Healthcare reform: Set up a framework for success, then get out of the way

ObamaCare has been a disappointment, even for enthusiasts of the legislation! Costs far exceed projections, and the signup of those uninsured is far below original goals. The numbers aren’t likely to improve much as CBO estimates continue to project the uninsured population will remain in the “tens of millions.” But there is a better way.
I’ve always been an enthusiastic proponent of healthcare insurance reform and all the “good stuff” like guaranteed insurability. And I believe the argument whether Obamacare should be “repealed and replaced” or just “fixed” is meaningless because that’s a distinction without a substantive difference—let’s just get on with it.
Obamacare was doomed from the start because it used a “shotgun approach,” and never identified and prioritized achievable goals. Unfortunately, it moved the healthcare system farther than ever before from operating in a free market system. And the cost estimates used to justify the legislation were so far off as to be materially misleading. Here’s a free market structure for a competitive insurance market using simple legislation, minimal bureaucracy, and limited regulations:
• Establish a standard of individual/family policy ownership. This would promote portability of coverage, and encourage cost control through transparency.
• Establish relatively cheap, catastrophic (major medical) insurance coverage, along with individual tax favored health savings accounts (HSAs) for “first dollar” (routine expense) coverage. The individual/family policy owner would choose the level of deductibles and co-pay amounts.
• Establish a “shopping cart” for choosing coverages. Buy what you need.
• Promote competition and choice by removing the prohibition for insurers to compete across state lines.
• Legislatively eliminate the harmful aspects of annual or lifetime limits.
• Legislatively eliminate pre-existing conditions as an obstacle to insurability.
• Permit insurance companies to underwrite coverage as they see fit. A “well-oiled” insurance payment system, which deals with risks, demands an underwriting process. This underwriting would affect cost, NOT insurability!
• For extreme cases that are excluded by insurance companies’ permitted underwriting rules, establish a taxpayer funded pool for underwriting “casualties.”
• These “casualties” would have insurability guaranteed, while an “initial” subsidy would bring their rates ONLY back to “market level.”
• Further subsidies could be granted for low income levels. All subsidies would come through the income tax filing using tax deductions, credits, and refundable credits where necessary.
• Even Medicare and Medicaid candidates could be accommodated through the general marketplace.
• Individuals and families would choose and pay for their own policies, have ownership of those policies, and would be subsidized ONLY through the tax treatment of their health care expenses.
• There would be some initial transition expenditures, but costs would be saved compared to Obamacare because the focus would be on solving problems, with virtually no new bureaucracy created.
Many existing problems are results of departures from free market principles and bureaucratic interference. We must institute and maintain an unimpeded free market composed of providers, insurers, technology development, pharmaceutical development, manufacturers, distributors, and product and service marketers. And we must learn to trust people to make their own choices.
We should set up a framework for success, establish basic rules and regulations for competition and compliance with goals, adjust tax laws and regulations to accommodate this system … THEN GET OUT OF THE WAY!