like going on Seamless to choose the things you want to order for dinner, you pick what you want and you pay for it.
People making over a certain amount of money (let's say in excess of the current annual Social Security cap) would be on their own and have to purchase some sort or private insurance. The preventive coverage would still apply to them. This is why we have actuaries to determine at which household income level would have these sort of things phase out, but lower income and lower-middle income folks shouldn't have to deal with crazy premiums with out of control deductibles.
Also, do what Allstate does. If you didn't have any major incidences in the last year, then lower the premiums accordingly. Award people for their good health.
This is a basic overview, but this is the position on which I stand.
Look: there's a lot of momentum growing for the Medicare-for-all option as proposed by Bernie Sanders. There's some merit to it, but it requires significant changes as to how people obtain their healthcare. We need to focus on technological solutions for coordination of care between doctors, for administration of payments to medical providers and for overall enrollment.