Notes On National Framework for Healthcare
The current iteration of the United States healthcare law, the Affordable Healthcare Act (signed into law in 2010) was an admirable (in aspiration) attempt at creating a national healthcare framework that would achieve universal health insurance coverage. It is admirable in its intentions but not its execution. The Affordable Healthcare Act of 2010 is a deeply flawed law that does not adequately address several core issues of the healthcare debate in a realistic fashion. The Affordable Healthcare Act is at best a bad patch on an already bad system. In addition to being inadequate for our healthcare demands it may have many negative consequences in many aspects of the United States economy and further divisions in American society. If the United States wants to move forward with the Affordable Healthcare Act, many changes of a radical nature will need to be implemented in the near future in order to make the practical application of the law live up to the admirable goals of those who authored the Affordable Healthcare Act. Or the United States will need to produce a new, separate law to address our national healthcare concerns, in the process making the Affordable Healthcare Act a worthy attempt assigned to the historical scrap heap. If the United States is serious about addressing its myriad healthcare concerns, one of the two above prescribed courses of action will need to unfold. Given the relative weakness and deep structural flaws of the current Affordable Healthcare Act, I advocate a completely new law to address our nation’s healthcare concerns structured very differently from the Affordable Healthcare Act. I will discuss our current national healthcare concerns and challenges confronting the United States, then outline the structural and societal deficiencies and merits of the Affordable Healthcare Act, and finally I will outline a general proposal for a framework of guidelines for a new national healthcare system. I want to iterate again, that these are ideas worth discussing and that they should not be taken as a finished product that is actionable in any way.
First, allow me to make a point regarding the absurd light I have witnessed many discussions on the Affordable Healthcare Act devolve into and be consumed by to a pointless end. I have come across a peculiar situation, unfortunately all too often, where any criticism of the general details or structure of the Affordable Healthcare Act is met with counterpoint, ‘You don’t want everyone to have healthcare,’ or a similar phrase producing the same effect. I believe this rhetoric is unproductive for uneristic debate and is dangerous for our democracy. For all intents and purposes, everyone outside of a few radical far right wing ideologues wants every citizen of the United States to have access to affordable healthcare. The idea that one side or the other seriously doesn’t want American citizens to have healthcare is a rhetorical tool designed for emotional appeal without logical or substantial grounding. We can all agree that we all want everyone in the United States to have healthcare. I defy one to find a serious American politician that readily admits to not wanting American citizens to have healthcare. If found they would be the rarest of a newly discovered species. A person may disagree with the methods of how the Affordable Healthcare Act achieves universal coverage and changes the American healthcare landscape AND still want every American to have healthcare coverage. The only disagreement lies in the methods used to achieve the goal of universal healthcare, not in the end goal itself. Therefore, in serious discussions regarding the merits of the Affordable Healthcare Act, we can refrain from making the absurd assertion that simply because someone disagrees with the mechanics of the Affordable Healthcare Act they do not want people to have healthcare. We should not mistake criticism of the means and details for rejection of the end goal.
Another undesirable consequence of the above described line of thinking is that it damages uneristic debate, which is vital for a representative democracy built with the concept of debate as a core tenant. A functioning democracy should be able to entertain debates on the merits of a law in a public forum. Opposition to certain parts of a law and critiquing them in public debate is part of American democracy and provides an avenue for dissenting voices. Debate also allows a proposed law to undergo the necessary criticism and revisions needed to improve the law and reach enough of a consensus for widespread adoption. As I have witnessed often, the moment a person makes a counter point to criticism of the workings of the Affordable Health Care Act with a similar comment to, “You don’t want everyone to have healthcare,” the debate is effectively over. In order for the political process to work in the United States in a fashion that respects the rights of the party not in power, an avenue for discussion and debate needs to be provided and nurtured. While many may disagree with criticism of a particular laws merits and functional details, it is still vital to respect and provide an avenue for the opinions of dissenters. By denying this avenue to critics of the Affordable Healthcare Act we are limiting our democracy. The above point made in this paragraph applies not only to Congressional discussions, but more importantly to interpersonal discussions between unelected citizens, in coffee shops, university classrooms, and other public forums found in daily life. While seeming not as important, one cannot dispute that the vast majority of public debate, by quantity, happens outside of Congress and helps form the national character. Why don’t we build our national character on a sound foundation.
