Some Thoughts on Fixing Obamacare – Shoot Holes in this Please

I’m not a healthcare policy expert. Not by a long shot.  The challenges facing healthcare in this country are enormous. While I may not have answers, there is no downside to generating discussion on alternatives.  Feel free to comment on anything you feel is wrong with my suggestion.

The problem legislators are facing in their attempts to “Repeal and Replace” or even modify Obamacare in a manner that will make their constituents happy is that they can’t answer one very important question-

“Who takes less ?”

The stakeholders in Obamacare are the Insurance Companies, Health Care Providers and Consumers.

Will Insurance Companies be willing to take lower profits ?

Will Health Care Providers be willing to charge less for the services they are providing or take less reimbursement ?

Will Consumers have to accept fewer services and lesser quality of care ?

No stakeholder is willing to take less. Which is why it will be near impossible to “fix Obamacare” in a way that makes consumers, also known as voters, insurers and healthcare providers happy.

Politicians can deflect and promote the benefits of a free market, but the free market shows itself every day in the profits of insurers and healthcare providers. I have yet to see a single public company in these spaces make an announcement that they are willing to or expect to take less because of changes to Obamacare. Have you ?

So what should happen ?

There are 2 risks that every single citizen of the United States shares:

1. We all can lose the genetic lottery and find ourselves getting seriously ill or worse. 

2. We all can lose the “wrong place, wrong time” lottery and find ourselves facing a significant or life threatening injury.

We all can take steps to reduce those risks, but it is literally impossible to eliminate them. On any given morning, every single person can wake up, feel a little off and soon come to find they are sick. 

At any given moment we can be in the wrong place and something catastrophic happens. A car. A bus. A baseball bat. A knife. A bullet.  etc.  All of the sudden our loved ones are praying for us.

Today, we deal with those fears by doing our own versions of risk management.  Most of us try to get a job that offers health insurance. Even if its a job we don’t like, we realize that if we lose in either of these lotteries we won’t be able to afford the health care we need.

Some of us do our best to afford the least expensive health care insurance with high deductibles and lie to ourselves that we will be able to save enough to cover the deductible or we can keep enough open on our credit cards to survive a disaster. Unfortunately,when disaster hits, we rarely have enough.

Some of us, like I did in my 20s feel invincible and think it won’t happen to us. Until it does.

Which leads to my suggestion.

Not one single person in this country is immune to losing the Genetic or Randomness of Life Lottery. Not one. Doesn’t matter if you are rich, poor, white, black or whatever religion you are, if any. We all have close to the same odds of getting ill or being in the wrong place at the wrong time.

It’s time we recognize these facts and deal with them accordingly.

Whether its Medicaid or a new program, every single person in this country should be covered 100pct for chronic physical or mental illness and for any life threatening injury.  

The premiums that we are paying to insurance companies as individuals or as company coverage for these significant risks would go from the insurance companies to the IRS. Only the cost of covering the what’s left would continue being paid to the insurance companies.

It would not be hard to do the math. Every insurance company does this analysis already. The government does this analysis already. We all would end up paying  more in taxes, but less in insurance and healthcare costs over time.

There would be no mandates. There would be no individual penalties.  No Tax Credits. No subsidies. No Offsets or deductions for buying higher end insurance. This will be single payer (yes i know its a dirty phrase in this country) for chronic physical or mental illness and for any life threatening injury.

Everything not covered by the above can be covered by insurance sold on the Free Market, managed by the states, sold across state lines, without government interference.

There will be unique opportunities for insurance companies to innovate knowing they wont have to face the most expensive healthcare problems and they can have the cushion of knowing that illnesses and injuries that they covered that transition to those covered by Single Payer Advanced will be reimbursed.

We all share the same risks, we all can share the costs of our greatest risks.

The  peace of mind this would bring to every family would make our country stronger. I know with certainty it won’t reduce innovation in healthcare. Technology is going to continue to boom and change our future.

There is something for everyone to hate in this. It doesn’t cover as wide a range of healthcare options as Obamacare, but it covers everyone. Immediately. No paperwork required. It is more humane, cost effective and fair than what the Republicans have proposed so far.

Which means everyone can rip it to pieces. Which is exactly what I want everyone to try to do in the comments so we can see how to make the concept better

PS – On the issue of drug prices, I would include an MFN for pricing for this government pricing.  Whatever the best price is you give to anyone, you have to give to this program.







310 thoughts on “Some Thoughts on Fixing Obamacare – Shoot Holes in this Please

  1. We must level the playing field for more competition. Open up the Medicare network and reimbursement schedule for commercial insurance companies. Let insurers compete on underwriting, the ability to improve the health of members, and programs to engage members in improving their health. This would also bring price transparency that is desperately needed. As you mentioned in your opening remarks, the big 5 insurers would be furious and likely lose profits, but it would save the healthcare system long term. As a billionaire yourself, what would be the biggest barrier to entry in starting a new health insurance company? Number 1 is having the network discounts. If you pay 70 cents compared for the same service Blue Cross pays 50 cents for, you’re cooked from “go”.

    Comment by Adam Marley -

  2. The Single Buyer Plan or the SB National Health Care Plan.

    Let me start with the statement that all planning, details and budget crunching would have to be carried out by the Office of Management and Budget, Health Insurance Companies and the Medical Community.

    What I am proposing is basically a Mutual Health Insurance plan that every American Participates in. Mutual insurance does not provide for profits, just the cost of claims plus administrative overhead. That is it. The Government and private business will no longer be involved in Health Insurance other than the IRS providing oversight and collecting the revenue and paying the premiums.

    Health Care has become a right whether we as Americans want to admit it or not since no Emergency Department of a hospital can turn away a sick person. This has caused a significant burden on the populace that is paying for their health care and the health care industry that provides it. Emergency rooms are over crowded since the uninsured use them as their primary doctors. It is the reason we have $ 500 aspirins in hospitals since the lost revenue must be recouped somehow. This is a plan that both Democrats and Republicans, Liberals and Libertarians can be happy with and hate because that is what compromise is all about but the real winners are the American people. Work out the details and Get-Er-Done.

    A summary of what this plan is capable of:

    • It will reduce Medical and Drug costs by creating a 350 Million person Risk Pool (Or whatever the U.S. population is at the time) therefore spreading risk across the entire population of the United States.
    • It will eliminate the abysmal treatment of our precious Veterans since they will be able to access any and all health care immediately.
    • The health of all Americans will improve since yearly physicals and vaccinations will be covered and encouraged.
    • It will provide Cradle-to-Grave Medical and Drug coverage for all Americans and eliminate all worries concerning Pre-Existing Condition or loss of coverage when moving from plan to plan, through divorce or death of a spouse or the change or loss of their job.
    • Everyone will contribute into the plan including any person inside the United States on visas or tourism and anyone in the world buying an American export. Since the rest of the world enjoys lower Drug prices and American drug research at the expense of the United States citizens the rest of the world will now contribute into the Health Care of the United Sates since the VAT tax will be applied to all goods and services including exports thus lowering the cost of Drugs for Americans.
    • It will vastly invigorate the economy and reduce the cost for Federal., State and Local governments since it will relieve all employers, including the government, the burden of providing health care as a benefit and in addition the Medicare Payroll tax will be eliminated for both employers and employees resulting in greater pay and greater profits. Our Esteemed three Branches of the Federal government and all State, City and Local government employees will now be on the equal footing as the rest of us Americans concerning Health Care.
    • It will help to balance the Federal Budget since it will eliminate the vast government bureaucracies that do little to enhance health care by eliminating the need for the Departments of Medicaid, Medicare, and Veterans affairs concerning health care. The workers in these agencies will then go to work for the private health insurance companies that will need additional workers to handle the massive increase in workload. The Federal government could then sell the Veterans hospitals and land to private interests and the doctors and nurses will move into private positions that will be created by the need for more health care providers.
    • Since they no longer have to provide health care benefits, the cost of running any government agency whether it is Federal, State, City or Local will decrease so Income, and Property Taxes will decrease.
    • The richest will contribute more since they consume more. Even tourists and teens shopping at malls or online will become contributors. Everyone will be contributing into the plan from the day they are born until the day they die and they will be covered from the day they are born to the day they die.
    • Even Car Insurance premiums, Home Insurance premiums and playground Liability insurance will decrease since the Medical Coverage portion is no longer needed.
    • All Monies (probably IOUs from the Treasury Department) now held by the Federal government to meet the needs of Medicare and Veterans medical will be transferred into the lock box immediately to begin the funding of the plan.
    • There will be a yearly Open enrollment beginning March 1st and ending April 15th through the IRS. Every Person inside the United Sates will choose the appropriate plan offered online by the Private Health Care providers on the IRS WEB site. The IRS will pass the information on to the appropriate Private Health Insurance company and pay the premium.
    • There will be no theft of funds targeted for Health Care since all of the revenue will be locked box never to be touched by any politician or government agency for other purposes.
    • It will increase Social Security payments since the Medicare premiums will be eliminated and there will be no need for Gap insurance.
    • It will lower costs and payment uncertainty for doctors, hospitals, and drug stores since every consumer will now be able to pay. The day of the $ 500 dollar Aspirin will be eliminated.
    • It will require every American to have either a Social Security number or a TIN. since the premiums will be handled by the IRS. All Americans will be accounted for since to receive health care coverage you will need to file taxes weather you need to pay taxes or not. Any person accessing health care without coverage will be required to explain why they are not covered and the IRS will be notified. There will be no reason for someone not to be covered.
    • The Health Care plan will be administered by the Private Insurance industry but no Private Insurance Company or investor will profit off the plan since it must be administered by Not For Profit insurance companies or subsidiaries setup for that purpose.
    • Long Term Care will be included in the plan to help the families that struggle with elderly parents.

