home

When health care is debated, most people assume that there should be only one health care system, and that the government should force the one health care system onto everyone. Supporters of government provided health care think that people who want free market provided health care should be forced to accept government provided health care. Supporters of free market health care think people who want government provided health care should be forced to accept free market provided health care.

But why should anyone be forced to accept anything they do not want? Since some people want government provided health care and some people want free market provided health care, why can't we have both? Multiple level health care rationing is an attempt to have both.

In multiple level health care rationing, the government provides health care.

Health care is rationed, and there are multiple rationing plans. Every person chooses one rationing plan. No person is forced to accept a level of rationing chosen by other people.

A simple health care rationing plan is likely to be controversial because different people want different levels of rationing. Multiple level health care rationing should be less controversial because people who want a different level of rationing will switch to a different plan instead of attacking the whole program.

Taxes would vary depending on which plan each person chose. A person who chose a plan with very little rationing would pay a high tax rate. A person who chose a plan with very strict rationing would pay a low tax rate.

For example, someone who does not want to be kept alive with a respirator or tube feeding could choose a plan which does not provide respirators or tube feeding, or a plan where life support equipment is disconnected after a month.

Why should a person who does not want life support services be required to pay taxes to provide life support services? (Why should a person who does not want to invade foreign nations be required to pay taxes to fund invasions of foreign nations? Why should people be required to pay taxes to provide any services they do not want?)

The costs of providing health care to the people who have chosen one plan should be paid by the people who have chosen that plan. The costs should not be shifted onto people who have chosed a different plan. If the plan with the least rationing has cost overruns, the taxes on the people who chose that plan should increase, but the taxes on everyone else should not increase. If the plan with the most rationing runs a surplus, the taxes on the people who chose that plan should be reduced, and the surplus should not be used to subsidize people who did not chose that plan.

If a person is run over by a drunk driver, and is lying bleeding and unconscious in the street, other people will probably put the victim in an ambulance and send the person to a hospital. This sort of emergency care should be included in all plans, so that emergency responders do not have to worry about whether or not they are supposed to help the victim.

The government should allow non government health care providers to exist and sell their services to the free market with a minumum of regulation.

The government would probably provide health care with government hospitals and doctors. Even if the government chose to contract with nongovernment hospitals and doctors, the nongovernment hospitals and doctors would be dependent on the government for money, and would have to comply with government standards and guidelines in order to be eligible for government contracts, and so the nongovernment hospitals and doctors would be effectively controlled by the government. The government would determine whether or not government controlled hospitals and doctors could also sell health care to the free market, and at what price. But hospitals and doctors which provide health care only to the free market should be mostly exempt from government regulation, and should be able to offer any service they want at any price they want.

People who think that health care should be provided by the free market instead of by the government could choose the plan with the strictest rationing and the lowest taxes, and then buy additional health care from the free market.

Some people would try to abuse the system by choosing the plan with the lowest taxes when they are healthy, and then switching to the plan with the most health care when they become sick. To prevent this abuse, people should be required to give five years notice before switching plans. During the five years transition between plans, people pay taxes at the higher rate, but receive health care at the lower rate.

Maybe the transition time should vary with age. The transition time could be five years for a young person, ten years for a middle aged adult, and 15 years for an old person.

The plan with the least rationing and the highest taxes might be especially attractive to the poorest people. The plan with the most rationing and lowest taxes might be especially attractive to the richest people. The system will fail if the poorest people all choose the plan with the least rationing and the highest taxes, and the richest people choose the plan with the most rationing and lowest taxes. Therefore, maybe the poorest people should not be allowed to switch to the plan with the least rationing and the highest taxes, but if a person who is in the plan with the least rationing and highest taxes becomes poor, that person should be allowed to remain in the plan with the least rationing and highest taxes. Likewise maybe rich people should be prevented from switching to the plan with the most rationing and lowest taxes, but a person who joins the plan and then becomes rich should be allowed to remain in the plan with the most rationing and lowest taxes. However, this might be difficult to enforce because rich people sometimes hide their wealth. Middle class people should be able to choose any plan.

