Health Care System Options for the United States

[Ban my account ffs!]

I voted for the Canadian model,  but perhaps I shoul've voted for the British model.  My problem with the British model is that private health care is still allowed, which I think is totally wrong. Rich people shouldn't have better access to health care than poor people.

I agree with this.  Socialism for me and capitalism for thee is never pleasant in practice, and that's what it amounts to in a two-tier system.

I'd ask Nix if he really thinks the U.S. would implement a fair two-tier system.  We have two-tiers in other things too.. like school lunch.  Pizza or burgers for me, a dry peanut butter sandwich for the poor kids!

But maybe you're okay with that... I have no idea.

[Hatman 🍁]

I voted for the Canadian model,  but perhaps I shoul've voted for the British model.  My problem with the British model is that private health care is still allowed, which I think is totally wrong. Rich people shouldn't have better access to health care than poor people.

This argument I don't accept. Mainly because: where does it end?

Short of establishing a truly communist society, I'm not sure why this argument wouldn't apply to everything. Why not limit the quality of food rich people can buy?

Ensuring access to high quality education, healthcare and a reasonable standard of living for all citizend should be a top priority, but that needn't involve senseless attempts at total equality just for the hell of it.

Health care is one of those things that I think is important enough that everyone should be treated equally. Education is another. I'd also throw food quality in there, since you brought it up. (This would be done through food quality regulation with the goal of raising the quality of food up, rather than lowering the quality of food).

I'm pretty big into the idea of equality, and I think for things provided by the state, everything should be equal. I don't care if a rich person wants to buy a nice TV or something, or a nice car,  but when it comes to the health of the public, it should very much "to each, according to his need".

[Deus Naturae]

I fail to see how anyone benefits in any way from banning private health care. Why should rich people have their health care payed for by the taxpayer when they could easily (and willingly) pay for it themselves?

Anyway, I'm for reforming health care into an actual free-market system rather than the terrible model the US currently has, which can't seem to decide whether it's capitalist, socialist, corporatist, or just plain cronyist.

Competition is the best way to reduce prices. So, I would get rid of all barriers to competition in health care. The greatest barrier is probably the lack of price transparency in health care and insurance. When consumers are able to compare prices in a free and open market, firms actually have an incentive to reduce prices (lest they lose business to more competitive firms). However, there is very little price transparency in health insurance because so many people have health insurance provided to them by their employer. Because of this, many consumers aren't able to compare health insurance prices. Employers have no incentive to compare prices because, under the US tax code, health insurance is an untaxed benefit (which is a main reason why so many people have employer-provided health insurance in the first place). This situation is only going to get worse when the employer mandate takes effect.

Furthermore, the fact that many consumers pay for their almost all of their health expenses indirectly (via health insurance policies) is also a barrier to competition. Consumers have no way of knowing how much a doctor's visit, injection, minor procedure, etc. actually costs because, other than a small deductible, those things are payed for by their health insurance provider, which then passes the cost onto them indirectly via premiums. If more people had catastrophic health insurance policies (in which the insurance provider only pays for major health expenses) and payed for minor expenses directly, consumers would find it much easier to compare prices between health care providers. However, Obamacare outlaws catastrophic plans, and mandates that everyone purchase comprehensive plans (in which the insurance provider covers all health expenses). In short, our current health care system is biased towards mechanisms that prevent price transparency, thus preventing competition and cost reduction, and Obamacare will only make this worse. I would get rid of all such anti-competitive mechanisms (including Obamacare), and make catastrophic health insurance plans, as well as out-of-pocket health expenses, tax deductible.

I would also repeal crap like the HMO Act in which the government allocates resources to health care providers. Under a genuine capitalist system, resources would be allocated to providers by consumers alone. Under such a system, providers that consumers democratically select are the recipients of resource rewards, and thus providers that provide quality care at low prices succeed. However, when the government gets in the business of resource allocation, providers become dependent on the whims of government (and the lobbyists that control it) rather than the demands of consumers.