    The difficulty with trying to resolve the Health Care crisis in the Untied Sates is the inability to think outside the box. Powerful special interests that do not what any changes are hard to overcome but I believe this plan will resolve the crisis. I call it “The Single Buyer plan” or the SBP National Health Care Plan.

    A big part of the problem is that far to many residents needing medical care and pharmaceuticals are not paying any of the costs for their care. This requires hospitals and pharmaceutical companies to charge patients that can pay, exorbitant prices in order to cover those lost payments. We all heard of hospitals billing $500 for an aspirin that actually costs the hospital .01 cents.

    So the first problem to solve is everyone must contribute without ridiculous mandates and mandate police. The way to solve this is to create a 7% National VAT tax. This way everyone, including tourists, contribute to the paying for health care. The revenue generated by this tax would be “Locked Box” with guarantees that it could never be touched except to provide premium payments (more on this later) for health care and pharmaceuticals. Now, at first glance, this would look like a 7% increase in taxes. Actually they may be no increase in taxes at all. In conjunction with the creation of the VAT tax there would be an elimination of the 3.5% Medicaid payroll tax. This would be a 3.5% percent pay raise for all employees and a 3.5 % increase in profits for all employers. There would be no exclusions for the VAT tax. Every product and service, including exports and imports, would be subject to it, period. Now that would appear to be driving the cost of everything up 7% but we just indicated that we gave every employee a 3.5% increase and every employer a 3.5% decrease that can be passed along in price decreases. in addition, greater reductions in prices would be generated since all employees, including the government and unions would no longer need to provide healthcare benefits greatly reducing costs of doing businesses. The tax would be fair to all since the more you consume the more you pay. The richest residents will bear the burden of the tax the most, since they consume the most all the way down to the poorest who will pay the least since they consume the least. Tourist (Who utilize our healthcare) and anyone avoiding declaration would pay in but would be unable to participate. This tax will not hurt commerce and would actually greatly benefit the economy because of the offset in costs previously detailed.

    The tax will be collected and distributed by the IRS. The plan will call for everyone to file taxes, regardless of weather you pay Federal income taxes or not. When a person files their taxes they will be given the opportunity to select a plan from any of the major health insurance companies. This is the “Open Period”. Every single resident will be given $ ?,000 (so families of 4 get $ ??,000) to purchase a Medical plan including drugs very similar that is what is offered today by the companies. Any health insurance company participating must be a non-profit company (major companies can setup non-profit subsidiaries just for health care). There should be no profiting from the national health care. This accomplishes some major goals. Everyone must come out from the shadows to get health care and it would create a pool of 350 million participants further reducing cost dramatically for health care. Hospitals do not have to charge $500 for an aspirin since everyone is paying for the aspirin so the charge for the aspirin can be dropped back to .01 cents. Anyone requiring medical care and not covered would be question as to why they are not covered, much like car insurance today.

    This would now resolve the great problem with our esteemed Veterans since they can now use any doctor or hospital in their plan. In fact, the Armed Forces would no longer be in the health care business except that which is required in active conflicts concerning field operations and transport to hospitals abroad. The Veterans Affairs bureaucracy can be eliminated and save the government billions of dollars. The Medicaid bureaucracy can be eliminated saving the government billions of dollars. The Medicare bureaucracy can be eliminated saving the government billions of dollars. The budget of every single government agency, including State, City and County throughout the United States would be decreased, since they no longer have to provide health care benefits, resulting in less local taxes. The Veterans hospitals and their land could be sold off to private health hospitals saving the government billions of dollars and would generate billions of dollars in revenue to be placed in the “locked box” through the sales of the institutions. All of the Medicaid money paid in over the last 8 decades ( Or should I say Treasury IOUs) would be placed into the “Locked Box”. The outcry of course would be that you are eliminating a lot of jobs and putting people out of work. Not so, the private health care industry would have to hire many of the laid off people to handle the administration of the plans and doctors and nurses to run the hospitals. The health care industry already has the infrastructure and experience in place to handle the plans.

    Imagine, every United Sates Resident, including Documented Legal aliens would be covered from cradle to grave with no complaining about who is and is not paying and who is and is not using health care more. Costs would greatly diminish and efficiency greatly increased.

    This resolution should be loved by Democrat and Republican, Conservative and Liberal alike. Business and government unions would be relieved permanently of the Health Care benefit and Medicaid taxes that would make the economy roar. Cost of care would drop dramatically, so much so that perhaps the VAT tax can be reduced.

    Fraud in the system would mostly come from one side of the equation since everyone would be covered and that anyone caught trying to defraud the system in anyway would be met with swift and harsh punishment of no less than 15 years in jail and forfeiture of all worldly assets. Tracking of expenditures would be easily tracked since they would be tied to each person’s Social Security number and Legal Document number. Every person would be notified of any usage of their plan and be able to view all usage of their plan through the participating health care insurance company the way they are today.

    The health care crisis can be solved if some great minds in America come together and formulate a plan like this. There will be great push back from special interests of course but that is expected and would have to be overcome.

    Comment by Jaycee Rel -

    • i been reading all the comment the simple and easiest solution is total government run. Even single payer may increase premium. The only way to pay is higher income taxes. government set prices for each procedure ,drug etc.. This way the young will end up paying to. I also will dump medicare and medicaid. Now in order to get better care everybody can get a blood test every quarter. i explain what i want in my blog but the government to corrupt on my system. We need better health care.

      Comment by Nick Ia -

  3. Lets say you just want to “fix” the ACA without any somewhat radical shift to partial single payer.

    First define what you’re trying to “fix”. The issue with the ACA is that the insured population is costlier than anticipated resulting in rising healthcare premiums. Which in turn can lead to the dreaded death spiral (a very real thing I watched it kill the organization I worked for.)

    So to fix it you need to dramatically change the insured population to one that is significantly healthier than whats in there already. And guess what! There’s an enormous, enormous population you could start moving onto Exchanges that would do exactly that! Everyone with employer-provided healthcare. Employment is one of the best single predictors of lower healthcare cost in the working aged population.

    (Personally I would love to shift my choice in insurance to the health exchange. Between switching jobs and having my employer shop around every year I’ve been on something like 5 different health plans in the last 6 years. Multiple times my wife and daughter have lost network providers that were essential to their care. Premiums and deductibles have continued to increase. Oh and I’m offered basically a single choice of insurance company with a high deductible and regular plan option. Much rather have had plan continuity over the years at essentially the same price)

    But the ACA and IRS made sure employers would have significant incentives to continue to provide private insurance. The ACA through penalties and the IRS not allowing employer contributions for health insurance to be tax free.

    But why oh why did they do this?

    Well you’ve left out an important stakeholder. The insurance brokers. These are the sales agents who connect businesses of all sizes with insurance companies for a significant cut of the insurance premiums (up to 10% as I recall). Every employer that would move employees to the Health Exchanges would have been a bite into their revenue and profits. The ACAs biggest failing is that it was designed to not impact profits of any single stakeholder in the healthcare industry hence it has to many compromises to work efficiently.

    So there you go. Alter the law to incentive employers to move employees onto exchanges. Maximize choice for ALL consumers, provide year over year continuity to consumers on employer-based plans, increase competition and remove an inefficient cost (brokerage fees) out of the system.

