No, it would mean that insurers asked questions about these factors when quoting for cover, the government wouldn’t need to be involved in this. It’s no more a ‘police state’ than when car insurers or life assurers ask similar questions.

As for letting people divert money to other things, yes why not? As long as they are covered by casualty insurance for major health problems, they can choose how much risk to take on for minor healthcare costs.

I would mandate casualty insurance (maybe with a prescribed maximum deductible) though otherwise you would get the problem of people choosing not to get insured and saving themselves the money then getting free treatment when they get seriously ill anyway because civilised society won’t just let them die.

“The Euros and Asians have found that unworkable. The risk must be spread around. Otherwise, you end up with wildly different rates for the same coverage and just repeat two great flaws in the American system (1)Younger and healthier people “opting out”, greatly increasing premium costs of families with medical problems or the aged. (2) You would just recreate the awful American problem of denying insurance and healthcare to those with a significant pre-existing condition until they bankrupt themselves on expenses then the state must give them care free……”

Well, I said that the amount paid by the government into an individuals health account would be adjusted for their age, gender and other risk factors not chosen by the individual, so a 65 year old with a family history of heart disease would get more than a 25 year old with no genetic risk factors. This would address your first point. I would let individuals take on the cost of chosen ‘lifestyle’ factors as this provides an incentive for individuals to reduce their own health risks.

Insurers and government could work together to come up with a list of pre-existing conditions that the market is unwilling to insure and individuals with those conditions could have an extra amount paid into their account to be spent on treating those conditions based on the cost of current treatments. This would keep the coverage universal while retaining the efficiency and choice of the market for the vast majority of cases.

Interestingly the British NHS is introducing ‘personal health budgets’ along these lines for people with chronic conditions, so a person with diabetes might get £x per year to buy NHS or private healthcare products and services with rather than just being passive recipients.

http://www.guardian.co.uk/society/2009/jan/16/nhs-health-personal-budgets

France number 1, Uk 18th, USA 37th….out of 191 WHO member states. All ranked according to certain set criteria and provided by the World Health Organisation. Of course, the WHO could have an agenda of its own, I suppose. Who knows?, ho hum.

So I’m not claiming it’s gospel or anything but it’s interesting. Especially since some replies here from Americans assume their system to be top dog.

Personally, I don’t have a clue as I’m not that knowledgable when it comes to other Health systems. I’ve only ever used the British NHS but not that often as ( touch wood) I’ve never really had a nasty accident or been ill enough to require medical treatment. Soemtimes you hear good stuff regarding the NHS and sometimes ” nightmare” stuff.

Anyway, heres’s the link :

http://tinyurl.com/bh9jhr

We have 60 years of expertise in Asia and Europe (over a century in Germany thanks to Bismarck) to look at what works and forms the basis of successful systems – Germany, France, Japan, Singapore, Netherlands, Scandanavian countries have the best systems.

Jonesy55 – The problem with your healthcare plan is that you want people penalized for risk factors which the Euros and Asians rejected because it would mean a police state to monitor people’s weight, miles driven…inspectors coming in to evaluate your home and what your “risks” were in employment and diet…and so on.
You also want to allow people to divert money out of healthcare accounts for whatever they wish to spend it on.

The Euros and Asians have found that unworkable. The risk must be spread around. Otherwise, you end up with wildly different rates for the same coverage and just repeat two great flaws in the American system (1)Younger and healthier people “opting out”, greatly increasing premium costs of families with medical problems or the aged. (2) You would just recreate the awful American problem of denying insurance and healthcare to those with a significant pre-existing condition until they bankrupt themselves on expenses then the state must give them care free……

Mirco – The real solution is 1) full private and personally funded personal healthcare (tax exempt); 2) full private donation funded charity healthcare (tax exempt).