[Hatman 🍁]

I fail to see how anyone benefits in any way from banning private health care. Why should rich people have their health care payed for by the taxpayer when they could easily (and willingly) pay for it themselves?

As I have already stated, they do not deserve better health care. Is it really that hard to understand why someone on the left might feel that way? Or do you not understand political ideologies?

[Sec. of State Superique]

Beveridge is also seen in Brazil.

[Frodo]

There is also the out-of-pocket model, but that is essentially what we had before the ACA, and I am assuming no one in their right minds really want to go back to that.  Hence, I did not include it as an option.  

We have libertarians, right-liberals etc. No sense keeping an option off the ballot because you find it disagreeable.

I did not keep that option out just because I found it distasteful.  I kept it out because we need to be realistic.  Like it or not, the Affordable Care Act is here to stay.  It is a fact we will continue to see increased government involvement in the health care industry.  Not less.  The only topic for debate is what form that should take once we set about improving and expanding upon the existing law.  

[AggregateDemand]

Goldhill Plan

http://reason.com/blog/2013/11/02/how-american-healthcare-killed-my-father

Finally found this again. Couldn't remember the guy's name.

[Mordecai]

Other (freedom and liberty).

[Lasitten]

The Scandinavian model of health care.

Of course I would reform the Finnish model a lot because currently it is not working properly - mainly because of too big gap between the two levels (basic and special health care) and the ineffective distribution system of money flows (the money comes from too many "pipes" to the system). And I would limit the activity of the private health care.

[Person Man]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question. On the other hand, it would make a lot of things much more simpler if we had some sort of legally guaranteed access to basic comprehensive  medical care with no strings attached. However, there are too many people with too many vested interests at this point for anything of that sort to be a reality.


That all being said, I think Obamacare is a good compromise. We all promise to buy insurance or sign up for Medicaid if we don't make enough money and the government assures that 94% (97% after the Medicaid expansion reaches enough states) of the population can see a doctor. That all being said, we all have a right to buy health insurance.
 
That all being said, maybe health insurance could be bought from a state that has more liberal regulations, at a discounted price and maybe eventually there should be a more visible non-profit alternative than what was built into Obamacare that is also publically run.

Whether its a straight line or not, in a generation, we will probably have a mix of the British and German system where the ban on insurance profit is replaced instead by a "public option". There will probably be built into it reasonable and constitutional tort reform and liberalized buying practices.

We will probably steadily get there or maybe Obamacare will be made irrelevant and the old system, perhaps even a Ryan-ized version) will be resurrected and  buoyed by a large creative financing scheme which will create a bubble, pop, and create the background for the ultimate reforms to take place. I don't think the ultimate reform to health care can be avoided by the insurance and doctors being "bailed out" the same way housing was. I mean, we all moved into apartments when we got kicked out of our houses. Are we just going to start seeing a vet when we lose our insurance when we can't afford the interest on it?

[Deus Naturae]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

[MurrayBannerman]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

[Matty]

I want truly free markets in healthcare. The OP is wrong to assume that the only solution is more government, especially when you factor in that more than 45 cents of every dollar spent on healthcare here is paid for by the government. We haven't had market healthcare since before world war 2.

Likewise, I don't think it is fair to compare governments of foreign nations when it comes to healthcare policy. Our government is notorious for being inefficient, slow, and wasteful. The german government is not.

I have no idea why there is such a strong impulse to bring change about at the federal level. Let each state create its own system.

[Person Man]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

[MurrayBannerman]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

No, not really. People don't act rationally in the health care market. Mostly because they can't.

[Deus Naturae]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

The answer to the first question is yes, more or less. In the US, government health care spending didn't start to ramp up until the early 1930's, receded throughout the rest of the 1930's and WWII, started to climb again immediately following the end of WWII and throughout the 1950's and early 1960's, exploded following the passage of passage of Medicare and Medicaid in 1965, and has grown considerably faster than GDP ever since.

Government resource allocation to health care providers and restrictions on health insurance policies mostly began in the 1970's, while the FDA was created in 1906, but didn't establish a pre-market approval process until the 1930's and even then the process didn't become that restrictive until the 1950's and onward.