    If you can get that kind of legislation enacted might as well add a pony for everyone too.

    Comment by Darin Berdinka -

  4. So we already have single-payer for the elderly, the disabled, and the impoverished. Under your plan, we’re also gonna have single-payer for the chronically-ill and the catastrophically-injured. Why not just transition to a full single-payer system?

    It’s time to accept the facts — if we as a society want all working Americans to be able to afford all the healthcare they need, a free market system is never gonna be enough, no matter how tightly it’s regulated. Healthcare is just an inherently expensive product. But unlike all other expensive products, we’re not okay with a massive portion of the population not being able to afford it.

    Our approach to healthcare policy thus far has involved trying to use government subsidization schemes to make a free market system work. I think we should instead have a government-run system and use free market mechanisms to make it run more effectively.

    I propose that the government should establish a publicly-run, single-payer insurance program. But the program should charge a deductible equivalent to 8% of annual household income. In other words, every household must spend 8% of their income on healthcare before the government kicks in and takes care of the rest of their healthcare expenses for the year.

    The deductible handles of all of the most potent criticisms of a single-payer. It deters people from overusing the healthcare system, thus reducing the fiscal burden on the government and preventing the sort of systemic overload & supply shortages we see in places like Europe. It also facilitates competition on pricing between providers of routine healthcare services (e.g. check-ups, specialist consultations, lab work), since most of the people using those will still be paying entirely out-of-pocket.

    Comment by pragmatic247 -

  5. to lose insurance companies’ hold on all of it, they need to be brought under stringent regulations..perhaps the money going to them would better serve -us the people- by going to the government/IRS…at least they can be held accountable more easily..and can’t make profits on all of us who need health care -particularly the disabled and chronically ill..

    Comment by Ambra Moore -

  6. Just a quick additional point! The notion that all people that have a chronic condition under the age of 65, is because of “Life choices” they make regardless of their family history, work conditions, economic status and many other factors is basically displays a lack of understanding of of chronic disease and human behavior not to mention today’s reality. To boiled down to an oversimplified point of choice is simply wrong!

    People today and for the past 40=50 years, in developed modern democratic societies have been free to choose and have had greater choice over the years. They have more choice today then ever, which includes making the right choice for their health. They know more about what’s healthy for them then ever. Yet chronic conditions are continuing to be on the rise and not only because the population is aging. Chronic conditions among people younger population are increasing steadily and have been for the better part of the past 25-30 years. More and more kids between the ages of 8 and 18 are being diagnosed with type 2 diabetes. Yes, choice is important, but it’s not the only factor and not every person is in the same situation. In fact for MOST people with chronic conditions today, it’s not simply a matter of choice,

    One of the main problems, is that for most people, they care more about their wallets then their health, so they don’t pay attention to their unhealthy habits. Yes, these are habits, really difficult habits to change. Any good psychologist/psychiatrist can explain how difficult habits can be to change, not only from a social point of view but also a biochemical point of view. Note that social support and the environment plays a role here as well. People also are more stressed then ever at home and at work which has an impact on health and increases risk of developing chronic conditions.

    Again, if you spread risk overall, you decrease cost for everyone. Any insurance actuary can explain this.

    There are ways from an insurance point of view to incentivize people with chronic conditions to make better choices and that could be decreased premium if you go to all your health check ups, if you attend all your sessions to the clinical exercise physiologist or dietitian that you were referred to because doing decreases your health risk in a similar fashion the not smoking, or wearing your seat belt does. If you are a non-smoker, and wear your seat belt in a car and don’t skydive your health RISK is deceased and thus you pay less.

    Whatever we do we cannot oversimplify a very complex issue, we cannot continue to repeat the same mistakes that got you in the problem in the first place and you have to be careful not to let yourself be manipulated by special interest groups and lobbies that would prefer that you stay sick or become sick or continue to make those bad “choices” so that they can continue to profit…

    Comment by HBalekian (@hnb250) -

  7. I would like to make a few comments to this, but for the record, I am not a health expert either. As I was contemplating my input, many people gave a ton of great inputs above and I apologize as I did not have time to read them all.

    First, I don’t agree 100% with your statement…”Whether its Medicaid or a new program, every single person in this country should be covered 100pct for chronic physical or mental illness and for any life threatening injury.”

    Life threatening injuries – yes
    Taking care of our elderly population — yes 
    Genetic lottery losers for chronic physical or mental illness – partially yes — 70-80%

    “Life choices” that lead to chronic physical or mental illness – no.

    Those are choices that have negative health consequences and those people who make those choices need to deal with those consequences. The general populace who lead good, healthy lives should not be paying more for health insurance to cover drug addiction, smoker related illnesses, alcoholic dependency, etc.

    — Health Company Treatment Centers funded through a mixture of 1) Health company funds, 2) donations, 3) % of Lottery business earnings, and 4) possible Government aid (but not as a standard) can help these individuals.

    The risk Health Insurance companies take, is part of their business. The government should not be subsidizing away that risk. All businesses take risks…and most don’t get subsidized.

    People buy insurance, because in general most people don’t financially plan or save for these unseen events. Tax deductions for Health Savings Account is a no brainer – great thing. It encourages a financially responsible behavior.

    — Health Insurance and other companies were stealing money from hard-working families by taking unused Health Savings Account money??!!!! This is abhorrent practice and these companies should be penalized.

    I would make these Health Savings Account program distinct and separate from Health Insurance companies or businesses that may abuse it. Perhaps financial institutions who can take a modest fee and invest the Health Saving Account money, so it actually grows for these Americans. Not Health Insurance companies or businesses investing the money and keeping the profits for themselves.

    Since it is obvious the Health Insurance or some business companies can’t govern themselves, we need government regulations to clearly define what the “spirit of the law” is and that it is for the American people’s best interests. Health care Insurance companies will continue to make profits without stealing from the American people.

    There are so many aspects to healthcare…a few are listed below:
    — The Affordable Care Act regulated a Family Practice or Internal Medicine doctor’s time for an appointment worth only $40. Doctors can’t afford medical school to only get paid $40. Or it makes the doctors rush through patients and not provide the best medical care as the push to get more patients through in a shorter amount of time.
    — Drug prices are a direct relation to the cost of developing drugs—which is very expensive. We don’t need these companies cutting corners. Also, people should be able to sign up and take risks for drug trials which may or may not help them – within certain due diligence parameters.
    — Health company appointment telephone lines and other lines need to be governed. Veterans, in some locations, are not able to get through on appointment lines leading to death or delayed treatment.
    — Health insurance companies are transferring mistakes of their employees to the patients, which is inexcusable. When you are ill, doesn’t matter how smart you are, its hard to deal with simple things like appointments or approval for recommend procedures. It shouldn’t be a hurdle a sick individual has to jump or climb over.
    — Physician Assistants (PAs) shouldn’t be allowed to prescribe narcotics under any circumstances for any State or program.
    — A Doctor of any medicine practice, including mental health, should not get paid unless they see a patient themselves and are responsible for the prescriptions their office provides to those patients.

    I could go on and on…obviously we’re not going to resolve healthcare issues in a blog. The leaders making these decisions should be experienced and not open to lobbyists.

    One thing I think we should focus on, is how technology can improve healthy living, communication with doctors, and ultimately healthcare itself. (Health Apps, etc) If we are to invest in our future…give tax incentives for investments in Healthy Living Medical Facilities.

    Comment by helpwhenyouneeditblog -

  8. Pingback: Jill Sebren

  9. This is a critical question in the US and can have an impact in many countries around the world as they look to other systems including the US for guidance in establishing the system that suits them best or that they can draw from for best practice. Unfortunately, the reality is that overall, if one compares to other systems, best practices are found elsewhere!

    Insurance Companies:
    They must focus more and more on products (packages) that contain services that help portray them as partners with their clients (individuals and companies) by providing a product that will help the patient not only get good coverage for an acute event such as emergency care but also in preserving their health and helping them avoid (or at least mitigate the risk of) a costly catastrophic event such as a cardiac arrest, stroke, open heart surgery, angioplasty and other services that carry high risk and may negatively impact quality of life.
    This will help them build loyalty and improve brand value! In addition to this, eventually their total payouts would go down because of fewer high end cost and avoidable complications.