We already make charity donation for healthcare tax deductable. And other countries have gone away from that because of the great disparities that exist in charitable giving to fund all needed “charity-based” health solutions. Meaning some “pet maladies” involving cute kids or a great celebrity cast of endorsers gets lavishly funded – sometimes overfunded so much that the money is more than is needed for care and R&D and has to, just has to, go to the non-profit execs compensation, and into more advertising to get more charity dollars and away from “competing diseases” after the same dollar.
More charity dollars go to R&D and care of an exotic genetic disease that may kill 700 kids a year than go to diabetes or lung, prostate cancer that kill 100 times as many people…..

I’m not sure that this would be the case because buyers will have the option of choosing cheaper policies and withdrawing the rest of the money in their account to spend on other things. Some will choose to do this so there will be a market for cheaper than average policies.

If the money was ‘either to be spent on healthcare or you lose it’ then I would tend to agree with you, prices would drift upwards so that the level of funding given became the minimum price.

Obviously the definition of ‘full service’ would be subjective but something that provides the sort of care that typical employer-paid plans do now with a low deductible would be a reasonable standard.

The problem is the equivalent to the price of an average full service insurance policy. If you cover all people legally residing in the USA, you will not be able to compute the price. Because there will be no market for the “average full service”. And it is never clear what is a “full service”.
The sum paid will become the minimum for all the services, because the prices will grow up given the increased demand. It is like a market with a minimum subside given to the buyers for unit of good bought. The prices will grow (usually fast) to meet this minimum.

The system could be working if you have a two tiers system, where (few) destitute people would obtain a subside to buy an insurance in the free market and all the working majority would obtain a bigger (much more bigger) deducible for their actual health insurance.

The problem, as usual, is that politicos will hear the complains that the minimum level is too low (it must be, else the system will never work) and will be asked to raise it a bit now and then or enlarge the number of people entitled. After a few years, the difference with the second tier will be negligible, the price will be raised and all people will fall in the “entitled” first tiers.

The real solution is 1) full private and personally funded personal healthcare (tax exempt); 2) full private donation funded charity healthcare (tax exempt).

But you wouldn’t need to nationalise the system or have government running hospitals to provide universal care.

Why not a system along these lines?:

Each legally resident individual has a healthcare account.

The government pays an annual sum into that account equivalent to the price of an average full service insurance policy for a person of that age, gender, genetic make-up, pre-existing conditions etc, basically the factors that the individual can’t choose to alter.

The individual then uses that money to either buy a full service insurance plan in the open market or alternatively a cheaper casualty-only policy in which case they can use the remaining funds to pay for routine healthcare costs.

If the individual has extra ‘lifestyle risks’ such as being a smoker, driving a lot, living in a dangerous area, being obese and so on that make their premium more expensive, they can either take a cheaper and less comprehensive policy, accept a bigger deductible, pay the extra from their own pocket or change their lifestyle.

Individuals could put extra money tax-free into their accounts to pay for plans that go beyond the average and they could take money out for other non-mediacal purposes once they were covered by at least casualty insurance (in which case the money would become taxable).

I would suggest that this provides universal coverage while keeping the government out of the business of running hospitals and deciding healthcare priorities for individuals who are better placed to make those decisions themselves. It also avoids the ‘poverty trap’ problem of means tested systems which provide subsidy for the poor only and take that coverage away when they get work or start to earn more money.

The figures don’t reach the wild sums paid out in the US but that’s not a bad thing in my opinion.

However the NHS does pay out a lot of money

http://www.nhsla.com/home.htm

“In 2006-07, 5,426 claims of clinical negligence …against NHS bodies were received by the NHSLA.

£579.3 million was paid out in connection with clinical negligence claims in 2006-07.”

£579.3m paid out in 5,426 clinical negligence claims is an average of £106,000 ($150,000) per claim.

Nationalizing the system in the USA will not work because there is too much variety of people, with different ethics, too much immigrants, it is too big to enable a strict control.

But mainly, after you have it in place, it will be too big to fail. But it will fail the people paying for it.