So, unless there is some government intervention or regulation I'm forgetting about, I think it would be fair to say that we had a more or less free market in health care prior to the 1930's.

Your second question is much harder to answer. I can't seem to find any information on historical health care prices (I tried looking at some CPI documents, but couldn't find anything that wasn't extremely recent), and even if I could, the prices would have to be adjusted for inflation in order to make a meaningful comparison to contemporary prices (though inflation itself has been a contributor to rising health care costs). Another reason it's hard to draw a comparison is because most consumers today don't pay their health expenses directly to providers. Rather, most expenses are paid for indirectly by third-party payers such as health insurers. Furthermore, the insurance itself is often not even paid for directly by consumers, but rather indirectly by employers. As I explained in my earlier post, this is the result of health insurance restrictions that require plans to cover certain things and special tax deductions for employers that incentivized employer-provided health insurance. It isn't really possible to compare health care prices from a period where consumers payed directly for health care goods and services with those of the contemporary period in which so many of these goods and services are payed for by government-incentivized third-party payers, and most consumers have almost no knowledge nor involvement in the pricing of these goods and services.

So, I can't really offer you any meaningful historical price data. But, it seems clear that a free-market system would be preferable to the countless cost inflationary restrictions, regulations, and distortive resource assignments that characterize our current system.

[Deus Naturae]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

No, not really. People don't act rationally in the health care market. Mostly because they can't.

What do you mean by this? Are you saying that it's impossible for a free market to exist in health care?

[Person Man]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

No, not really. People don't act rationally in the health care market. Mostly because they can't.

What do you mean by this? Are you saying that it's impossible for a free market to exist in health care?

There's two things he might be getting to-
 1) A derivation of "rational irrationality" where one person makes a decision that's right for him, but actually makes everyone else poorer. i.e a bank trying to protect what is has already earned by refusing to lend its money, but as a result has fewer customers. 
2) People will do whatever they can to survive and that might mean making unnecessary treatments or even risk doing things that might make them sicker or kill them. 

It would be my guess, from what I heard from students who have come from countries that are too poor to have any health care policy at all, that the cost for over the counter stuff is very cheap, but if you get something that requires any technology past WWII, you are basically in the same boat as an American dog or cat that belongs to a family of modest or insufficient means.

[MurrayBannerman]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

No, not really. People don't act rationally in the health care market. Mostly because they can't.

What do you mean by this? Are you saying that it's impossible for a free market to exist in health care?

There's two things he might be getting to-
 1) A derivation of "rational irrationality" where one person makes a decision that's right for him, but actually makes everyone else poorer. i.e a bank trying to protect what is has already earned by refusing to lend its money, but as a result has fewer customers. 
2) People will do whatever they can to survive and that might mean making unnecessary treatments or even risk doing things that might make them sicker or kill them. 

It would be my guess, from what I heard from students who have come from countries that are too poor to have any health care policy at all, that the cost for over the counter stuff is very cheap, but if you get something that requires any technology past WWII, you are basically in the same boat as an American dog or cat that belongs to a family of modest or insufficient means.

Pretty much. The general idea is that buyers normally don't - or in emergencies can't - compare and contrast prices, service, etc...

[Deus Naturae]

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

No, not really. People don't act rationally in the health care market. Mostly because they can't.

What do you mean by this? Are you saying that it's impossible for a free market to exist in health care?

There's two things he might be getting to-
 1) A derivation of "rational irrationality" where one person makes a decision that's right for him, but actually makes everyone else poorer. i.e a bank trying to protect what is has already earned by refusing to lend its money, but as a result has fewer customers. 
2) People will do whatever they can to survive and that might mean making unnecessary treatments or even risk doing things that might make them sicker or kill them. 

It would be my guess, from what I heard from students who have come from countries that are too poor to have any health care policy at all, that the cost for over the counter stuff is very cheap, but if you get something that requires any technology past WWII, you are basically in the same boat as an American dog or cat that belongs to a family of modest or insufficient means.

Pretty much. The general idea is that buyers normally don't - or in emergencies can't - compare and contrast prices, service, etc...