    Healthcare providers:
    The fee-for-service model is huge contributor to the problem because and from a fundamental health economics points of view is a big part of what created the problem in the US (along with long established lobbies). The fee-for-service system serves emergency services (such as accidents) and acute care and communicable diseases such as bacterial infections well. This is what we were mostly dealing with at the turn of the century about 100 years ago.
    The problem today (and for the past 50-60 years) is that the bulk of all medical treatments (70-75%) are related to NON-COMMUNICABLE diseases which are chronic conditions such as heart disease, diabetes, hypertension, obesity, high cholesterol, metabolic syndrome, just to name a few of the most common. THIS IS WHERE MOST OF THE COST IS COMING FROM. This is evidenced in the fact that, again, about 70% of all healthcare costs today (and for the past 50 years) are related to treating these conditions and their complications. Because people live with these conditions for 20-30 years or more, the fee-for-service model within which the doctors must work in, is totally not well adapted for today’s reality and for this population. The way the model is now, it is actually more profitable for healthcare providers if you are sick and need more medical attention, and hospitalization and God forbid, if you suffer a stroke or heart attack and need major expensive surgery!! At the moment, it is more of a sick care system then a healthcare system. This is one of the drivers of medical inflation in the US (especially as the population is getting older) and one of the core reasons healthcare cost in the US with respect to GDP is among the highest in the world! YET, the outcomes are as good as Cuba’s (Sorry Mark, but this is true)! The US ranks in 37th place according to the WHO organizations of World’s Health Systems. That’s lower then the UAE, Costa Rica, Malta, Chile and many more. If, on the other hand, outcomes are tracked and providers would be reimbursed on value and outcomes, then the standard of care would increase across the board and we would see fewer expansive, high end complications with hospital stay. It would be in the best interest of the healthcare provider to work in a coordinated, multi-disciplinary fashion to ensure the patient gets the best care, stays healthy and isn’t ending up in the emergency ward and hospital when he is not suppose to be there.

    Consumers don’t have to accept “fewer services” and lesser quality of care”, they just need to demand more accountability and coordinated and comprehensive care that will help them better preserve their health, prevent complications and improve their quality of life. This likely means some form of bundled payment (that is risk adjusted for each person according to their condition) that includes all specialties that contribute in improving outcomes and quality of life and decreasing (or mitigating) complications. This means a payment that covers doctor’s visits, consultation with dietitian, clinical exercise physiologist and perhaps consultation with psychologist for behavior change depending on the situation. All this would be far less expensive then all the procedures and complications mentioned earlier (stoke, heart attack, amputation because of diabetes, kidney failure, open heart surgery, angioplasty, etc…plus hospital stay).

    Yes liability is an issue in the US. Yes, the cost of medications is a huge problem in the US and yes they will need reform but the way care is delivered is, at the moment, as I mentioned, sick care not healthcare!

    As for the ACA, a few things can be tweaked such as how much the younger folks are paying for coverage, what the deductible is, what penalty is for not getting insurance and other incentives can be introduced (tax credits and other) to address the main issues and some of the things that are driving costs up for certain people. One critical factor in decreasing the overall risk pool is to get as many people covered as possible which means not only the sickest people but also the younger healthier folks as well. This will effectively decrease the cost across the board for everyone.
    Note that the higher deductibles are suppose to incentivize people to be more responsible and accountable for their own health and take positive actions towards staying healthy (or healthier) which, as we know does not always work.
    Health Savings Account are a viable option that can help with payments when needed for all sorts of services including preventive services (dietitian, clinical exercise physiologist, etc).

    One thing is for sure, healthcare is not like a car or like purchasing anything else and it’s like no other business. People don’t always know what’s the best option for them (especially in healthcare) and that is why you need to have a bare minimum coverage in order to meet today’s healthcare needs and positively affect cost. At times, the consumer knows what they need only after they see it or are made aware of options but those options need to be there to begin with for them to make that informed choice!

    Comment by HBalekian (@hnb250) -

  10. Mark, it’s simple. Buyers compete on only one thing: price. It’s a rare buyer who offers his doctor’s daughter piano lessons in exchange for prioritizing knee surgery.

    Single payer systems achieve lower prices, because buyers don’t compete with each other. It’s called collective bargaining. The reason Medicare gets better prices than any other insurance in the US is because grandmas don’t compete.

    Guys like Bernie aren’t just “mindless socialists”, they get it. And a lot of the country does, too. Single payer isn’t a dirty word in as many circles as the vocal minority would have you think. And the data around the world shows it achieves lower prices for the same outcomes.

    All the fear-mongering from the right comes from having a mantra: the government is always worse at everything. So perhaps the key is to make four large insurance companies and make sure people to use one of them, which is the model in Israel since 1995.

    As with all market distortions, though, we have to be careful. With great power comes great responsibility. Look at how Amazon can squeeze publishers, Apple can lord it over app developers, etc. Regulations and risks of litigation make it more expensive for doctors today. Perhaps there is a deal to be struck with reducing / streamlining regulations in exchange for transitioning to a single payer system.

    What is missing, in my opinion, is a roadmap that enough stakeholders can sign off on, that transitions smoothly to a single payer system.

    But with the rise of automation, wages will become less and less effective as a way of delivering money/good/services to the regular people. Once the truck drivers, fast food workers, and various attendants/assistants are laid off, it’s a pipe dream that they will all “re-educate” themselves for the “new economy” because AI will automate things across the board, including in the “new economy” jobs. Demand for human labor will continue to get lower. And thus, we will need single payer systems or UBI anyway.

    Perhaps (just for political reasons) we can phase in UBI and people can choose to spend it on health insurance. They will still compete with each other so prices will still go up, but maybe UBI can grow with inflation. It might be the more politically palatable move than single payer, because buyers will compete and Libertarians and Republicans will be happy.

    Comment by Gregory Magarshak -

  11. “… would go from the insurance companies to the IRS.”
    “Power corrupts, and absolute power corrupts absolutely.” -Lord Acton

    Comment by Dave Scotese -

  12. Good points Mark. Let me state the basics: The abject US healthcare mess stems from system failure to correlate the two fundamental building components of any healthcare policy/program: Cost of Care, and Delivery of Care. At the very root before these two items can be addressed intelligently is whether healthcare coverage is deemed universally a Right, or a Privilege for US citizens. Until we answer the latter, it will remain a complex, unresolved sh*t storm. No one in Congress seems willing to frame it in these terms.

    Ours is a really complex bad mix of both Right and/or Privilege. A Right, if you’re 65 and older, or Medicaid eligible (based on financial, emotional, mental need), or in a class (e.g. military, veteran, etc.). It’s a Privilege for everyone else—if one can afford it. If one is employed by an organization that offers group coverage (hopefully affordable), you’re generally fine. Everyone else—go pound sand, pay out the nose. As 1099 self-employed, pay up–if you can afford premiums, or go uncovered. Risky, and nonsensical.

    This bad mix is impossible to manage. Is financially unsustainable for all. Unresolvable. Out-of-control with drug companies, insurance companies, ACOs under ACA laws (big hole here), FDA, crazy torts, fee-for-service, State Laws, etc—I could go on and on with the MANY layers and bad actors!

    We must choose and declare: Right or Privilege. Only one. Not both. Then step forward to couple Cost of Care and Delivery of Care matters.

    The US dismally and shamefully fails to provide a *basic* level of healthcare for all. A basic coverage would/should de-risk the 2 points of LIVING you pointed out. Seemingly all “peer” countries in the world have figured this out. Theyre doing just fine protecting their societies—with greater per capita percentage covered at much less the overall cost. In US, our total spend is +3x vs. our next “1st world” peer, yet we leave 20% uncovered, where peers cover 95%+.

    My initial solution path to make sense of all this once and for all:
    1. Pass SIMPLE legislation making healthcare coverage a basic right for everyone. Define and provide a *basic* level of protection so that no one ever faces financial ruin, or bankruptcy, due to a major medical event.
    2. Remove state boundaries in health insurance industry. These protectionist constructs inhibit free market forces that would allow economies of scale. This would force insurance companies to play better.
    3. De-regulate and simply regulatory complexity. Perhaps an unintended consequence, the ACA laws as written encourage ACO (accountable care organizations) to get bigger by acquiring and concentrating market power amongst fewer.
    4. Reform tort awards so that they’re reasonable. Providers have to charge high prices for services because liability insurance is so costly—due to vastly high tort awards,
    5. Stop all these fee-for-service stuff. It only incentives the bad actors to keep charge more with disregard.
    5. And on, and on (I best stop here for now…)

    Lastly, I estimate a large chunk of US healthcare would be affordable to remove the unlimited spend in military and other seemingly black box programs that US citizens never get a good accounting of. I’m all for a strong military, but c’mon. No accounting! The US tries to rationalize the cost of healthcare within its own bubble. Rubbish! In any typical American household budget, to afford something on a limited budget, we simply figure out don’t spend on other things.

