Universal Health Insurance a simple workable plan

Health Care Reform

Basic Proposal: (a) Create one pool of money (b) Set its size as some specific percent of an independent economic figure e.g. the GNP, or taxes collected in the year 2000. (c) Fund most of it from taxes (d) Appoint a board of governors with the power to set guidelines, contract, and set up combined or separate insurance pools. (e) specifically give them power to set certain services that can expand or contract dependent on the status of the fund meeting its budget (f) require the board of governors to meet the budget. (g) insulate the board of governors and providers operating within their guidelines from suits arising from those guidelines so long as they are general (not aimed at individual patients), and derived from the scientific practice of medicine and health maintenance.


The U.S. health care system supports reasonably good health for an industrialized first-world country but it is more expensive than any on earth, a growing percentage of people would like health insurance but can't get it or can't afford it, and the Balkanization of the insurance pool contributes hugely to the frustration of doctors and provider organizations by creating massive paperwork demands and siphoning off care dollars into unweildly insurance operations.

Fixing it has its own enormous problem: medical care is supposed to help keep us alive and free from discomfort and disease. Just about everybody would like themselves, and some of their loved ones to stay alive and free of discomfort and disease to the maximum degree possible for the maximum length of time possible. When this can be done with out personal expenditure, the demand for "medical care" is virtually infinite.

In this respect the demand for medical care is different from the demand for other necessities like food and shelter. There are reasonable points where it is possible to say: you've met your necessities. You may want to go beyond that point but it is not reasonable to demand that the taxpayers support you in gluttony and luxurious accommodation. It is far harder to set such a point, or attain agreement, to a point where you believe the taxpayers may say: Sorry, but keeping you, your parent, your child, alive and in good health (or sending you to try an untested and inexplicable "healing" practice, is just too expensive. Nevertheless if we all are to have a health insurance pool funded by the tax base that does not bankrupt everybody or fail in arbitrary ways, then it must on occasion NOT meet the needs of some people, and the best it can do is be highly predictable, both as to how much it takes from the rest of the economy, and how much it gives back.


(a) Create one pool of money. This is obvious. Everybody needs medical care sometimes. If the pool includes everybody, then the funding is transparent, and everyone benefits. Further with one huge pot of money available, the public can drive a hard bargain to keep costs fairly low. This is not to say, that private insurance carriers should be prohibited. Only that they should function to insure those people who want to go beyond the level of health care that can be provided to everybody by the national health insurance. On the other hand, if the board of governors determine that it is sensible to divide the pool up into subpools - for example a "free choice of providers plan", a "core set of providers plan" or a true HMO where nearly all services are provided by one entity, or regional variants, that should be within their powers. Whatever is set up should have enough diversity to encourage independence and innovation.

(b) Set its size as some specific percent of an independent economic figure e.g. the GNP, or taxes collected in the year 2000.
Provision of health services as a publicly funded activity should not have an infinite draw on the economy; it should not have an indefinite draw on the economy. On the other hand, we as a public ought to be able to come up with a figure of just how much of the economy we are willing to devote to this. I see that one estimate is that health care in 2008 took 17 percent of the Gross Domestic Product (GDP). Lets say we want to try providing health care to every citizen and permanent resident using 10 percent of the GDP of two years ago. This gives us a figure of how much we need to spend and and a budget within which the governors of the plan must operate.

(c) Fund most of it from taxes. Some co-payments should be required, but generally the system should be funded through our hopefully-progressive and hopefully fair taxation system.

(d) Appoint a board of governors with the power to set guidelines, contract, and set up combined or separate insurance pools. If we try to get Congress to create this system including all the necessary guidelines and partitions of the insurance pool, you will probably not only not get universal health insurance, but if you do, you will get something that has all kinds of cost controls that are not even intended to work. You will get political interference every time there is an abortion, or someone is allowed to be taken off a respirator, or some acupuncture-aroma therapist is rejected by the system. You will get every contractor inserting a wedge in the system to breed some dollars into their coffers. And rather obviously you will get the law and regulations written by people who are not in the business of providing or even using health services. I am sure there are better suggestions, but appointments to staggered terms by the Surgeon General, the Center for Disease Control, the American Medical Association, and some political appointments aimed at nurses and heavy consumers of medical services would be a reasonable start. Give this entity the power and responsibility to operate. Let Congress get on with what it does best (such as hypocracy, filibustering, and rasing money to stay in office.)

(e) specifically give them power to set certain services that can expand or contract dependent on the status of the fund meeting its budget (f) require the board of governors to meet the budget. (g) insulate the board of governors and providers operating within their guidelines from suits arising from those guidelines so long as they are general (not aimed at individual patients), and derived from the scientific practice of medicine and health maintenance.

The above points are too closely related to treat separately. It does little good to just give a large bureaucracy an annual budget. They must have the power to reduce services, if necessary to meet the budget. Better yet they should have the power to expand services to use all the funds, and to shift resources to provide the best possible product. The particular danger for the set up described here is court interferance will bust any budget created. After all it is not coming out of the judge's pocket. This can and will happen if anyone can sue the provider following a board guideline, or the governors themselves every time they are disgruntled by a denial of payment, for medical services. So long as the guidelines have a basis in science, e.g. the guideline can point to evidence that some expenses produce a lesser outcome than others, the courts should be kept out of the system.

Bear Law, Berkeley Ca.