In a perfect world, a totally free market system would work. Seeing the doctor would be like buying a loaf of bread. If people could afford health insurance or health care on their own, going to the doctor would already be like buying a loaf of bread. In that sense, total privatization is out of the question.

This argument rests on the premise that we currently have a totally free market system in health care. That clearly isn't the case.

It's more of a series of non-competitive markets.

was it ever free? If so, how'd that work out?

No, not really. People don't act rationally in the health care market. Mostly because they can't.

What do you mean by this? Are you saying that it's impossible for a free market to exist in health care?

There's two things he might be getting to-
 1) A derivation of "rational irrationality" where one person makes a decision that's right for him, but actually makes everyone else poorer. i.e a bank trying to protect what is has already earned by refusing to lend its money, but as a result has fewer customers. 
2) People will do whatever they can to survive and that might mean making unnecessary treatments or even risk doing things that might make them sicker or kill them. 

It would be my guess, from what I heard from students who have come from countries that are too poor to have any health care policy at all, that the cost for over the counter stuff is very cheap, but if you get something that requires any technology past WWII, you are basically in the same boat as an American dog or cat that belongs to a family of modest or insufficient means.

Pretty much. The general idea is that buyers normally don't - or in emergencies can't - compare and contrast prices, service, etc...

In a free market, private insurance for catastrophic health events would still exist. This was more or less the way health insurance in the US existed prior to the creation of regulations/programs requiring/incentivizing insurers to cover health maintenance (screenings, office visits, etc) rather than just catastrophic events. If we got rid of those regulations and programs and moved to a free-market system, consumers could still purchase catastrophic health insurance plans that cover health emergencies, but would be able to pay for minor expenses, such as routine health maintenance, out of pocket, and thus would have the ability to compare prices between providers.

In addition, if we got rid of the tax deduction for employer-provided health insurance, it would have the effect of at least partially delinking health insurance from employment, which would mean that consumers would no long have to rely on their employers for insurance, and would be able to freely compare prices between insurers. Consumers would have more choice as to what kind of plan they have, and would thus have the option to pay for more health care services directly and thus compare prices between providers.

[Person Man]

Would prices or just supply fall if providers were simply  expecting to be paid like a grocery store? I'd imagine it could work for everything else if all emergencies were covered. No questions asked. I saw that in Atlantic once. Where the government would cover all emergencies but routine stuff would be bought like anything else. However chronic things leave unconvinced of liberal solutions.

[DC Al Fine]

Would prices or just supply fall if providers were simply  expecting to be paid like a grocery store? I'd imagine it could work for everything else if all emergencies were covered. No questions asked. I saw that in Atlantic once. Where the government would cover all emergencies but routine stuff would be bought like anything else. However chronic things leave unconvinced of liberal solutions.

Presumably the patient would have to pay (either through private insurance or out of pocket) for the first treatment(s), until it was determined their condition is chronic. The awkward thing would be determining what counts as "chronic".

For that reason, I'd prefer something like Obamacare, except without the link between insurance and employment.

[muon2]

Would prices or just supply fall if providers were simply  expecting to be paid like a grocery store? I'd imagine it could work for everything else if all emergencies were covered. No questions asked. I saw that in Atlantic once. Where the government would cover all emergencies but routine stuff would be bought like anything else. However chronic things leave unconvinced of liberal solutions.

Presumably the patient would have to pay (either through private insurance or out of pocket) for the first treatment(s), until it was determined their condition is chronic. The awkward thing would be determining what counts as "chronic".

For that reason, I'd prefer something like Obamacare, except without the link between insurance and employment.

What if there was no purchase of insurance by employers, but employers paid a tax similar to workers compensation to help fund the pool?

[Potus]

1. Standard Health Credit

The standard health credit would essentially be a voucher for individuals to get health insurance. The credit would be the same amount regardless of the cost of the plan, creating a financial incentive for people to get what they need/want and not the most expensive plan they can buy. It renders any impact the effects overutilization has on costs moot.