    Thanks for raising the issue and offering the opportunity for discussion/feedback!!

    Comment by jameswong1111 -

  13. Mr, Cuban

    You are ignoring probably the most relevant stakeholder, those folks that enjoy the ESI tax exclusion. Group Plans, both private and public sector where an employee earns an employer paid premium, tax free. In addition using section 105, the employee contribution is deducted before calculating payroll taxes. I have read this perfectly legal tax exclusion amount to $400 to $600 Billion per year in US tax revenue, or enough to cover everyone on Medicaid.

    Furthermore negotiated groups bargain for enhanced plans that then crush the municipalities who have no choice but to raise property taxes. Dr. Jonathan Gruber, in his lecture at Holy Cross in 2009, stated the problem isn’t necessarily uninsured folks because they has access to healthcare, but rather the ones who are over insured, that drive up the costs with no buyer discretion in the provider market.

    Comment by Tom Cavanagh -

  14. Hey Mark, the ideas you have proposed work on the surface but there are some issues when looking into the details. The greatest aspect of your post are the discussions and brainstorming around possible solutions which people are talking about in a civil manner. It is rare to find a leader who is willing to throw out ideas to get a discussion started on a difficult topic and to be willing to accept feedback from the entire internet – you are a great example every leader.
    That said, I have tried to address a number of the items in your post – I have not done each subject justice as the overall complexity of the industry would require a novel to address.
    A fundamental part of Obamacare (ACA) was the penalty for not carrying health insurance. During the marketing of the ACA there was a commonly quoted statistic that there were x # of millions of Americans without insurance – a large number of these were people not looking to obtain insurance. As you mentioned, younger and generally healthier people had to weigh the costs of a health plan compared to the likelihood of needing to use insurance. Being younger, I didn’t view health insurance as a necessity due to the costs versus the probability that I would go to see a doctor maybe once a year and possibly require a visit to an urgent care facility once per year (I live hard). Being a self-pay patient paying cash, I could typically work out a great deal with the providers since they were getting cash on the same day of service and not having to deal with getting reimbursed (cash cycle management is a major concern for many smaller physician groups). This is not an attitude which is uncommon with younger persons – it won’t happen to me but if it does I will figure it out. However, as our nation ages, the younger people were absolutely required to reduce the healthcare costs across all age groups; the younger people were supplementing some of the cost for the older generation. Most states mandate some form of automobile insurance to register a vehicle so it is not out of normal to require insurance coverage.
    It is obvious that the US system as it exists today is not a sustainable one, especially for low and middle class families. But you are absolutely correct, no one (HC or other industry) is going to want to take a smaller piece of the pie, but all entities involved are getting massively wealthy – at the expense of everyday Americans. What you have proposed here would greatly simplify the monstrosity which is the US healthcare system.
    The single payer system has long been viewed as the gold standard in reducing the costs associated with administering health benefits. Models of how this system do currently exist in places such as Canada, the UK, and many emerging markets which require more centralized control and planning. However, they are not ideal for all cases. There are often massive misalignments of supply and demand when healthcare is not subjected to market forces. So much so that effectively all non-urgent care is relegated to a waitlist. That is why many Canadians for example come to the US and pay cash (or utilize a Health Advocate to agree on pricing) for non-urgent surgical procedures. This is also a leading argument when proposing allowing the market to determine supply and demand. With no market competition, a central payer can and does dictate what pricing for services should be – studies have shown that universal coverage reduces physician earnings by as much as 70%. There may well be many older physicians who retire as they no longer see the payoff for their work and currently there are not enough doctors coming up to replace them. This would further complicate the issue of supply and demand of healthcare services. In conjunction with the massive disparity in population size and density when comparing the US market with existing single payer systems it is highly unlikely that this solution would benefit most Americans. The consequence of this is wealthier patients who are willing to pay above single payer rates would be able to use the best doctors and hospitals and we would expect a similar pattern to Medicaid – doctors only willing to treat for higher rates.
    To a certain extent we already have some of the features of what you are proposing – look at Medicare for example. Medicare Advantage plans were offered to allow private insurers to offer and administer Medicare plans and in the majority of states private insurers were able to administer these plans more effectively than the government. Further, Medicare/Medicaid are significantly less efficient when looking at fraud, waste, and abuse reduction. I believe it was a study by the National Institute of Medicine which estimated as much as 30% of all medical claims were wasted and government administered plans were on average much less effective than private payers. Under ACA, many abnormally large claims and non-covered losses were largely essentially reinsured by the American taxpayers. Health and Human Services (HHS) calculated the necessary funding requirements to cover these catastrophic claims and applied a tax to all private health plan offerings. The fund was in the black for 2 months or so as I recall. Unfortunately, the taxes and fees had to be kept low from a political position to get the ACA passed so this fund was largely ineffective in its intended purpose but further increased the costs of health insurance for the majority of Americans.
    Additionally, health insurance is far more complicated than benefits administration and claims payments. There are matters of enrollment, benefits configuration/ coordination, customer service, etc. which the government does not have to fully engage in based on a single payer model. While this may reduce some costs, it will undoubtedly increase many more – especially in a model which also allows for private payers to offer certain benefits.
    Regarding the financial aspects of your proposal, I do not agree with having the IRS be the fiduciary in this or any system. The IRS at capacity enforcing the existing tax code so having them be the vehicle for collecting and appropriating funds is going to be difficult without massive expansion and I don’t think there are many people who are looking for a larger, more involved IRS, haha.
    What would greatly benefit our system is reducing costs in areas which do not directly improve healthcare delivery, such as in the area of litigation. Now before I anger a bunch of attorneys, I am not advocating removing the ability to seek indemnification for legitimate cases but there are attorneys who make a career out of exploiting this area. Medical malpractice costs (both insurance and settlements) have already reduced the number of practicing physicians in certain specialties such as pediatrics and OB/GYN. This change would need to be well thought out to protect both the patients and providers but would reduce a significant cost from the industry which overall reduces the effectiveness of delivering healthcare services.
    Second, investments which aim to reduce fraud, waste, and abuse should be rewarded more heavily as these costs also reduce the effectiveness of our healthcare system – this would be a good use of investment dollars.
    Lastly and in my opinion most importantly, we need a reimbursement model which will help to reduce the cost of health care overall. Around 1% of the population is responsible for 20% of current medical costs due to chronic conditions – some of which are preventable, such as COPD and lung cancer as related to smoking, or those which can be mitigated through healthy behaviors (such as ER admissions related to diabetes which can often be improved through healthy lifestyle choices). With all the technology that exists today investments in improving individual health outcomes are likely to be the lowest cost investments which optimize the long-term results. Coordinating care and reducing redundancy in treatment (through a better electronic health environment) would optimize each and every dollar associated with healthcare. As people require less care for preventable issues, more care can be appropriated for genetic related issues and unforeseeable injuries – this would optimize the time, effort, resources, cost, etc. of providing care across the industry. The resulting lower costs would enable hospitals and physicians to charge less for each encounter which should in turn require the insurance payers to cover less losses and therefore charge less revenue. In a model where payers, providers, and individuals are all engaged, it is likely the individuals who are most capable at effecting positive, sustainable, long-term changes in the industry.
    How much are we as individuals responsible for doing our part in improving the healthcare situation in our country? An ounce of prevention is worth a pound of cure!

    Comment by Matthew Lukas -

  15. Growing up, I watched my Mom became OCD towards providing dignity to seniors living at the care home my Dad’s Mom lived her final 18 years. After my Dad died a month before his mother, I watched my Mom spend her next 10 years providing home care to her parents to keep them happier at home.

    After my Mom was diagnosed with Alzheimer’s, I attempted the same for her. As a baby boomer engineer I knew my best chance to solve the issues before someone care for me was to get first hand experience.

    A few things I found:
    – An invisible army of home caregivers carry extreme burdens 24/7 with little to no support and many with no compensation.
    – Pride to low self-esteem prevents many from requesting timely support.
    – Age dries senior caregiver’s support options most due not being able to keep up with tech, rarely driving beyond their closest grocery store and soon will stop letting any stranger, including safe ones, into their home.
    – The protocols connecting a unique home care environment to a ‘one-size-fits-all’ healthcare platform doubles the burdens while creating ‘Catch-22s’ the caregiver fully endures since they must become ‘one’ with the care receiver. The extra burdens and C22 pressure takes direct toll on their health they break prematurely ending low cost home care and while the caregiver is faced with their set of new health issues.

