The Current System
Doctors become members of insurance groups. Patients subscribe to these groups and are limited to only those doctors within the group. The absurdity of this arrangement is best illustrated by applying this same arrangement to the auto industry. Suppose that AutoInsuranceCo only allowed its customers to purchase AutoManufacturerCo cars and use AutoManufacturerCo mechanics. Furthermore, if an auto needed repairs, the owner would first need to take the car back to the dealer and get prior approval. Once this approval was received the customer could only use AutoRepairShop.
Separate Doctors and Insurance Companies
The key to this solution is to separate the doctors from the insurance companies. Insurance companies would cover treatment options and customers could select which plans they desired based on their own ability to pay a deductible. If a patient values cancer coverage he will pay for this. If a patient values traumatic coverage rather than routine coverage he can pay for this. This is akin to the auto insurance coverage where a person can select varying levels of coverage based on his own evaluation of the risks and likelihood of certain accidents and results from those accidents occurring (i.e. uninsured motorist, personal injury).
This will allow a patient to select any doctor to treat him. The patient can then negotiate the fee and the insurance company will pay its share of the treatment. This gives incentives to the doctors to lower prices and provide better care because they will be competing with each other more directly instead of getting automatic patients from insurance company referrals.
This may sound like a cruel idea but no service is owed to any person who cannot afford to pay for it. By eliminating “free” care to those who show up at emergency rooms without insurance coverage it will force people to place health care insurance on a higher priority level and thereby increase the amount of people who are covered. Those that do not pay for coverage will have acted upon their own value system without costing everyone else.Children who are not covered would still receive care but the parents would be held responsible for the costs via the court system. If a patient cannot or will not provide identification information, the hospital will be absolved from all liability for non-treatment.
In addition to this, bankruptcy law could be amended to remove healthcare debt obtained while a party is uninsured from the list of dischargeable debts.