Designing a health care law

I think that one reason that “Obamacare” is such a disaster is that several different goals were set, and when they conflict, it is not certain which has priority. For example, is it to provide universal coverage, or to reduce costs? What works to help us move toward one goal does not necessarily help — in fact, may actually hurt — our progress toward another goal. Of course, I might even question the desirability of some of the goals: Is it really necessary to have universal coverage (which “Obamacare” does not achieve anyway)? I would rather see coverage for everyone who wants it — allowing people who think they can do without to go their own way. (This is called “self-insurance.”) And if this means that too many people self-insure and then cannot cover themselves when a big, expensive procedure comes along, this will cure itself as stories of the people in question surface. (If your worry is instead that these people will come aboard only when they sense that they will age to become more needful of health care, put in a provision like what we have in Medicare — if you don't enroll when you are eligible, then when you do enroll, your premium is higher. That should discourage this practice.)

One thing I really dislike is the “one-size-fits-all” nature of most insurance plans — which actually becomes worse with “Obamacare.” Why should a single male have to pay for insurance to cover maternity benefits? Or, for that matter, a post-menopausal female? Health insurance coverage should be like the way Part D (the prescription drug benefit) of Medicare works — every year I get to choose from a large number of plans, and, for example, I choose — voluntarily — to pay a somewhat higher monthly premium to join a plan that requires no co-payments on the drugs I take regularly, while others might opt for a plan where they pay less per month but have to pay a couple of dollars every time they pick up a prescription at the drug store. Requiring all plans to cover certain conditions is not the way to go.

I am not going to design a complete replacement for “Obamacare” on this site. I do not have the expertise. I am only giving ideas for a few specific points. I will also refer the reader to an article by James C. Capretta and Robert E. Moffit on the National Affairs website, which I found because of Dennis Sanders' “Big Tent Revue” blog. Capretta and Moffit's solution is not ideal, but many of their ideas would make, to me, a good starting place.