| How would we ensure that healthcare is provided to the millions of Americans who are currently lacking health insurance? I would start by arguing that the current model of health care delivery is broken and, moreover, unsustainable even for the part of the population with adequate health insurance. I think that different alternatives should be piloted to see what works and what doesn't. It will be interesting to see what happens with the Massachusetts model. I firmly believe that no single solution should be implemented on a national scale until it is proven to work at the state level. States should try different things until a winning solution is identified. One idea I had is to treat health care in a manner similar to how we care for our automobiles, where you have one system for maintenance and another system for catastrophic events. Applying this to health care would mean that routine health maintenance is accomplished with relatively low-cost community clinics, where a high percentage of routine health care would occur. This would allow hospitals to focus on what they do best, which is to handle serious health issues, such as crippling diseases, injuries from accidents, etc. This could result in less expensive health insurance, because "maintenance" health care would not be covered by insurance. Instead, people would go to their community clinic for maintenance care and pay for service, just as they pay for maintenance service on their car. Think about it: if your car insurance covered all service on your car, even something as routine as an oil change, it would be prohibitively expensive. Yet that is the model we currently have for health insurance. The difficulty inherent in this idea is to identify the services that would be performed by the community clinics and those that would be left to the hospitals. In considering the line between the two, I would argue that the clinics should provide those services that do not require expensive equipment and infrastructure. Instead, the clinics should provide basic treatment, diagnostic services, and wellness programs. This would make it easier to add new clinics by keeping the costs down. However, realistically, the clinics would need to be subsidized to some degree to ensure affordability. |