Surveying the healthcare landscape in February of 2014 before the implantation of the Affordable Healthcare Act, it becomes clear the United States did not have a ‘healthcare system’ in the traditional sense of the word. We had a healthcare market, which entails the benefits and costs of a market based system. Healthcare costs are set by the collective decisions of the market participants and most healthcare infrastructure is private. As opposed to a government run healthcare system like Britain’s National Healthcare Service or Canada’s healthcare system in which most infrastructure is operated by the national government which sets prices as well. A single payer government run system allows for price controls, but is dependent on the competency of those public servants running the system. Generally markets respond to changing circumstances, such as increasing pay to attract workers to jobs with shortages, faster than government run systems and more efficiently allocate resources.
Our healthcare market is augmented by the practice of employer provided or subsidized healthcare plans, which theoretically serves to partially defray the cost of healthcare to the individual. Corporations and other business have been providing the bulk of Americans healthcare coverage since the advent of price freezes enacted during World War II. With millions of men under military service and government price and wage freezes imposed by the United States government for the war effort, business needed a way to attract and retain workers beyond the usual peacetime practice of raising wages. The most effective way they found was offering fringe benefits to employees, which were not subject to limitations by the US government. One of the most popular and effective benefits was the offering of healthcare coverage to workers. The duration of the war and the relative strength of the United States economy which produced tremendous financial gains for American firms, made this practice ingrained in the American corporate structure and worker expectations. This practice of employer provided or subsidized healthcare has endured to our present day. Objectively this practice of employer provided healthcare seems to be inefficient for corporations, workers, and insurance providers. Providing healthcare for workers, especially in a time period when healthcare costs are increasing at over twice the rate of inflation, is a growing and burdensome cost for employers that isn’t abundantly transparent to the casual surveyor. It makes employing American workers more costly, for example wages for the average Canadian worker are higher than wages for the average American worker, but Canadian workers are less costly to employ than American workers. The main culprit for this cost differential between Canadian and American workers is the healthcare costs associated with employing Americans. Healthcare costs are also a variable cost largely beyond the control of employers, wage costs are much easier to plan for and give employers total control over that expense. Adding in the historically difficult to predict long-term cost of providing subsidizing healthcare for retired employees, healthcare costs can become a major expenditure for employers. Providing healthcare coverage for employees is a burdensome cost for employers that make American business less competitive in comparison to international competition who do not have to provide healthcare for their employees.
The employer provided healthcare system also decreases mobility within the labor market, hurting the efficiency of the American labor market by tying employees to their current forms of employment. Workers are less likely to take risks and leave their current jobs as well as staying longer than is optimal because of worries about obtaining health insurance, especially if an opportunity does not work out. Workers flexibility within the labor market is decreased by the employer provided healthcare system as well as creating a less dynamic labor market for employers. Another consideration of the employer provided healthcare system dependent on workers leaving their current jobs, affects one of the United States great strengths, our entrepreneurs. The prospect of losing your healthcare coverage may be a factor that makes the decision to leave one’s current job and start a new company that much more difficult. It may also dissuade workers from quitting their current jobs and joining a startup company, therefore depriving the next Google of talented employees. In short, removing the connection between employer and healthcare will make the US labor market more dynamic and fluid, producing a better result for employers, workers, and entrepreneurship in the United States.
The current healthcare framework in the United States has created a bureaucratic triangle between insurance providers, employers, and individuals which has produced an unnecessary middle man, the employer. Instead of a direct relationship between the average citizen and their health insurance provider, the citizen must obtain health insurance from their employer and negotiate through their employer. The employer as the middleman between citizen and health insurance provider creates more bureaucracy in an industry that is already rife with bureaucracy and paperwork. On any level, an extra middle man complicates the health insurance process for hard working Americans and slows down the ability of health insurance providers to quickly respond to the needs of the citizens they cover. To put it simply, by placing the American business as an unnecessary middle man in our healthcare system, the United States has made a less efficient healthcare system. A more efficient system that has a direct relationship between insurance provider and individual reduces a middle man, creates less bureaucracy, paper work, and makes interaction between individual and insurance provider much easier.
Given all of this, we are left at an impasse, do we want to keep the employer provided healthcare framework and work within it towards a solution or do we want to create a new framework independent of employers. The authors of the Affordable Healthcare Act have clearly chosen the former path.
