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I think a single payer universal system would be best but I don't think it is feasible with all the insurance companies already existing.
What I would like to see is have govt take the place of employers in negotiating insurance premiums. Instead of each insurance company having to negotiate with each business they work with they instead negotiate one rate for each type of plan that they want to offer in a regional market.
Insurance companies would be able to negotiate with regional/local doctors and hopsitals to determine what they will pay them on their own as it is now. They create plans based on local market areas. Consumers would then pick whichever insurance company fits their needs based on cost, coverage, doctor network.
The plans can be paid for by taxes on employers on a per employee basis. Determining that rate would be tricky. Ideally, it would be as close as possible to the current average amount businesses pay towards their typical employee's premiums. Therefore there is not much of a change in what they are paying. Hopefully, since it would be much cheaper for an insurance company to negotiate one rate with the govt vs 1,000's of different rates with varying businesses based on multiple factors, there could be an immediate reduction in costs. Obviously we can work out subsidies for small businesses where this would be a major burden and assistance for low income families.
Under the new plan, people could continue to have their premiums deducted from their checks if they wanted to.
This could completely replace medicare for seniors and any state-specific publicly funded health care options for the poor so that might also have big changes in costs.
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