If the plan with the least rationing and highest taxes is most attractive to poor people and the plan with the most rationing and lowest taxes is most attractive to rich people, then maybe some of the taxes collected from the people with the most rationing and lowest taxes should be used to subsidize the people with the least rationing and highest taxes because that would transfer wealth from rich people to poor people. However, this would create social tensions and conflicts because the people in the plan with the least rationing and highest taxes would be constantly lobbying the government to take more money from the plan with the most rationing and lowest taxes, and the people in the plan with the most rationing and lowest taxes would be constantly lobbying the government to take less money from the plan with the most rationing and lowest taxes. If no money is transferred from any plan to any other plan, then people will not argue or fight about how much money to transfer. Alternately, money could be transferred indirectly by exempting health care taxes but not payments for free market health care from income and sales taxes.

Multiple level health care rationing works best if there is not a lot of inequality of wealth, or else if there is a lot of economic mobility. Rich people should become poor and poor people should become rich more frequently than people switch plans.

People should choose a plan when they are young and poor and healthy, and stay in that plan for the rest of their lives. People should decide what health care they want and are willing to pay for while they are healthy, before they need health care.

People should be allowed to switch plans, but should be discouraged from switching plans frequently. The key to the success of multiple level health care rationing is setting the correct limits on switching plans. If there are too few limits on switching plans, people will game the system. If there are too many limits on switching plans, then people are not free to choose their level of health care rationing.

Multi-level health care rationing treats people unequally. Inequality is acceptable as long as inequality is based upon the choices made by people. But inequality without free choices is a caste system, and is a violation of human rights.

Babies should be included in the same plan which covers their birth mother. Prospective parents should be encouraged to choose a plan with less rationing so that if a future child should be disabled, then the parents can be assured that the disabled child will be taken care of for the rest of the disabled child's life, even after the deaths of the parents.

Immigrants should be included in the plan with the most rationing.

Emmigrants should be required to pay the health care taxes for five years after they emmigrate, but would not receive any health care. Governments should not tax noncitizen nonresidents, but contracts with noncitizen nonresidents are enforceable, so the multiple level health care rationing system should be defined as a contract.

The government could negotiate reciprocal transfer agreements with other governments with similar health care plans to make it easier for people to immigrate or emmigrate.

Theoretically, this sort of a health care plan could be provided by the free market. A private insurance company could offer a contract where you agree to pay a part of your lifetime income in exchange for lifetime health care. This sort of insurance contract is illegal in most countries, but it would be easier to legalize it than to create a government plan. However, there is a large number of people who want the government to provide health care, and these people would not want a governmentlike health care plan provided by the free market.

Also, the insurance company will probably have different management at the end of your life, and might even have gone bankrupt. People may doubt that the insurance company will be able to fulfill the contract in the distant future. In a free market, people often judge the reliability of a business by considering the reputation and history of the business. But it might take several generations for a business to acquire a good reputation for fulfilling lifetime insurance contracts. So many people would be reluctant to sign such a contract.

Multiple level health care rationingis a pragmatic solution. It should be acceptable to people who want government provided health care because they can choose a plan where they pay high taxes and the government provides free health care. If multiple level health care rationing includes deregulation of free market health care, then multiple level health care rationing should be acceptable to people who want free market provided health care because they can choose a plan with low taxes and strict rationing, and buy additional health care from the free market.

It is important that multiple level health care rationing should include both government provided health care and deregulation of nongovernment health care. People who want government provided health care may oppose deregulation of nongovernment health care, but if multiple level health care rationing does not include deregulation of nongovernment health care, then people who want free market provided health care will not support multiple level health care rationing. People who want free market provided health care may oppose government provided health care, but if multiple level health care rationing does not include government provided health care, then people who want government provided health care will not support multiple level health care rationing.

I think that a free market health care system would be better than multiple level health care rationing. However, I realize that many people oppose free market provided health care, and so I think that it is easier to establish multiple level health care rationing than to establish free market provided health care. I think that multiple level health care rationing would be better than government provided health care, and better than the current system highly regulated nongovernment health care. Also, I favor competitive federalism, and so I think that health care policy should be set by competing regional governments, not by the central government.

home