While containing many significant flaws, the Affordable Healthcare Act does have several effective functional changes worth keeping in one form or another. The advent of health insurance exchanges, allowing young adults to stay on their parents medical insurance plans until the age of 26, and banning health insurance providers from charging higher premiums for those with adverse pre-existing health conditions are examples of effective structural changes to the state of the healthcare environment in the United States before the advent of the Affordable Healthcare Act.
The concept of creating an exchange for healthcare plans was a very effective improvement on the previous listless state of information one finds upon undertaking to identify, let alone research health insurance plans in our current system. Before the implementation of the Affordable Healthcare Act, a prospective health insurance buyer was confronted with the polar opposite of information transparency about health insurance plans. One is left to one’s own devices and must search in a healthcare world without any guiding or formal structure. The person who seeks to purchase health insurance must peruse many health insurance company websites, make their own comparisons, and identify as many health insurance providers as possible in a completely diffuse, decentralized health insurance market. This daunting task is made possible by the lack of any formal structure or regulation of the healthcare insurance market. This informal, decentralized market is highly inefficient for disseminating information about health insurance and providing timely and effortless connections between prospective health insurance buyers and health insurance firms. To draw a comparative example, imagine a world in which stock exchanges do not exist. Now one is tasked with buying stocks for a diversified portfolio. One must identify available stocks to buy, ascertain historical stock price movements for each stock, calculate a rate of return on each stock, and compare stocks to each other in a comparative analysis, all with the goal of creating a portfolio in which one can earn a return above the market return. Outperforming the market is a difficult task today even with modern stock exchanges and transparency of information, woe betide the individual who must attempt the same task in a world without a centralized hub of information that makes comparative analysis exponentially easier and substantially less time consuming, i.e. a stock exchange. Given the readily apparent and truly incredible advantages that stock exchanges provide over the alternative lack thereof, in terms of increased information accessibility and ease of comparative analysis, it seems quite odd that we have not utilized exchanges for other aspects of the United States economy. Exchanges should be a politically tolerable idea given the overwhelming wide acceptance and use of stock exchanges. A healthcare exchange will allow prospective health insurance buyers to more easily discover and compare health insurance plans, making the process substantially less time consuming. Exchanges will bring the full effect of market forces to bear, forcing health insurers to compete against each other, which is made much easier by the fact that consumers can more easily compare prices. Without exchanges insurers can exploit the lack of comparative information available to consumers to charge higher prices.
While the idea of a healthcare exchange is an effective one and should be adopted, the affordable healthcare act employs the idea in such a way that it creates unnecessary and burdensome complexities for the United States healthcare system, one of the many flaws of the affordable healthcare act. It is a great step that the affordable healthcare act employs exchanges to list health insurance, the benefits have been outlined in the preceding paragraph, but the affordable healthcare act decentralizes the exchange idea and allows each state to construct their own exchange. Theoretically there could be 50 healthcare exchanges across the United States, each operating independently from each other and potentially each operating with different rules and procedures. This lack of a centralized system creates asymmetric problems in the aggregate resulting from different policies and rules across states. This regionalization of healthcare has detrimental effects for labor market flexibility and the ability of workers to relocate for new job opportunities. Policies that apply in certain states may not apply in other states. Creating a centralized system for healthcare, for example a single national exchange, would be incredibly more efficient, uniform, and support labor market flexibility.
Another flaw keeping the affordable healthcare act from becoming truly transformative healthcare legislation is its acceptance and promotion of the employer provided healthcare system and relationship. As mentioned earlier, the employer provided healthcare system is rife with inefficiencies and hurts labor market flexibility. In addition, the affordable healthcare act has requirements for small businesses to cover more employees, creating increased costs for small business owners and entrepreneurs. Entrepreneurship has been important to the economic development of the United States, creating many of the United States’ current largest employers and providing a pathway of social mobility for hardworking, ingenuous Americans. The affordable healthcare act is increasing the costs of starting a company in the United States, especially for the majority of entrepreneurs who are not backed by millions in venture capital funding. In order to compete in an increasingly competitive global economy, the United States will need its entrepreneurs and needs to give them the best chance of succeeding.
