I think the sheer volume of charitable donations Americans make every year really shoots holes in the “people are okay with others with less suffering”. (There is also evidence to suggest people, on average tend to be a lot more altruistic than one would think, but I don’t have the studies I’m talking about to link.)
But that aside, let’s tier the insurance. Something like this:
- Anyone can opt out of private insurance and opt into medicare. However in order to do this, their Medicare rate goes from 2.9% (half of this is “paid by the employer” so you only see 1.45% come out of your check, but the employee really pays the entire amount) to 15%, and the employer will be required to “pay” up to whatever they pay employees who opt for private insurance.
The additional 12.1% would be capped at $6000 if you make under $50k, capped at $7,500 if you make between $50k-125k, capped at $8,000 if you make $125k+
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Basic care plans - These cover routine doctor visits, checkups, minor issues, blood tests, etc. A panel of doctors, and only fucking doctors will determine what is or isn’t basic care.
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Basic care + medical life insurance - These would be the same plans in #2, except with a government sponsored “medical life insurance” plan that will cover medical costs for your family etc if you die after racking up insane amounts of debt with the government. opting into this would be an additional payroll tax, requiring you to work, or you must cut a check to a government program. The funds collected by the government will be transfer to a private fiduciary, and by law, untouchable by congress. No robbing peter to pay paul.
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Catastrophic plans - more expensive, only cover major issues like heart surgery etc. Again doctors determine what falls under catastrophic
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Basic + Catastrophic
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Cadillac Plans (basic, catastrophic & medical life) - these have a sting tax that as only those making more will be able to afford it…
This should basically eliminate the need for the individual mandate if you implement punishments for willfully going without insurance until you need it, via first year premium increases.
I’m fine with eliminating life time & yearly limits.
Preexisting conditions/medical bankruptcy/etc:
This is tougher. What if in a situation where you couldn’t or wouldn’t get insurance, something happens and you now have $200k in medical debt? Or you have a preexisting condition that priced insurance out of your income range?
The government should designate charities that help fund these bills as a priority, and give taxpayers a credit for the first $2000 they donate to them, and an above the line deduction for the remainder.
In addition to that, they should have a “payment plan” option, rather than an “insurance option”. This would be a regulation that ensures that people faced with significant issues are protected from bankruptcy and abject poverty to get healthcare. Instead of getting insurance and socializing the cost via that, they get a “loan” or “payment plan” that works for them at very low if not zero interest rates, that can’t be more than say, 8% of their after tax take home pay. This would also be a payroll tax deduction. The IRS should then give employers a 10% general business credit for any of these loan amounts they pay on behalf of their employee, which will NOT be included in taxable income for the employee.
I don’t know, I’m just brain storming here…