    Notes post turning 50:
    – the uptick of healthy friend’s losing the health lotto feels more like we’re trying to avoid snipers.
    – those ‘aged’ out of their job/healthcare are finding ‘overqualified’ prevents them from finding any job with/without health care.
    – our healthcare system will easily keep us alive another 50 to 60 years, not the 30-40 years dialed into the retirement plan.

    All in all, seems mixing baby boomers with our healthcare system will result in something not unlike ‘elephant paste’.

    I would consider a health amendment knowing how the 2008 housing crashed played out. After drilling into the itemized health costs, it’s hard to imagine our healthcare industry isn’t creating a massive bubble like tech and finance did. A health amendment to protect seniors and those at the end of life seems fair since they should take part in our fall.

    Else voting amendment for them…
    The 15th and 19th amendments created equal ‘healthy voter’ rights. With age, being locked in, drugged induce, etc creates too many voting booth hurdles. Many barely have the energy to get to the mailbox. If they could add their vote maybe many issues healthy people can’t grasp would be fixed before the Piper has to sit them down to explain how fate really works.

    A baseline amendment seems reasonable since an insect, doorknob or sneeze proves other people’s health is my responsibility, especially if I care for my family. Allowing sick people to bear arms never pans out well. If the founding Fathers risked their lives to write it, making sure citizens are healthy enough to maintain it makes sense.

    Still, the home care issues I saw were mostly created by half-baked capitalism where a shareholder is valued more than a person’s life. Fifty years ago…okay. Today, way to many references to show we don’t have an excuse.

    Fully-baked capitalism where at least those who aren’t capable of a full life are given more value than a shareholder…is a jump-able hurdle. Maybe in another fifty years our kids will raise the bar to help everyone.

    Definitely open to discussions on a baseline health care amendment but think creative capitalism is optimal.

    Comment by Joseph Chip Caver -

  16. You have some great ideas here. We need to remember, people need healthcare, not health insurance. There is a comment above about setting insurance like an auto policy as high deductible and bringing in a good foundation of community based standard care. This is where we will head if we are smart. From someone who worked in claims for a large insurer, 95% are simple visits that are costing $300 instead of the $20-$40 they should. At the end of the day we are getting gouged and our quality of care isn’t even as high as it should be. Take a look at the profits of the large payers and you see proof. We lower the cost by bringing in more nurse practitioners and right sizing the care required for the need. Introduce competition for these easier services and the doctors will migrate to the tougher cases with the higher dollar amounts naturally. “Right sizing” the care needed eliminates waste, including those trips to the ER for a cold. The “ER” should have the responsibility not to treat a non-threatening type of situation. Lots of re-balancing and re-routing of care would tighten up these wasteful practices. Thanks for opening up this question.

    Comment by Jason Black (@Jason_M_Black) -

  17. We are not having the right fundamental conversation. Health insurance does not equal health. Health insurance should revert back to insurance (like your car, renters or homeowners) and be there when the big stuff goes wrong. Within that gap, we will create a new system of helping people improve their baseline health – this dream has to happen at a local level, with people helping people. We need to recognize each and every one of us can do one small thing to improve our health (even as small as replace one can of soda with a glass of water per day) and that what each and everyone of us should do is very different and accepts a whole host of other realities (income, work, family, location, weather, cultural norms, etc.). The solution is not difficult – we just have to begin with the right mindset and at the right place.

    Comment by Joanne M. Frederick (@FrederickJoanne) -

    • my main concern is the current health care system is ancient. doctor don’t check vitamin level. We need more preventive care so thing wont. our food supply is tainted. and what about these vaccine are they really safe

      Comment by Nick Iacovelli (@nickhere1) -

  18. Revised Comment below due to typos in previous post:

    I’m not a healthcare expert, but your ideas sound like a common sense solution. Imagine if in this wonderful country, we had more concern for each other’s healthy well-being. I only wish I had health insurance coverage. The medicaid expansion wasn’t accepted here in Virginia. So being unemployed, for me, means being uninsured. Over the last four years, I’ve been working assiduously on ways to create my own livelihood. One of the many outcomes of that would mean being able to afford and have health insurance. So how does an able Main Street gal experiencing economic issues bring her idea to life? I feel so invisible. (Comment is by Lorraine)

    Comment by yogasports (@yogasports) -

  19. I’m not a healthcare expert, but your ideas sounds like common sense. If only we had more interest in the healthy well-being of each other on this wonderful country. I only wish I had health insurance. The medicaid expansion wasn’t was accepted here in Virginia. So being unemployed, for me, means being uninsured. Over the last four years, I’ve been working assiduously on ways to create my own livelihood. One of the many outcomes of that would mean being able to afford and have health insurance. So how does a Main Street gal bring her idea to life? (comment by Lorraine)

    Comment by yogasports (@yogasports) -

  20. Pingback: Democrats Against Single Payer ← Health Over Profit

  21. Thank you for posing the question. It is the only base from which we have to solve this issue, but it can be solved. For the discussion to begin however, all politicians need to stop with the posturing rhetoric and get down to business. I do not want another press conference where we hear about health care being a right for everyone or ObamaCare is a scourge to all Americans. Really, I want all of the them simply shut-up, go in a closed room, develop a plan that works functions for most people, be honest with straight-forward language when presenting it, and move on.

    Comment by kentscotland -

  22. Price Transparency! This is the key. The price should be published by Providers no matter what insurance one has. It’s terrible today! When i call to ask how much x y or z costs, the provider asks me to tell them which insurance I have, then they’ll tell me how much. All codes should have a price and be required to be published for all to see and know! Regardless of which insurance company!

    Comment by Camyrah (@Camyrah) -

  23. Hi Mark. My comment was omitted from the proposal for a purely HSA process. I believe we need to get rid of insurance companies altogether as they are so convoluted in their billings, payments and coverages. The following HSA proposal has been sent to every Colorado state representative and my federal (Gardner and Bennett) representatives as well as directly to the White house.

    Comment by Nancy Davis (@seniorphotonut) -

    A. Every individual to have their own HSA to be used individually or collectively within an immediate family.
    B. HSA funds could never be used for any purpose other than direct payment to approved health providers.
    C. HSA funds could be transferred to another account that might be short in time of catastrophe or willed to beneficiaries.
    D. All HSA accounts to be held in local financial institutions capable of reinvesting holdings in the form of loans to local individuals, homeowners, and small business or corporations that are entirely American made in focus.
    E. HSA holding institutions could never charge for their HSA services as they would have the benefit of holding and reinvesting the funds in the community.
    F. HSA holding companies would be responsible for the distribution of medical payments with the signature approval of the fund owner or guardian.
    G. HSA holding companies would be responsible for providing educated and bonded representatives for managing these accounts.
    H. HSA representatives would be responsible for maintaining and managing beneficiaries and will distribution.
    I. HSA institutions would be responsible for maintaining a “superfund” account made up of closed accounts willed to the superfund account or donations to it. This account to be used for catastrophic illnesses and injuries creating costs in excess of the individual members accounts.
    J. HSA owners would be responsible for determining and submitting all medical personnel and institutions they choose for record to pay.
    K. A state run “oversight” committee would be set up to monitor fraud and medical ethics as well as complaints, problems and mediation procedures.
    L. Doctors and medical facilities would be exempt from lawsuits when participating thus reducing their costs further. HSA owners would sign agreements not to sue doctors and facilities which they choose as their providers. Mediation would be a requirement in case of disputes.
    M. A software system of accepted health care providers and their ratings and reviews would be available for all HSA members to use.