The affordable healthcare act will achieve an increase in the percentage of Americans covered by health insurance, which is a wonderful accomplishment, but it does not at all adequately address the increasing and projected to increase costs to the United States government, especially considering that many of the newly insured will be insured by and expansion of Medicare and Medicaid. Much of the projected cost savings in the affordable healthcare act rely on projected efficiency gains in the healthcare industry. Basing cost saving projections on efficiency gains is a bit suspect given the historical difficulty in predicting efficiency gains and that those gains are assumed and outside of any control by the government. Savings by efficiency may very well come about, but the large gains projected under the affordable healthcare act are unreliable and seem the product of wishful thinking. In addition, the affordable healthcare act does not address in a real way the increasing cost of healthcare to the United States government. The cost of Medicare and Medicaid are predicted to increase at similar rates under the affordable healthcare act as without. The increasing cost of healthcare entitlements to the United States government is projected by the congressional budget office to become greater than military spending and a drastic burden on the United States government, providing less money to spend on education and infrastructure. The affordable healthcare act only addresses one side of the healthcare debate in the United States, increasing coverage, it would be better if it also addressed the cost of healthcare to the United States government.
Finally, the long-term societal impacts of the affordable healthcare act may serve to further divide the United States. Much has been made in the media of the wealth gap between the wealthiest and least wealthy in American society, and more importantly the shrinking size proportionally of the middle class creating greater class divides in the United States. While much attention is hyped for ratings, there is a very real danger of creating a more divided society and this divide is increasingly being defined on education lines. In an economy where agriculture and manufacturing no longer provide a significant proportion of jobs, services and skills become much more important. Having a university education is increasingly important. Social scientists have identified educational attainment as the greatest indicator of economic success, health, and living standards in the United States. The United States is moving towards a society that is increasingly being divided by educational attainment. I believe the affordable healthcare act will increase this social divide further, primarily because it keeps the employer provided healthcare system as the primary avenue for obtaining healthcare in the United States. Very well educated people have better chances of obtaining jobs with employers who will pay for high quality healthcare as a benefit. They do not have to seek health insurance from an exchange. Those without an education who cannot obtain a highly coveted job with a firm that provides health insurance will be forced to seek healthcare on an exchange. Healthcare exchanges will be utilities primarily by the uneducated. Perhaps a stigma will evolve for those who purchase healthcare from an exchange, I hope not. There is a real danger in the affordable healthcare act further defining the socio-economic divide in the United States. For those who are concerned with the socio-economic dynamics of American society, they should consider the social implications of the affordable healthcare act.
Given the state of congress at the time, politically the affordable healthcare act was surely the most feasible and less disruptive option, which is amazing given the extreme lack of support and opposition it entailed. American citizens, for the most part, like other country’s citizens around the world, are uncomfortable with drastic change and adapting to a new societal paradigm. It is unsurprising that politicians worried about reelection prospects chose the less disruptive and more comfortable option. The safe approach would be appropriate if it achieved effective reform, but with the Affordable Healthcare Act we are left without effective healthcare reform. American elected officials have chosen comfortable mediocrity over difficult effectiveness. The American people deserve better from their elected officials.
After highlighting the inadequacies of the pre-Affordable Healthcare Act environment in the United States and of the Affordable Healthcare Act in addressing the many demands of the American healthcare landscape, I will present some ideas and the general framework for a healthcare system that I believe will better serve the United States. Again, these are ideas intended more for thought and rumination than a finalized plan that is ready to be adopted. They are too general and need to be worked through further to be immediately actionable. Hopefully they will provide some food for thought for the existing conversation.
As highlighted previously, the employer provided healthcare system is inefficient and in the guise of the affordable healthcare act may actually increase socio-economic divisions in society. I propose completely removing the employer provided healthcare system so that no one in the United States will receive their healthcare from their employers. Removing the implicit obligation of employers to provide health insurance for their employees will have the same effect as a tax break for employers and make American workers cheaper to hire. It will make American firms more competitive around the world because a variable cost much outside the control of the firm is eliminated and it will make American workers more attractive to hire by domestic and foreign firms. The benefits to the economic competitiveness of the United States are real.
In exchange for the employer provided healthcare system, I believe the United States should adopt a system that brings the best of the free market and government systems together. I propose setting up one national healthcare exchange that every health insurance provider will be required to list on as well as the United States government creating a government run insurance agency that will provide multiple insurance options for those who are priced out of the exchange.
