I've always been a fan of HSAs + HDHP w/ extremely good coverage (no lifetime limits, etc.) beyond the self-insured amount. (Keep preventive care, birth control, etc. in the exempt amount, too, and especially public health stuff like vaccinations, since it reduces overall cost.)
I currently have an HRA (essentially a non-accruable form of HSA) through employer; it gets the incentives wrong so there's every incentive to use as much care as possible (slightly more convenient providers who charge 5x as much to the plan; as much care as possible).
I still have some hope ACA 2.0 could include:
0) Transparent pricing and mandate that anyone prepaying cash gets the medicare price. Maybe medicare prices have to rise.
1) Catastrophic/HDHP being encouraged for everyone. Potentially, subsidized for some income levels (i.e. money goes directly into your HSA, and HDHP premiums can be reduced.) I'd prefer if those premiums be market-based and then explicitly subsidized.
2) End employer deductibility for health insurance (over, say, 5-10y window); make it deductible, if at all, for individuals only. Employers for many many reasons should have nothing to do with health care -- privacy, portability, etc.
3) Pressure to reduce actual costs of health care delivery. End the AMA cartel's reign on care -- there is a LOT of care where 5% of the cost could produce a 90% as good solution, and people should be free to choose that if there are no negative externalities. Really, only antibiotics and contagious disease should have enforced minimum standards which can't be deviated from even w/ informed consent. This is especially meaningful for terminal or end of life care.
4) Any subsidies come from general tax and not from adjusting the underwriting (which is essentially a tax on people buying certain classes of health plan only, to cover others)
5) All government plans, except deployed active-duty military ONLY (i.e. care in war zones), go via this plan; end the VA and tricare. Provide superior care to gov/mil people by making this overall plan better, and for everyone. The President can have a personal doctor for COG reasons, but all other senior government people go through the plan, too.
6) Potentially fold medicare/medicaid into this as well.
7) Explore single-payer
8) Relatively unlimited access to medication (certainly imports from overseas), outside of antibiotics. If there is patent protection, shorten term. Reduce trials costs (safety must be shown, but not efficacy) -- efficacy and superiority can be decided by informed consumers, who may not be individuals, but could be insurers or other groups.
I currently have an HRA (essentially a non-accruable form of HSA) through employer; it gets the incentives wrong so there's every incentive to use as much care as possible (slightly more convenient providers who charge 5x as much to the plan; as much care as possible).
I still have some hope ACA 2.0 could include:
0) Transparent pricing and mandate that anyone prepaying cash gets the medicare price. Maybe medicare prices have to rise.
1) Catastrophic/HDHP being encouraged for everyone. Potentially, subsidized for some income levels (i.e. money goes directly into your HSA, and HDHP premiums can be reduced.) I'd prefer if those premiums be market-based and then explicitly subsidized.
2) End employer deductibility for health insurance (over, say, 5-10y window); make it deductible, if at all, for individuals only. Employers for many many reasons should have nothing to do with health care -- privacy, portability, etc.
3) Pressure to reduce actual costs of health care delivery. End the AMA cartel's reign on care -- there is a LOT of care where 5% of the cost could produce a 90% as good solution, and people should be free to choose that if there are no negative externalities. Really, only antibiotics and contagious disease should have enforced minimum standards which can't be deviated from even w/ informed consent. This is especially meaningful for terminal or end of life care.
4) Any subsidies come from general tax and not from adjusting the underwriting (which is essentially a tax on people buying certain classes of health plan only, to cover others)
5) All government plans, except deployed active-duty military ONLY (i.e. care in war zones), go via this plan; end the VA and tricare. Provide superior care to gov/mil people by making this overall plan better, and for everyone. The President can have a personal doctor for COG reasons, but all other senior government people go through the plan, too.
6) Potentially fold medicare/medicaid into this as well.
7) Explore single-payer
8) Relatively unlimited access to medication (certainly imports from overseas), outside of antibiotics. If there is patent protection, shorten term. Reduce trials costs (safety must be shown, but not efficacy) -- efficacy and superiority can be decided by informed consumers, who may not be individuals, but could be insurers or other groups.