two separate funds for two separate purposes
Planning for prevention

February 3, 2011 -- Healthcare dollars are spent in two fundamentally different ways and should be collected and managed accordingly. These are:

  1. Preventive and predictable health care expenses: our children's immunizations, prenatal care, our routine diagnostics (PSA tests for older men, mammograms for older women, etc.), and our periodic checkups. These things are completely predictable from the moment we're born -- indeed, from the moment we're conceived -- through our entire lives. The costs should be budgeted and funded for every one of us without exception. We should all pay into a system that provides them, and there is no reason for anyone to earn a profit from it. It's a public service like law enforcement and fire departments and should be funded and provided similarly, by publicly-funded, local community clinics. There is no place in the preventive/routine care part of a rational health care system for for-profit insurers. The incentives in such a system are wrong and result in a system that's unfair and that delivers inadequate care.

  2. Costs of casualties and illnesses (unpredictable): should be managed as insurance in which risk is shared across an entire population. The services are best delivered (as they are today) by for-profit, centralized, high-capital-cost, acute-care facilities (hospitals and specialized service units such as dialysis centers, imaging centers, clinical labs, psychiatric offices, and hospices). Anyone to whom a casualty or illness happens would be covered, and everyone would pay in to the fund equally (the "triple mandate"). The fund would reimburse the service providers with preference and incentives for those that provide the best care and the lowest prices.

This is just common sense. None of this would prevent anyone from buying any other health care service, or from using the provider of their choice who might be "outside the network". Anyone can buy whatever they want if they have the money. The Canadians have forbidden this, saying that it would create a two-tier system and perhaps they're right. Alas, we already have a two-tier system in the USA, and it's ugly: those with and those without. Obama has taken some baby steps toward an overhaul... A good start. We need that and a whole lot more!

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