A national healthcare exchange is superior to collective state exchanges because it brings national market instead of individual state market forces to bear lowering prices through greater competition, provides better mobility in the labor market, has a set rules and regulation system that applies throughout the entire country, and will have more than enough participants to make the exchange viable. As discussed earlier in regards to the current pre-affordable healthcare act system, market forces can be utilized to great effect; competition by insurers lowers prices and markets adjust faster to shortages or gluts in the industry as with creating higher salaries for nurses during a time of nurse shortages. A national healthcare exchange brings the benefits of market forces to work in the healthcare industry. With the majority of Americans buying their health insurance on a national exchange instead of through their employers, market forces can still provide their positive benefits to consumers in the healthcare industry. Also with the majority of Americans buying their health insurance from a national exchange, it provides a much deeper pool for the exchange than any individual state exchange could ever produce. This much much deeper pool for the national exchange will alleviate any fears that currently exist about enough people buying from exchanges to make them viable, after all, they will not have any other choice but to buy from the national exchange. Also with every insurance company forced to list on a national exchange, greater competition will be more effective in prices than a state exchange’s capacity to lower prices.
A single national exchange will produce the result of anyone who purchases health insurance from the exchange operating under the same rules and regulations regardless of where in the United States they are living when purchasing their health insurance. This makes it much easier for Americans to move between states when they do not have to worry about meeting requirements or regulations for a particular state. In addition to a general uniform set of regulations, removing the employer provided healthcare system for an exchange will provide an environment where workers are more likely to leave existing jobs for new ones, creating a more efficient labor market. In the current employer provided healthcare system, employees may be reticent about quitting their jobs for new ones with the worry of losing their health insurance. (The dilemma of paying for health insurance when in between jobs is a real challenge and will be addressed later in this essay) Taking a job that also includes a degree of quality of health insurance will no longer be a consideration. Entrepreneurs will no longer have to factor in the cost of employees health coverage when starting the next Google or Nike and they may leave their current occupations to start their new firms without worrying about losing their employer provided healthcare. (Again the dilemma of paying for their health insurance in between will be addressed later in this essay) The multiple benefits of utilizing a national exchange are very persuasive.
Another benefit of a national health insurance exchange, without employer provided health insurance, is that it does not create the necessity of requiring all citizens to have health insurance or to fine those citizens who choose not to have health insurance. Even with maintaining an employer provided health insurance system, a national health insurance exchange will have the numbers necessary to make it viable without fining those who choose not to have health insurance. And with all those who previously received their health insurance from their employers, purchasing health insurance from the national exchange, the national exchange is further augmented and is made even more viable. Americans, like many in other nations, do not like to be told what to do or to have restrictions placed on their behavior. I suspect most hostility to restrictions is mostly philosophical in nature and not actually derived from any physical discomfort these restrictions cause in the routine of daily life. Nonetheless, removing the requirement of obtaining health insurance will ease opposition to healthcare reform by removing a philosophical rallying point for the opposition.
A national health insurance exchange will most likely succeed in lowering the prices paid by consumers out of competition, but prices may not be low enough for every American. A person’s healthcare is too important to leave to the market alone. Having a healthy workforce is important to the productivity of the American economy. I propose the United States government create a government run health insurance company, which will offer multiple plans, to provide health insurance for those few who are priced out of the national healthcare exchange. Non-government health insurance firms do not have the ability to operate at a reduced profit or at a loss as can the United States government. The United States government can utilize economic demographic data as well as historical price analysis of the national health insurance exchange to set prices properly for those priced out of the national health insurance. To qualify for the different government health insurance plans, one will have to meet certain income criteria, so those earning below designated income levels will qualify for different government health insurance plans. The government will determine these income levels from economic demographic data.
I propose the United States government health insurance company provide at least three different options for paid health insurance and one option that is free. The free option will be open to those earning below a certain income threshold in order to allow only those who need it to have access and diminish the cost to the United States government. This free option will only provide the bare essentials of health coverage, it will not be nearly as high quality as what one could purchase on the national health insurance exchange. This will be achieved by reducing choices. One on free government health insurance will be able to see a doctor and get all the treatments they need, but they will not have a choice in which doctor they are able to see. They will be assigned a doctor by their insurance and that will be their only option, same with seeing specialists. The free government health insurance option will provide all the necessary care one needs, but without choice. I liken the free option to a used Toyota corolla. It is not flashy at all and without creature comforts, but it is more than capable of getting one from point A to point B. Using economic demographic information, the United States government will price the three paid government health insurance options and the income thresholds for each accordingly so that they accommodate the needs of those who cannot afford to purchase a private plan from the national health insurance exchange but earn too much for the free government insurance options. The government insurance options are meant to augment the health insurance exchanges and fill in the gaps at the bottom for those priced out of the exchange.
