Despite being a “grumpy sort of libertarian” I’m not entirely unsympathetic to the concept of some sort of single payer system in some form. Free market health care would be ideal. It also seems impossible. The vast weight of state and corporate interests pushing against a true free market system seems impenetrable.
Free market health care can’t work when the prices for everything are hidden from end consumers behind co-pays, insurance policies, medicare, etc. The only way to possibly introduce real free market reforms into healthcare is to force prominent upfront disclosure of prices of drugs and services to consumers so they can actually know what they are paying instead of hiding costs behind impenetrable walls of health insurance payments, medicare billing, co-pays unrelated to real costs, and drug prices that are never posted anywhere for consumers to see.
Even that would likely not be enough. Being able to pick from just a handful of insurance plans (or having to take or leave what one’s employer provides) does not give consumers enough power to really drive the free market’s power. Due to Medicare, Medicaid, military and the VA health care, Federal and State employee heath care—not to mention numerous state and municipal health care programs—government influence already dominates the health care market. Add to that millions of people who’s choice of health care is dictated by their employer with no input from them, save for the choice to change jobs.
I’ve often thought a national single-payer major medical/catastrophic insurance plan might be something that could fly politically. A national plan that takes over when total expenses exceed 10,000 USD or something. (I define “major medical/catastrophic” as expenses relating to a single medical condition and its sequelae.) Is this the answer? I don’t know. There does not seem to be the will to make real free market reforms, and the current situation with the Republicans are trying to patch Obamacare to make it palatable to the various interest groups who have paid them off over the years, is no fix.
As it stands, the current US health care system (with Obamacare and everything else) stacks the deck in favor of people who are connected to the government/corporate insurance programs, leaving small businesses and their employees, the self-employeed, and entrepreneurs out in the cold. They are stuck with vastly overpriced health insurance—or even worse, no health insurance—and a government ready to fine (sorry, “tax”, thank you John Roberts) them for the crime of being too poor to afford a crappy Obamacare Bronze plan. The type of health care which is precisely the sort of “fake insurance” that the Democrats railed against in their campaign for Obamacare—and insurance that costs most families nearly as much as their rent or house payment each month.