Insurance is, in essence, buying protection against risk.
Your house could burn down....so you pay someone to hedge that risk. The insurance company goes out and invests the premium you pay and makes a profit.
The insurance company, in turn, manages its own risk by A) applying actuarial science to charge premiums that co-relate to the amount of risk posed and B) By entering into re-insurance agreements with other insurance companies.
While this insurance model works just fine for high-deductible indemnity type insurance polices for health, it's a HORRIBLE model for providing healthcare to a population.
An insurance company - an entity in the business of hedging against risk - has no business being in the business of keeping people healthy. And it shows - insurance companies have done an awful job of providing care to the ENTIRE population of this country.
Sure, there's been a terrible lack of regulation and oversight...but insurance companies are doing, by and large, what a for-profit insurance company must do to remain in business....minimize its exposure to risk by refusing to take on the riskiest "customers" who are most likely to incur large claim payments.
The cure for our national healthcare sickness is a complete paradigm shift. Take the insurance companies out of the healthcare business. Anything less simply won't do.
Instead of employers paying healthcare insurance premiums...tax them, much like they are taxed for social security. Use that money to set up a trust fund to pay for healthcare. Take the medicare and medicaid systems and merge them into the same trust fund.
This healthcare tax can pay for the cost care for the gainfully employed.
For the people who are unemployed or retired, therefore not eligible for employer healthcare tax contribution, the government picks up the tab....much like the current medicare and medicaid
So, now that we have this HUGE pool of money in a trust fund...invest it wisely to ensure that inflation doesn't have a negative effect on the assets being held...and even look for a modest rate of return above the rate of inflation.
Disallow, by statute, Congress from raiding the trust fund to cover shortfalls elsewhere in the budget
At the same time, set up an "exchange" where people can pick from a list of healthcare "plans" offered by private companies acting as benefit administrators...not "insurance" companies.
The government negotiates rates with these benefit administration companies directly...and pays them directly.
The benefit administrators are allowed a small, token, statutory profit above their costs for care provided. No huge CEO bonuses, no downtown corner window offices. These companies should also not be allowed to refuse or drop coverage based on the existing health condition of individuals.
The companies can compete for business by offering value-added benefits, wider range of coverage offered - for example some may choose to pay for colored contact lenses, not just the basic ones etc. Or they can compete based on how large their coverage footprint is....how many doctors or hospitals they offer coverage at. In addition, the companies can sell "cadillac" coverage....for items not covered nor considered medically essential...like fake breasts, or teeth whitening.
At the same time, do some meaningful, rational "tort reform". If you wanted bigger tits, for example, and the doctor fucks up...you get a new set of tits from a different doctor. However, if you're a 28 year old father of two who gets maimed for life due to doctor error....you get a few million bucks to make sure your family doesn't become destitute.
Buy drugs where they are cheap - Canada, India, Brazil, South Africa, Israel. Limit patents on life saving medicine that jacks up the prices and reduces competition from generics.
Tell me why this wouldn't work.