    A. When managing institutions are approved and in-place, individuals will open an account directly with the institutions of their choice. Initial deposit would be voluntary amount.
    B. Voluntary tax deductible donations by the individual account holders.
    C. Funds could be transferred into the account through payroll deductions in lieu of insurance payments, Medicare and Medicaid deductions.
    D. Employers would receive tax benefits for any additional donations they would make to employee accounts or accounts set up for indigents.
    E. When the account is in full activation with medical providers in place and a minimum balance of $1,000, the Federal Government would provide a one-time bonus of $10,000 or more.
    F. Parents of newborns could set up an account with $1 or more and the federal government would award $10,000 to that account.
    G. Tax free and interest free lines of credit on assets such as homes or cars or good credit would be provided by holding institutions to help establish new HSA accounts.
    H. Tax deductions would be provided for any person or business donating to any HSA account with a max of an individual account not to exceed $1 million and “superfund” not to exceed $10 million per institution.
    Exempt persons:
    A. Native Americans benefiting from government provided health services. Any Native American opting out of the reservation benefits must sign a declaration of denial of the reservation benefits.
    B. Millionaires and billionaires that are already self-insured. Tax deductions would be given to them for donating to superfunds or individual HSA’s.
    C. Insurance provisions as we know them would be continually reduced until the HSA program fully implemented.
    Benefits of HSA:
    A. Elimination of costly insurance filing and management
    B. Reduction in the cost of medical care.
    C. Direct billings that the lay person can understand
    D. Fewer superfluous tests since the fear of being sued would be removed.
    E. Access to any approved medical provider or facility of the owner’s choosing
    F. HSA funds would be held and invested locally instead of in current insurance corporation’s investment methods that do not benefit the local community. .
    G. HSA funds would be required to be managed and reinvested on the local level in American only loans.
    Submitted by,

    Nancy N Davis

    Comment by Nancy Davis (@seniorphotonut) -

  25. Mark. Why have you not included the insured…..the individual …. in some of the involvement to lower the costs ? Most health issues are not the missed-gene variety. Most american citizens are over-eating and most of all, eating unhealthy. Why not tie in a *getting-healthy* tag for any insured that is considered obese by the US nutrition guidelines. Give breaks to insureds that are making progress to a healthy lifestyle.

    Comment by Phoenix340B (@Phoenix340B) -

  26. Mark, I’ve been thinking about your blog and the fact that you stated that none of the involved parties in the healthcare game want to give an inch is absolutely correct. However, for a functioning program to implement, it’s going to take a group effort. How the heck this could happen is beyond me given the current state of mind in our government and political entities. The only suggestion I could think of is find an example of a well functioning facility and build on it. Make accommodations, whatever is needed but start somewhere. We live on the West Coast and they have a medical plan called Kaiser Permanente which, for those who either pay for it or receive coverage through an employer, isn’t a bad option. They have collaborations with the other hospitals in the area and they also have their own medical/dental clinics. It’s not perfect but given the prices for medical services, it’s way better than nothing. I think that graduate doctors, etc. could pay off student loans by working in public health for the first years after graduation. Loan forgiveness programs exist now and are under utilized. I tell my dental hygiene students to take advantage of these things. The biggest mistake we can make is involving the government in healthcare. Holy cow! I also think big business should stay in the background. I realize profits need to be made (and investors are necessary) but my gosh, it’s out of control. Healthcare IS big business! Mindset needs to be reset with a focus toward the health and strength of a nation instead of “it’s all about me!” (Twitter needs to be outlawed for government officials, ha ha.) If we actually have a candidate for the next presidential election (providing we survive the current administration) that shifts the focus to building a sound foundation of personal responsibility , integrity and taking care of America’s health by appointing the appropriate people it would be a good start to changing the “all about me” mindset. Fixing the ACA would be a daunting task. It’s abolishment should never have been a promised. It’s such a mess now, a re-do will more than likely take years. Our nation’s healthcare experts (doctors, dentists, nurses, dental hygienists, etc) should be involved in the transitional process. I feel, as do many, that our government has forgotten why they are there and that we, the people, elected them to work for us. They have become their own subculture without regard for their constituents. If anyone dares to show common sense, pride in our country and a willingness to work for the good of the people, ( with an idea or place to start planning healthcare reform) they will be elected in a heartbeat. Thanks for sharing Mark. I think it’s going to take many of us to drive the point home. Sheryl Armstrong

    Sent from Mail for Windows 10

    Comment by Sheryl Armstrong -

  27. How about this: if you make under a pre-determined amount of annual income, you are allowed to buy into a basic medicaid program, so that you are covered, paying anywhere from $50 a month to $250 per month, per se. Besides helping to subsidize Medicaid, it creates an effect on the market that is favorable to the consumer. In countries with public healthcare, most opt to go to private clinics to avoid the long delays. Due to the fact that they could opt to wait for free healthcare, clinics are limited in what they can charge. Having an expanded medicaid for middle-class would help to inject a strong level of competition to the insurance companies, which are fairly united as an industry. The government would have to negotiate drug prices and cost for services as they do with the VA, however, to keep pricing down. Besides the insurance companies, hospitals have, like other businesses, pushed profitability for shareholders, escalating cost of services. I live on the Texas/Mexico border, and many come here just to see a doctor in mexico or to buy meds. Nevertheless, despite a very poor population in the Rio Grande Valley, the medical industry is one of the biggest in the area, and it seems that every doctor is driving a Maserati and doing extremely well. Between the pharmaceutical companies inflating prices (just look at the epi pen!), doctors and hospitals pushing up cost, and insurance companies trying to justify higher premiums as a result of this, there is no real alternative. You have to introduce a new player onto the court. Now, I’m not a communist, nor even a liberal. I did have a subordinate die due to lack of health insurance just before Obamacare, as he was making $9 per hour and at 60, and as a diabetic, his entire paycheck would’ve had to have gone to cover his premiums. He died of pneumonia in his home, and was found several days later. My wife and I haven’t had any more kids because of the high costs, and in the past, pregnancy was considered a pre-existing condition. Are we to quit our jobs to avoid having to pay $40k plus to have another child? The poor do so, and, in the end, the middle-class is having less kids and this could result in future problems for society. Frankly, I do believe that all children under 18 and senior over 65 should be covered for basic healthcare, period. Rather than giving money to other countries, we could easily cover this. However, something has got to give. Most middle-class families are on the verge of bankruptcy if their family is afflicted with injury, cancer, or other ailment.

    Comment by Victor Matisse (@viktor_alpha) -

  28. Mr. Cuban,

    I come from Macedonia, the healthcare system here ( no matter how terrible it is due to corruption ) is pretty simple. On the salary you recieve ( pre personal tax, that tax is 10% and it is deducted ) your employer pays a certain percentage for both health insurance and retiremend fund to the govt. The public healthcare is then equal for all ( or should be if they follow the regulations ) and you are provided the same free care, the same participation for something which isn’t fully covered, and you pay the same for something that isn’t covered at all ( like aesthetic surgeries, thoes IVs they give you if you are wasted, etc… ). That means that regardless if you earn ~$220 ( which is the minimum here ) or $2200, you get the same stuff.

    The employer must pay that ( unless he opts not to register you and people usually don’t complain given the situation in our country ) and that also covers the spouse if he/she isn’t insured and the children if they are under 18 or over 18 but full time students, but they mustn’t be older than 26.

    Comment by Lucius (@dmaliot) -

  29. Compassion and benevolence, are an evolved part of human nature, rooted in our brain and biology, and ready to be cultivated for the greater good.

    Comment by Sofia Tinatina -

  30. My blog stated my plan for heath care and the future of government. I was going to run for president but i got sick Mr Cuban Tell me what you think?