Under this new scenario, Medicare and Medicaid will cease to exist and their previous users will enroll in either an insurance plan from the national health insurance exchange or one of the government health insurance plans. The United States government forming a health insurance company provides the government with the same negotiation power with hospitals, doctors, and pharmaceutical providers that private health insurance companies currently enjoy. The United States government, backed by the taxpayers, will be able to leverage a higher financial security rating and a nationwide pool of participants, comprised of those utilizing government insurance plans, to negotiate great rates and conditions for itself and its participants. By entering the market as an insurance company, the United States government will be able to negotiate and gain an offensive power in controlling costs that the United States government currently does not enjoy with Medicare and Medicaid. Within the context of government provided healthcare, a government insurance firm operating in the marketplace provides the government with the greatest ability to control costs. We must not be under any illusions though, creating a government health insurance company will require the recruitment of qualified staff and the nationwide infrastructure to serve participants and fulfill obligations and operations.
It is important to note that there is a precedent of the United States government operating firms in the general market place already. The United States government operates banks and insurance firms serving military veterans and their families. They provide many much needed services to military veterans, from mortgages to auto insurance. A viable precedent has been established in the United States already.
While I believe the general framework described above is the most efficient system for creating a comprehensive healthcare system in the United States, it is not without its faults. Requiring most people to purchase their insurance from a national exchange, even with less expensive health insurance costs as a result of the exchange, is asking most people to pay more for their health insurance from the employer provided system. Given that firms can no longer offer health insurance as a fringe benefit, it seems reasonable that firms would raise wages to attract top talent and that hopefully wage increases offset the new cost of health insurance purchased from an exchange. This may not happen however, wage increases could not be consummate with new health insurance costs. In all likelihood adopting the healthcare system advocated for in this essay will require an additional cost to most Americans. Ideas designed to save the government in healthcare costs may actually turn out to be more expensive than previously thought. Many who opt for government health insurance plans may be dissatisfied with the extent of their coverage in comparison to plans available on the national health insurance exchange. What will follow are several other proposals of this new National Healthcare Framework that are important on their own and in order to combat some of the anticipated faults in this new National Healthcare Framework.
In order to combat the increased cost of individuals paying for monthly insurance premiums that were previously paid for by their employer, a Health Savings Account should be made available to every American, regardless of employment. If an employer wants to set up an HSA system for their employees that is great, but if they don’t, individuals should be able to create their own. HSA funds can’t be used for paying premiums, but the can be used to pay for all other kinds of care, including supplements, mental health, and almost all medical expenses that are not insurance premiums. The federal government should also substantially increase the limits an individual can contribute to their HSA per year, but perhaps the government can also increase the penalty for early withdrawal. Employers should also be able to match up to a certain amount the contributions of their employees to their HSAs.
In general, the healthcare framework needs to focus on preventive care and early detection in order to keep aggregate costs down. Get away from treating issues when symptoms appear, but before they appear. Insurance companies should be allowed to write off the full cost of some or many early detection services from their taxes, potentially make some early detection services mandatory for all insurance providers, for example: given the prevalence of cancer in the United States, liquid biopsies like Galleri by Grail and MRIs like PreNuvo could be eligible to be written off of taxes by insurance companies and/or mandated for all those they insure at a certain frequency like once a year for example. Other ideas for early detection and prevention should also be considered, among them could be perhaps having like 4 visits with a nutritionist included in insurance as an example.
The healthcare framework should have health insurance include all types of health, so vision, dental, and some mental health.
From a political feasible standpoint, creating a government health insurance firm may not be possible. Given the current extreme partisanship enjoyed by both main political parties and the republican opposition to the relatively benign affordable healthcare act, it is more likely than not that a healthcare law with a provision for a government health insurance firm will not come close to passing. Under any national healthcare system there will most assuredly be very passionate and vocal detractors, as the current pre-affordable healthcare act system and the affordable healthcare system have experienced, but passionate dissent should not be automatically confused with well thought out identified systemic flaws.
I believe the national healthcare system I have outlined in this essay to be the best, most efficient system in general that the United States could employ. I believe that it combines the best of a market system with the best of a government provided system. Hopefully this essay will encourage discussion on the topic of healthcare reform beyond a mere debate on the affordable healthcare act or nothing new at all. The affordable healthcare act is an admirable effort at healthcare reform, but I believe the United States can and must do better.