Catastrophic coverage run through private insurance with a upper limit (8% of income) with Medicaid to expand to cover those who cannot afford the upper limit . This coverage would kick in when someone, in a calender year, has spent over $5,000 or $7,500 on any healthcare related expense. It would cover hospitalization, visits with physicians (incl. nurse practitioners and physician assistants), medications and "durable medical equipment". To reach the $5,000 or $7,500 limit, any healthcare expense that is covered by a Section 125 plan would be included, even though many of these expenses would not be covered by the catastropic insurance itself.
Expansion of the Federally Qualified Health Centers (FQHC)/Rural Health Clinics (RHC) to allow communities and providers to offer affordable healthcare with strings attached. FQHC's, otherwise known as community health centers, offer comprehensive healthcare to low income communities, with the Governement subsidizing through grants and cost-based reimbursement. RHC's allow private physicians in rural, underserved areas to obtain cost-based reimbursement for Medicare. I would expand/reform these programs beyond rural and low income areas to provide cost-based reimbursement for all patients based on the patients being charged according to a sliding scale based on income. If a person has insurance, the sliding scale would apply to the copay, deductible, etc. In both the FQHCs and RHCs, the cost-based reimbursement would have an upper limit per visit, as they do now.
Reform of the malpractice system. Yesterday, I read an article that says that overuse and unnecessary use of the healthcare system is driven by physicians paid for treating illness, not maintaining health. I think these costs are driven by fears of malpractice. Someone who wants to sue his physician should have two choices: 1) a healthcare court which gives awards based on the injury, not on the supposed 'neglegence'; and 2) use a regular court, but the plantiff must prove the 'negligence' according to a very high standard, and if the physician successfully argues that his care was based on the correct use of a national guideline or other evidence-based practice, the plaintiff loses.
Expansion of HSAs. A person should be able to save $ tax free for any healthcare cost that would be covered by a section 125 plan.
Creativity The most important outcome of this would be to open up the healthcare system to true market forces and allow the "vendors" to package healthcare services in ways that are currently not covered by health insurance. This is where I think the American version of national health care can be better than France's, Germany's, Australia's and anyone elses healthcare system.
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