I have previously posted some articles on the French healthcare system, which is the best in Europe.
Here is an article on the French system.
The French citizen or resident joins Caisse Nationale d’Assurance Maladie deTravailleurs Salariés (CNAMTS)—health insurance organisation for salaried workers. That covers about 80% of the population now and it pays 80% (often more like 70%) of a fee schedule for the doctor visit although specialists are allowed to charge more. French doctors are divided for payment and fee schedule purposes into three “sectors” after 1980. Sector 1 doctors agreed to abide by the fee schedule established in 1960, modified for inflation and technological changes. They are mostly primary care doctors although some had waivers from the fee schedule prior to 1971 because they were more experienced or had great reputations. Few are still practicing. Sector 2 doctors could set their own fees but reimbursement was still determined by the fee schedule. These two categories correspond roughly to Medicare assignment in the US. If you accept assignment, you agree to accept Medicare payment as the full payment (or 80% of it plus the Medi-Gap payment).
The French have private insurance that acts like US “Medi-Gap” polices but for all.
It seems unlikely to me that Democrats would accept a health plan that allowed balance billing, which is the only way to control costs, short of pure rationing. The French basically provide a fee schedule that is the same for everyone but which allows doctors to charge more if the patient is willing to pay. For example, I called the office of a new internist last week to schedule an appointment. The clerk required that I submit all my insurance information, not my health status, and the doctor would decide if he would see me. If he is that busy, perhaps he could justify charging more.
Here is another article from that series explaining the French system.
French primary care physicians are paid less than American but medical school in France does not require a college degree and is free. I suspect that system might be more attractive in the US than many realize.
Unfortunately, such a radical reform is unlikely. There are other options under consideration.
Here is one from an Arkansas Congressman.
Title 1: Private Sector Health Insurance Reforms
Data show that a small percentage of the insured population accounts for most healthcare expenditures. This bill creates an Invisible High-Risk Pool Reinsurance Program to pay medical costs of the highest risk individuals in insured populations. It does not affect patients or the services they receive—it just shifts some of the risk of paying for care to the government, allowing insurers to charge less for all private insurance coverage.
Title 2: Medicare and Medicaid Reforms that Promote Solvency and Increase Access to Health Insurance Plans
This portion of the bill preserves Medicare while fulfilling obligations to people who have funded the program for decades. It also allows Medicaid to fulfill its original purpose of providing for aged and disabled individuals while providing able-bodied, working-age adults private insurance plans through exchanges.
Title 3: Promote Transparency and Competition to Lower Prescription Drug Costs
It’s clear that the red tape surrounding experimental drugs and prescription drugs in general needs to be addressed. Patients with severe illnesses deserve access to medicine that could save their lives. That’s why the bill eliminates delays surrounding generic drugs and biosimilar products by providing more efficient processes.
Title 4: Increase Competition and Lower Costs by Discouraging Provider Monopolies
These provisions center on hospitals, providing incentives to promote hospital and provider competition and encouraging hospitals to reduce costs. Medical clinics and hospitals are the healthcare system’s first line of defense. Patients in rural and urban areas should have access to the best care at a fair cost.
Title 5: Digital Health Care Reforms
This section establishes policy allowing for increased use of innovative technologies—options in telemedicine, for example. Rural areas often struggle to attract providers. When facilities can use video messaging services to provide certain types of care, they essentially eliminate geographic and time zone constraints. Policies in Titles 3, 4, and 5 work together to promote a healthcare delivery system that works for all while allowing innovators freedom to take our healthcare to the next level.
Here is a key provision.
This bill creates an Invisible High-Risk Pool Reinsurance Program to pay medical costs of the highest risk individuals in insured populations.ection establishes policy allowing for increased use of innovative technologies—options in telemedicine, for example. Rural areas often struggle to attract providers. When facilities can use video messaging services to provide certain types of care, they essentially eliminate geographic and time zone constraints. Policies in Titles 3, 4, and 5 work together to promote a healthcare delivery system that works for all while allowing innovators freedom to take our healthcare to the next level.
We had risk pools before for the uninsurable. Democrats insisted that “pre-existing conditions” be included in standard policies, which made the policies unaffordable without huge deductibles. People with pre-existing health problems are uninsurable. No one sells fire insurance to a person whose house is burning down. Risk Pools are the answer. The French system excludes the pre-existing condition, but allows standard coverage for unrelated conditions. If a cancer patient gets appendicitis, that is covered while the cancer goes to the risk pool.
There are other reform proposals. Another comes from the Heritage Foundation.
Association health plans (AHPs). AHPs allow businesses, especially small businesses, to band together as a group for the purpose of purchasing health insurance for themselves and their employees. By banding together, small businesses and the self-employed will be able to avoid costly federal insurance mandates that Obamacare imposed on the individual and small-group markets. In June 2018, the Administration issued major regulatory changes to ease the formation of such associations for these purposes
This would restore the small group option eliminated by Obamacare.
Short-term, limited-duration insurance (STLDI). STLDI offers individuals a coverage option that is not subject to the costly insurance regulations of Obamacare. In February 2018, the Administration proposed restoring long-standing rules of operation for such short-term plans, undone by the previous Administration, and proposed consideration for extending the terms of such arrangements as well.
This could restore the high deductible catastrophic plans for young adults that were ended by Obamacare.
Health reimbursement arrangements (HRAs). HRAs are an employer-based health care financing arrangement that provide employees with greater access and flexibility for financing their health care. The Administration is expected to release a proposed rule to expand the flexibility of these arrangements, including consideration of using them with non-group coverage.
This continues employer based plans but there needs to be some cost control. The McCain health plan in 2008 had some provisions but the candidate did not understand them or could not explain them.
Provide block grants to the states. In lieu of the Obamacare spending scheme, the proposal would provide states with a fixed allotment of federal funding. The funding would be based on current state ACA funding and would be gradually rebalanced based on each state’s number of low-income residents, bringing greater equity between the states. The states would adhere to the following guidelines in using their allotments:
This is a way to control Medicaid spending. Obamacare is mostly an expanded Medicaid with private insurance being cost shifted into paying for it. Reforms, such as work requirements, are best left to the states.
Breaking the insurance company-hospital iron axis is important. French doctors and hospitals are required to post charges. This could be done online as many medical practices and hospitals have web sites. The charges need to be cash prices as pricing has been badly distorted for many years, first by Blue Cross and more recently by insurance companies which conceal payments and charges as “trade secrets.”
What we need is a cash medical system, with charges clearly disclosed and insurance for those items that are “insurable,” meaning those that can be underwritten by actuaries. Other conditions that are not “insurable” like trauma and critical care must have transparent accounting for charges.