What should be done about health insurance? The Gilbert plan

There was a moment in the last debate between John McCain and Barack Obama when the Republican candidate took Obama to task for his health care plan, calling it a "single payer system." "If you like that, you'll love Canada and England," McCain shot.

I would love Canada and England! I recently left my cushy job with benefits to hit the freelance lifestyle, with its attendant flexibility in spending waking hours with my three young children. I'm the primary breadwinner in my household, to boot, so I've been hemming and hawing over what I need in my budget. Cable's out, and I'm considering saying goodbye to the Blackberry (ohhh!). We don't drive, but I have a little in the budget for bike lights and the occasional replacement inner tube. I'll be honest: I wasn't thinking that much about health care costs. Maybe it was one of those fingers-in-the-ears moments, squeezing my eyes shut and saying "nahnahnahnahnah!" every time the topic came up.

I got my COBRA paperwork today, and just for health care, I'd be spending $1,036 a month; more than my mortgage payment (if you exclude taxes). I wrote about this on a local mamas' site, threatening to go without insurance and pay out of pocket for well baby visits and such, and was immediately begged (literally "please please PLEASE") to buy health insurance. I started griping about the costs and the cheated feeling I have: essentially I'm being asked to pay thousands each year to protect me from total bankruptcy, should there be a health crisis in my family. Tracy Coenen suggested I post here about what I'd like instead.

It turns out, neither Obama's nor McCain's plan would be ideal (though, for the record, McCain's would be completely unhelpful, especially for parents who work for small businesses). Instead, here is how I'd structure the health care system:
  • Mandate one rate for everyone. It's mind-boggling that insurance companies pay far less than individuals for health services. It's nonsense: it doesn't cost less to provide care to a patient who has insurance, the only possible justification for this practice. It probably costs more for insured patients; hospitals have whole departments dedicated to billing insurance companies and knowing the ins and outs of Medicaid. Competing software systems navigate the mysteries of proper coding. If I'm going to the doctor, I should pay the same price as someone who has Blue Cross.
  • All payment for care for catastrophic accidents, serious illnesses, births, vaccinations and preventative care / physical exams should be paid for by our income taxes. I shouldn't have to decide whether to get a mammogram or pay my power bill. I shouldn't have to worry about losing my house as I'm in the ambulance after an uninsured motorist hits me while crossing the street. If my husband gets cancer? I should only be crying about my husband's disease, not my impending homelessness.
  • Insurance could pay for routine, elective and supplemental care. Want acupuncture? Couples counselling? Elective c-section? Extensive genetic testing for your baby? Occupational therapy? Infertility treatments? Visiting the doctor for routine flu? Insurance could pay for these costs. That way, the "haves" could still have more than the "nots." Individuals with insurance could see their physician for every ache and pain. Those who didn't have it, would have to pay out of pocket. (But if the aches and pains turned out to be cancer, it would be covered by taxes.)
  • Farm subsidies and all support for unhealthy food should be erased. See Michael Pollan; no more wheat, corn or soy crop subsidization, period. No more transportation tax credit for food companies. This will save money to help pay for health care. Also, when America can't get cheap sugar, vegetable oil and processed flour, nor can they get cheap, tasteless, nutritionally-bereft produce from all over the planet, they'll start eating healthier and we'll save money on health care costs.
  • Gardens and cooking programs in all schools as part of curriculum. Feed the kids food that was actually cooked (and grown where possible) onsite will greatly increase our nation's health. Take away the tests so the school systems can have money and time for the new food programs.
  • Malpractice payouts should be severely limited everywhere. I think it's awful that some doctors make terrible mistakes. However, I shouldn't have to pay for them through sky-high medical costs. This system doesn't seem to be effectively reducing mistakes; it just makes people more miserable as they prolong their grief in a senseless search for monetary justice. Money won't bring your loved one (or missing limb) back. Somehow the rest of the world gets by without paying victims millions for other people's screwups. I'm sure we can manage.
So, that's my plan. If I were advising the next President, that's what I'd demand. What do you think?
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