Campaigns promise generalities but laws have to be specific. The health care disaster shows how difficult the road from promise to result is.

The current mess simply tried to do too much. There are two main problems in health care: cost and coverage.

85% of Americans have coverage that they are reasonably happy with. Costs are high for many reasons. We want short waiting times and high quality. We have some the best outcomes for most major diseases and access to wondrous new drugs and technology. Part of the reason health care is expensive is because we value it so much.

Yes there are administrative inefficiencies, but the cost shift from underpayment from government programs drives up costs much more. If one wanted to help drive costs down we would discuss tort reform, allow insurance companies to cross state lines, promote health savings accounts, promote final directives, and stem Medicaid fraud.

But rather than address the problems of the 85% they sought to address the 15%. Yet those without coverage are not without health care. And a case can be made that those 15% are closer to 5% when you exclude prisoners, those already qualified for government programs, illegal aliens, and those able to buy health coverage who choose not to.

But the difficulty comes when you require medical underwriting without pre-existing conditions. This sounds great but there are still two critical problems. Without forcing everyone to buy insurance people would simply wait until they needed it and the claims experience would drive costs sky high.  Without compressing the difference in premiums based on age, the older American’s would just get guaranteed coverage that they could not afford.

Both of these place an undue burden on the young.  Yet If we want to get health insurance into individual hands then we need some assurance that individuals can get reasonably priced insurance.

We could treat health insurance like a life insurance contract.  The younger you are the cheaper it is. You could lock into a plan period with restrictions on increases.  This is essentially an HSA.  When you are young with few claims you can build ‘cash value’ that can be tapped when you are older. This can be encouraged with individual tax credits for individuals to buy their own health care.

We tend to treat health insurance like auto insurance except that we file a claim for every oil change and flat tire. No wonder administration costs are high.

The problem is that the government wants to provide a benefit but not incur the cost. This leads to more cost shifting , some form of rationing, or lower quality care.  Proponets of more government involvement in health care contend that market forces do not work in the health care field.  I disagree; it responds to market forces too well.