You pay 100% up to deductible (out of pre-tax HSA), government insurance covers everything after that.
It would be interesting to see how many people stay under the deductible, and not cost the government program anything. Along with publicly posting prices for most services, so people can spend their deductible most efficiently.
This isn't very well thought through. But I'm trying to imagine a system that combines market forces for everyday health care expenses, paired with government health insurance for the truly massive expenses of traumatic health events.
So one problem you end up with is people that won't go to the doctor for preventative care or before issues become worse (and thus more expensive to fix) to save money now.
It's why the ACA specifically says preventive care, immunizations, medical screenings, etc. cannot be subject to copay or deductible or coinsurance.[1]
I’ve had the same thought, but keep it private. Mandate everyone is on a high deductible plan with government support to make the deductibles lower for the truly poor.
Make health insurance actual insurance again - instead of health plans.
It’s the same basic idea but a little less vulnerable to the whims of politics. Of course, your idea is more palatable for democrats (though not very) and mine is more palatable for republicans, meaning neither will happen.
Also, tie drug prices to the prices other countries pay damnit. The only reason something so obvious hasn’t happened can only be because of lobbying.
I think any kind of reform to US health care is going to require a substantial role for the market (ideally without coverage networks, deductibles or those insurance company death panels that refuse to pay for care that a doctor considers medically necessary) and probably an expanded role for Medicare, Medicaid and CHIP. There should probably also be a single payer malpractice insurance program so that doctors can start private practices again, a federal law requiring safe staffing ratios for nurses (maybe tying this to Medicare funds?) and antitrust action to break up hospital monopolies. Addressing college costs and cancelling all student loan debt would also help as many doctors are still repaying their med school loans decades after graduation.
keep in mind that for the vast majority of Americans the bad outcomes of the NHS would still be a massive improvement from what they have now which is basically no care at all. I know people who are solidly middle class but are putting off needed healthcare because of costs that wouldn't be any issue whatsoever if they were UK citizens and for lower income US families there's no NHS waiting list as long as "You will never be able to afford what you need"
I agree that, if we were to look to implement some version of the NHS here, we should learn from their mistakes and shortcomings, but it we took it as is today it'd still be a net win for Americans.
I imagine it's still a lot better than the high cost and poor outcomes we have here in the US.
One small edit is how it actually works in much of the rest of the world:
You just walk into a place, hand them your health card, and get an xray (or anything else you want or need).
The clusterfuck US healthcare is just show how deeply dysfunctional the political system is.
Health insurances should be banned. Everything should be paid in cash, prices posted at the door, and government should maybe co-pay to help low income and/or unfortunate (cancer and such), possibly funding most effective preventing healthcare to make sure everyone gets, all paid from normal taxes.