This is more a matter of aiming at opening up a discussion than anything else right now, but, what if Ryancare were fixed? I’ve already shared my opinion on the House plan, and I know that some readers think that there’s really no reason to do anything other than keep the ACA in place as-is, but the plan does have some potential.
What if the credits were based on a metric of standardized cost for a representative high-deductible plan, with an individualized credit based on age, sex, and location/region?
What if the credits were refundable, and payable in advance and directly to the provider?
What if the network of sliding-scale clinics were increased, and funding encompassed grants for under-the-deductible treatment at hospitals?
What if the narrow network concept was cleaned up — that insurers worked out relationships with providers that meant that potential customers could reliably determine who’s in and who’s out-of-network, that those network relationships endured in the long term, and that insurance customers could access needed specialists reliably, and were not trapped into high rates for out-of-network doctors at the ER? What if being in-network meant more than agreeing to a fee schedule, but also required a willingness to follow standardized standards of care?
What if funding for the tax credits came from a FICA/Medicare-like tax, or a transparent general income tax hike, rather than being hidden so as to appear to be “free” to taxpayers?
That, in a nutshell, would be Janecare.
Image from Wikipedia: https://commons.wikimedia.org/wiki/File%3ADoctor_examines_patient_(1).jpg; By Unknown photographer [Public domain], via Wikimedia Commons