The credit would be paid for by getting rid of the employer deduction for health insurance. This shift away from employer-based plans to a more individual approach solves two issues with our healthcare system besides overutilization. It cuts costs by allowing individuals to tailor their plans to actually care for their needs(I.E., "I'm diabetic, so let's make sure I have coverage for that so I don't have a really expensive surgery down the road."). It also solves the issue of affordability you own your plan, not your boss. You have your insurance whether you are employed or not.

2. Health Savings Accounts

Combined with the standard health credit, health savings accounts go a long way to solving the issues in our healthcare system. Since the credit pays people to get what they need and to at least cover catastrophic care, we need a funding mechanism for the "oil changes" of the medical world.

Allowing people to save tax-free cash without limits and without stipulations is a great way to cover checkups, testing, etc. It's an issue of cost containment. People are more frugal with their own money that they saved.

3. Healthcare Efficiency Deduction

There is a lot of operating cost in the medical industry. One of the major drivers of costs is the inefficiency of care and coordination. Since people respond to incentives, we should create an incentive to make the provision of care more efficient.

When the provider files their business expenses in Year 1, they are kept on file for one year. A fraction of the difference in cost-of-care between Year 1 and Year 2 is made deductible for Year 3. However, this could also act as a counter-deduction. If the cost of care increased from Year 1 to Year 2, your taxable income would increase.

This is a fairly simple mechanism to make efficiency profitable. Cutting organizational costs is a key part to healthcare reform.

4. Cost Negotiating Bodies

We should set up a legal framework for cost negotiating bodies. These bodies would be very flexible in nature, but all would be voluntary. Part of the standard health credit could be used to pay dues to a CNB. The priorities of these CNB's is to reduce the cost of insurance for members of that CNB by using the dues to essentially subsidize plans.

These voluntary bodies do two things that everyone generally likes. First, it makes insurance more affordable. It cuts premiums for everyone, which in turn pressures hospitals to reduce prices to make sure their services are covered by insurance. Access to CNB's is not unique to any class of people, either. The poor receive the same standard health credit that the rich do, which can be used to pay dues to the CNB. Second, it pools risk. CNB's have more bargaining power when they have more members. The more dues they collect, the more they are able to leverage insurance companies to give people a break. By encouraging everyone to enroll in this bodies, we are pooling risk to lower prices for high risk individuals.

It's important to note the correlation between what insurance is willing to pay and what providers charge. When we reduce what insurance will pay, we also pressure providers to cut the bill itself. Cutting the actual cost of care benefits everyone, even those who are not in a CNB.

The flexibility of the CNB is important. With the abolition of employer-based coverage, some employers may choose to offer some sort of health benefits to their employees by starting their own CNB. States like Vermont that constantly pursue some grandiose leftist dream will be able to start a statewide CNB with mandatory enrollment for everyone. The flexibility should appeal to everyone.

It is worth exploring a relationship between not only CNB's and insurers, but also CNB's and providers to further reduce costs.

5. Standard Pricing

Providers, in our convoluted system today, can't tell you how much an aspirin costs because it is so reliant on which network you're in. To improve the effectiveness of the CNB's, we should create a more reasonable system of standard pricing. By creating rules for providers about manipulating prices depending on network, we are going to very quickly drive down the cost of care across the board.

6. More Competition and Exchanges

This one has been beat to death and we've got the infrastructure for it now. We should open up the sale of insurance across state lines and provide a comprehensive national insurance exchange. Companies in the exchange have to compete for consumers and are able to compete across state lines.

This is just a commonsense, competition-minded cost containment measure. It drives down the cost of insurance.

7. Expand Supply of Care

This is a bit more abstract in some parts. We need to really evaluate the mountains and mountains of regulations we place on the medical industry. Right now, we are faced with large shortages of doctors. Part of this is the issue of college affordability which I could go on about for just as long as I have about healthcare. We need to focus on ways to cut red tape, to reform our tax code, embark on tort reform, and generally expand the supply of care.

We should evaluate the cost-of-government on the medical industry. I don't think we'll like the result very much. We need to focus on scaling back that cost-of-government in order to lower the actual cost of care.




