> The emergency allowed states to serve as “laboratories of democracy,”

Honestly, I've never liked that metaphor much, because it's missing the most essential attribute of a laboratory: actual experiments.

A real experiment is designed, run, completed, and evaluated, but "laboratory of democracy" policies always seem to be missing those last two crucial steps. When's the last time you heard of a state allowing an experimental policy to sunset, or taking a hard look at its results and honestly, openly concluding that it turned out to be a failure?

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> Rather than asking, “How can we increase coverage?” we can ask, “How can we provide better health to more people at lower cost, year after year?”

It's good to see people starting to see through the conflation of health *care* with health *insurance.* One of the strongest criticisms I remember being raised against the Affordable Care Act when it was still just a proposed bill was that you can't fix a problem by making it worse: the insurance system is responsible for so much of the problem with the health care system, so why feed tens of millions of Americans who've successfully evaded it thus far into its maw?

A proven solution that actually succeeds at lowering costs is what's called "restaurant pricing." It has two parts. 1) Every medical facility (hospitals, clinics, etc) publishes a public "menu" of every product and service they sell and what that product or service costs. 2) Everyone gets charged the price on the menu, regardless of how they're paying for it.

This simple, common-sense solution has a proven track record of driving medical costs down pretty significantly and improving care, through the basic market forces of transparency and competition. So of course hospitals and insurers fight tooth-and-nail against it whenever the idea comes up. But if we could get restaurant pricing instituted as national policy, it would go a long way towards fixing health care problems in this country. It wouldn't magically fix everything, but it's probably the single biggest improvement we could make.

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Aug 10Liked by Robert F. Graboyes

Another thoughtful post with great ideas. Your question “How can we provide better health to more people at lower cost, year after year?” Is truly the better question. I would also offer “How do we shift away from the idea that health is something purchased from experts toward a society that knows as individuals we are our own primary care providers through the actions we take every day?” When each one of us makes decisions about what we eat and how we live, expecting someone to later give us a pill or do surgery to correct the damage done seems the wrong way around. Certainly there are diseases and incidents that cause harm beyond our own reasonable control, and experts come in handy when that happens. But there are many other ways we can lead healthy lives without extremes in diet or activity, and if we did that there would be more available to treat the other stuff.

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Aug 10·edited Aug 10Liked by Robert F. Graboyes

Perhaps 30 years ago, I wrote a public health policy for Robert Blank, then a leading Poli Sci expert in that field.

Part of the 35- or so - page paper was a suggestion for extending HSA type insurance to many possible clients who didn't work for companies that had the capacity to do so.

Briefly, I believe that the feds could randomly sort, say, 50-100,000 potential individuals/families that are either on Medicaid or uninsured/underinsured and have insurance companies bid to sell the government HSA + catastrophic health insurance for that group. In addition, for very poor individuals/families, the feds could create and fill the HSA accounts up to equal the copays/deductibles. Just like regular HSA, anything left over for the year could go into a pre-tax investment account. I understand that not all would understand that last part, but still . . . And you could put into the account on a sliding scale, like the idiotic ACA up to maybe 4 times the poverty level.

I don't have the numbers any longer, and they would be dated anyway, but back then the cost was way less than the cost of Medicaid and the management of Medicaid. Plus it would save resources of hospitals and doctors' offices.

Please think about that, in a fleshed out form.

I got an A for the paper, and Prof Blank loved the idea, but said it would never get passed due to rent seeking. I agreed, but I still think it would work.

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