If it weren’t for some of the unions you would wind up with you health care aid making less than a McDonald’s cashier. Take it from me it is no fun laying in your urine or feces for hours, because of lack of care or personnel. Everyone is equal(unless you have private nurses), no matter how much you pay or don’t pay at this level.

It is my contention that the current system is horrendously distorted by government policy. Tax policy encourages third-party payment of insurance premiums. Insurance companies already operate under heavily regulated conditions by the individual states, and the action of the healthcare market in general is dominated by the action of huge state enterprises like Medicare.

The distortions on the market today constitute a system where almost all the incentives are lined up against cost containment or letting market principles work. The unintended (or intended, depending how you view gov’t & corporations working together) are to make it nearly impossible for individuals, the self-employed, and very small businesses to buy reasonably-priced insurance, thus giving an enormous market advantage to large corporations who have the bargaining power to reduce rates. The incentives align for both employed individuals in corporate plans and for Medicare recipients to over-consume health care services, as they’re almost completely insulated from the costs.

Now, the proposed plan above isn’t a “libertarian” plan. The original poster admits that point #2 violates libertarian principles. Even with that caveat, I think it’s a move towards market principles from the current system.

I would also state that Obamacare is a large net move AWAY from market principles. In addition to adding the mandate and the exclusion ban on pre-existing conditions, it maintains the third-party provision of all medical insurance for the bulk of the consumers by expecting companies to kick in even more for insurance and by retaining Medicare in its current form.

So I’m not making the argument that a mandate and ban on exclusion are themselves pro-market, but that if you have those in conjunction with ending the employer subsidy for health insurance provision and voucherizing Medicare, the combination is more market-based than the current system. I say that because it starts to align costs with the person doing the consumption, giving the actual patient the incentive to economize or to price-shop in ways that they wouldn’t even give two shits about today.

Whether or not it’s “market-based” isn’t dependent on its relationship to the current situation.

However, given that the current situation is that:

- ObamaCare’s “individual mandate” is not yet in effect and will likely be repealed;
- ObamaCare’s pre-existing condition exclusion ban is not yet fully in effect and will likely be repealed;

… implementation of this plan from the current situation would be a move away from, not toward, market principles.

Whether it would result in lower costs is an open question.

The idea that it is in any way “market-based,” however, is absurd on its face. Requiring some customers (individuals) and forbidding others (employers) to buy, forcing sellers to sell to all comers, and socially engineering it through the tax code is, to steal your phrasing, “the opposite of market-based.”

You are correct regarding the market, but the deck is stacked by government policy towards a company offering health benefits and away from an individual market. That, coupled with the extremely large market distortion created by Medicare, and we have what I would call a non-functioning market. FYI I don’t propose BANNING employer-provided insurance, but I suspect that when you take away the market props and have a functional individual market, most employers will voluntarily exit.

As for the individual mandate, I’m with the original poster that it’s not a libertarian policy. I don’t like it. I’m just not sure I’ve got any other answers, considering we live in a society that will expect taxpayers to pick up the tab anyway. I think that the suggestions in the post above are light-years better than the current situation we have, but if someone can find a way to improve the situation without a mandate, I’m open to the argument.

In a market, actors are free to make decisions. For example, my employer is free to offer me health benefits as part of an exchange for my labor, and I’m free to accept that offer. To propose banning that is anti-market, period, end of story.

As far as the individual mandate bit goes, my response to all variants of it is the same — go fuck yourselves. The day the individual mandate takes effect is the day I become uninsured as a matter of principle.

Item #2 is authoritarian, but has merit as a direction toward personal responsibility (PR hereinafter). Item #3 works, but only if you consider insurance companies arms of the State and not private entities. (I happen to think, as they are presently constituted, they are the former.)

#4 and #5 are fine, or not — depending on the ‘force’ aspect. (Providing encouragement, tax credits, shelters for providers, etc. All for it! mandating it via govt? not so much!)

You also miss a few things: hospital reform; breaking the AMA union walls; opening to integrative and alternative healing; shifting from aftercare to ‘wellness’ …

decent start, though …

Today, most people get their medical insurance through either their employer or the government. They rarely if ever see any semblance of a price tag, and the insurance company servicing their employer views *the employer* as the customer, not the employee/patient.

Creating a more individualized market where individual participants are forced to make choices, taking costs into account, is key. Ideally I’d go one step farther than Greg suggests and declare up front that the MINIMUM mandated plan be a high-deductible health plan with a health savings account option. This would protect people from the worst of catastrophic health care problems, but force them to make most of their spending come out-of-pocket. I expect total medical service usage will decrease as a result, and the lower demand should reduce costs across the board (and at the very least reduce aggregate spending).

Today we don’t have a functioning *market* for healthcare services.

The keys are to disassociate health insurance from employment, voucherize Medicare and block-grant Medicaid to the states, and then (because we don’t live in a society that will allow those without insurance to die) have an individual mandate with an HDHP as the minimum insurance plan accepted.

Making the individual market the *primary* market rather than an afterthought, and increasing the relative burden of out-of-pocket costs to the total, are two HUGE changes that will allow the market to function.