Healthcare vs. Health Insurance

We are talking about the issue of healthcare as if it is health insurance. The reason I have focused mostly on the issue of cost containment is because that's where the money's going. Insurance is too expensive because care itself is too expensive. My plan would reign in out-of-control healthcare spending and make care more affordable.

It's important to distinguish between healthcare and health insurance, but we cannot ignore their relationship. By embarking on cost containment measures, insurance will become more affordable. If we successfully cut the cost of care and everything stays the same for insurance companies in terms of reimbursements, their expenses will actually decrease.

The competitive pressures of the exchange will force insurers to drive down the cost of premiums making them more affordable for everyone. Since the standard health credit remains unchanged, this downward pressure on costs will redirect money into health savings accounts and into cost negotiating bodies to apply even more downward pressure.

[Deus Naturae]

1. Standard Health Credit

The standard health credit would essentially be a voucher for individuals to get health insurance. The credit would be the same amount regardless of the cost of the plan, creating a financial incentive for people to get what they need/want and not the most expensive plan they can buy. It renders any impact the effects overutilization has on costs moot.

The credit would be paid for by getting rid of the employer deduction for health insurance. This shift away from employer-based plans to a more individual approach solves two issues with our healthcare system besides overutilization. It cuts costs by allowing individuals to tailor their plans to actually care for their needs(I.E., "I'm diabetic, so let's make sure I have coverage for that so I don't have a really expensive surgery down the road."). It also solves the issue of affordability you own your plan, not your boss. You have your insurance whether you are employed or not.

This is a good idea, especially the part about eliminating the deduction for employer-provided health insurance. But, overutilization is going to persist as a problem as long as the market is artificially biased towards comprehensive plans. Because the large majority of peoples' health expenses are covered by third parties (and likely still would be even with this credit), people will be incentivized to to demand all sorts of treatments and procedures, as long a they're covered by their third-party payer, regardless of the cost. The costs are passed on to everyone in their insurance pool rather than them individually. As long as people are unable simply compare prices for different health care goods and services, they will have an incentive to overutilize care.

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Another good idea, but again, in order to for these to function optimally, you would need to get rid of all the regulations/programs that create a third-party payer system in which people don't pay for health care goods and services directly. That means repealing the HMO Act, getting rid of all regulations that require insurers to cover health maintenance (visits, screenings, etc), and gradually phasing out Medicare.

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Not only is this unnecessary, but it would create a perverted incentive to decrease the quality of care. Under a free-market system, providers would already have an incentive to be more efficient (efficiency is inherently profitable), but they would also have to ensure that the quality of care remains high so that they don't lose consumers. With this deduction, efficiency becomes more profitable regardless of the effects it has on consumers because the profit comes not in the form of a consumer payment, but of a government tax allowance. This would make providers less responsive to patients and create an incentive to decrease the quality of care.

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No way. You're taking the third-party payer system and turning it into a fourth-party payer system! Not only would health expenses be passed on to insurance pools, they would then be passed on again to CNB pools. Providers would charge high costs to insurers (as they do now), who would then pass those costs on to CNB's, who would then pass the costs on to consumers in the form of higher dues. This would further destroy consumer input in health care by setting up yet another barrier between consumers and providers. It's those barriers that are responsible for the lack of price transparency (and thus the high prices) that we see today.

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So basically price controls? This is a classic example of government intervention in an attempt to "fix" a problem government created in the first place. There would be no need to regulate the prices providers can charge if government hadn't created a system in which consumers have no idea how much providers are charging.

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Allowing interstate competition is a no-brainer. Why the need to create an exchange?

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100% agreed. As I said before, one of the biggest problems is government mandates (at both the State and Federal levels) that require insurers to cover health maintenance rather than just catastrophic health events.

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The problem isn't just that health insurance is too expensive. The problem is that, due to government intervention, health insurance is operating in areas where it likely wouldn't exist at all in a free market. In order to get health care to function like a normal market, we need get rid of anti-competitive mechanisms that prevent consumers and providers from interacting directly with regards to prices.