    Comment by Nick Iac -

  31. Mr. Cuban,
    My name is Wayne and I have watched you over the years on Shark Tank. I have witnessed your sense of humanity and your desire to truly make universal needs of Americans available to all. I am currently retired, and was employed over the past 35 years by a major manufacturer of Diagnostic Imaging equipment, who’s international HQ is in the Netherlands. My primary function was Vascular and Cardio Vascular diagnostic imaging equipment as an installer and a provider of service on broken equipment. Over the past 20 years of my career, I was a service specialist who worked in their call center for equipment issues. As a specialist I have traveled to many of the leading hospitals throughout the United States, Canada Europe and China as well. The fundamental debate over health care has been over how to provide fewer services and throw more cost on the sick and needy. I have not heard anyone push back on our Hospitals, Physicians or the Pharmaceutical Industry.
    I wish to see profound and transforming changes in our hospitals which will take a considerable amount of time to change. In most all cities if we look at a map of hospitals throughout a city we will see that most hospitals are located within a five mile radius of each other. My approach would be to create Hospital Complex’s. If we should look at these Complex’s from above you would see the following. In the center of the complex you would find Diagnostic Imaging Services, Laboratory Services. IT services, Pharmaceutical Services, Surgical services and any other common need services that hospitals need. Like spokes on a wheel you will find Hospital Patient care buildings, where hospitals can build their representative centers. You could have Methodist, Baptist, Catholic, Humana, Jewish, University and VA hospital patient care centers these patient care centers would encircle the center of the wheel. Also part of the outer spoke should be a building for Doctor Offices. Design the center to be compact that would also have the ability to grow vertically when the core services demands grow.
    As an observer of Hospitals and the Health care industry I have seen multi million dollars of equipment bought just to say I have something another hospital doesn’t have. I have seen in the US expensive diagnostic imaging equipment only used 4 to 6 hours a day, where as in Canada these expensive machines are used 12 to 16 hours a day. This is called equipment utilization. America purchases 50% of the diagnostic imaging equipment manufactured as well as all other necessary equipment that is made for the entire world. By eliminating every hospital needing the same or similar equipment eliminates a tremendous amount of waste that can be contained and passed on as savings to the patient. Also equipment utilization can be maximized to a minimum of 12 to 16 hours a day.
    In most every hospital built today you will find very large lobbies often skinned in marble or expensive woods and many chandeliers along with expensive art works These lobbies can be very large and some may have open spaces that reach several stories upwards that cost millions of dollars to build, heat and cool. When I need to go to a hospital as a patient I am not interested in their luxury facade or luxury lobbies. I am a patient who is sick; I am not there to be in a resort atmosphere. My primary interest in a hospital are simple; number one is it clean, number two is it properly staffed number three do they have the diagnostic equipment to identify my problem and also the staff and doctors who can carry out that mission in a quick and precise way when possible. Hospitals today are more interested in selling the superficial and not the services they can provide the sick. Many hospitals today are known as nonprofit hospitals, you and I both know that is a phrase that really does not mean nonprofit. What it means is that at the end of the year after all salaries and expenses have been paid and if there are extra monies left over they are divided between the Executives and physicians of the hospital. I am sickened when I hear that the VA hospitals are paying Executives of the hospital bonuses. My first question is why? My second question is what deeds have the executives done to earn these bonuses. To me that seems absurd and gut wrenchingly wrong to place our warrior’s health care responsibilities on someone who is earning a bonus to contain cost. Cost should be contained in all situations but not at the expense of patient needs.
    Pharmaceutical companies are charging outrageously high prices all in the name of continuing research and cost. The American pharmaceutical industry needs to be exposed to outside competition and their patent protections sliced in half. When I say outside competition I mean the rest of the world not just in the USA. At the same time they are paying their CEO’s and Executive incredible salaries and cloud level bonuses that the common man could never expect to earn in 100 lifetimes. And the same can be said about some hospital Executives as well. Our Government is always ready to step in and tell the tax payer what they can have or not have. It’s time for the Government to step in and say that Healthcare CEO’s and Executives who earn over 1 million dollars in salary or bonuses that they will be taxed at 75 to 85 percent over a million dollars. This should include board members as well.
    Our delusional President and Congress need to start standing up for the People of America who sent them to Washington and not the rich and powerful. It will take extraordinary intestinal fortitude for a President and Congress to do what is right and not what some overpaid lobbyist whispers in their ear. What I have suggested will take legislative action by the Congress to bring common sense laws to achieve these goals.
    As a thin part of the health care industry, I have had the honor and privilege to meet and know some of the most extraordinary physicians and health care professionals who work tirelessly every day for the common good of patients throughout America and beyond. I can also say the same about the engineers who have worked to create the miracle machines that provide Doctors with incredible clarity of disease and abnormalities.
    I have written this to you Mr. Cuban because I think you are a person of compassionate principles who cares about all and not just a privileged few. I believe that you have the means, influence and the voice to help make common sense changes. I do have much more to say, but if what I have stated does not make sense to people, then my words and time would only be wasted.

    Thank You,

    Comment by Wayne Gabbard -

  32. There is a dirty issue that nobody wants to tackle – the effects of illegal immigration on the Healthcare system. This is the #1 threat to the Healthcare system but it ripples outward and has a cascading effect on our economy.

    Fact 1: Illegal immigrants flood our emergency rooms with everything from a sniffle to a major amputation. They use the most expensive health care availalble and do not pay.

    Fact 2: If they stiff each hospital for these extremely expensive health care treatment, where, as an astute business person, do you turn to make up for the lost revenue: The customers who have the ability to pay.

    Fact 3: Since these customers pay in to insurers, the insurers are the front line to bearing the brunt of this cost shifting from our healthcare system.

    Fact 4: Hospitals across the USA for the past 50 years have been shutting down at an alarming rate.

    Conclulsion – Two choices: Limit/reduce illegal immigration into the USA will reduce this dollar hemmoraging to our Healthcare system OR provide Healthcare to everyone (legal + illegal) and create a sorting system so our Hospitals are not the primary care giver to undocumented immigrants (illegals).

    Ok – so here are the stock responses: Do you want to pay $30 for a hamburger at McDonalds? Nobody wants the jobs that illegal/undocumented workers accept readily.

    Answer: BULLSHIT! We already are paying $30 for our hamburgers. The system has shifted the cost of those hamburgers to our healthcare premiums.

    Why are we asking the Healthcare Insurers to take the hickey? They are all profit seeking vehicles and have ready subsititution risk (i.e. I can change from Blue Cross to Kaiser to whomever). They are run by smart people who manage to win. Do not blame them whatsoever.

    1) Enforce our immigrations laws and punish any employer who employs illegal/undocumented workers.
    2) Insure everyone – even visitors. And create a system that can quickly and readily sort the sniffles from the amputations so costs can be contained in the proper ways.

    My $.02.

    Comment by Vernon Briggs -

  33. Anyone can lose the genetic lottery/bad luck game, but we have a floor to our financial pain. You can always get treatment, even if you can’t pay, and then declare bankruptcy if you cannot meet those financial obligations. If you take that away, people will buy into the system because the alternative is far worse than paying a premium.

    Your idea is a good one, but Congress wouldn’t ever do it because constituents would hate it.

    Comment by Jim Wang -

  34. Pingback: Mark Cuban Getting Involved In Politics, Takes First Aim At Adding Clause To U.S. Constitution | Nwo Report

  35. Mr. Cuban,
    The laws of supply and demand are not included in your proposal. This situation is a math problem as much as it is a health issue. The potential patients far out number the doctors. As we migrate toward the cities, this only worsens. My grandparents chose to heal themselves when possible, due to extreme travel time to medical care. In addition to U.S. citizens, people from countries around the world are competing for U.S. doctors time. They are willing to pay more than a single payer system would. The rich also prioritize health care. This leaves the poor, middle class, and those in transition to fight for access to the doctors that will accept the lower pay from Medicaid. As coverage expands, these doctors become more sought after. Their time becomes more valuable and even they choose to charge more, leaving the Medicaid system that much more deficient. One possible solution would be to food the market with doctors, or people that can do what doctors now do. Then allow the free market system to operate on an organic state. The other solution would be to convince large subsets of the population to avoid health care. As the majority of health care expenses are incurred during the first and last six months of life, we could promote a #juststayhomeanddie campaign!
    tldr: when patients far outnumber doctors, care will be priced at a premium that many cannot afford.

    Comment by stevenfromtx -

  36. ‘Betrayal’: is the year’s most important article. Corrupt Congress could fix the sick healthcare system in 3 sentences. #Obamacare #Potus #Realdonaldtrump

    Comment by w1152 -

  37. Pingback: Mark Cuban Getting Involved In Politics, Takes First Aim At Adding Clause To U.S. Constitution | RWC News

  38. I am familiar with the healthcare industry and health insurance because I was selling health insurance before Obama was elected.

    If we’re thinking from the perspective of simply paying for the cost of healthcare in the current status quo, this makes a certain amount of sense to me. Something we would commonly do when selling insurance to individuals was to pitch a high deductible, no frills plan to keep premiums down and then sell supplemental accident and critical illness coverage to take care of the deductible at least in cases of accidents or critical illness. Although, it left an obvious gap for other situations, the idea was the same. When you as one policy to only cover certain situations and another policy to cover only certain other situations it is possible to have comparable coverage for lower premiums.

    My two primary thoughts are:

    1. Horror stories I’ve heard of wait times for needed care in other parts of the world that have government sponsored healthcare.

    2. I don’t hear anyone asking a more fundamental question. Everyone seems caught up with the idea of how to pay for the cost of healthcare but very few are discussing the ways to lower that cost.

    I can think of several things including limiting litigation opportunities to prevent frivolous lawsuits that are costly and drive up malpractice insurance premiums which is no doubt passed on to the consumer.

    Another larger issue is the inflated cost of education. That’s it’s own issue but certainly plays a factor.

    However, there is a much simpler approach every American can take that is completely within their control and would have a drastic affect on the cost of health insurance. That is to change our lifestyle to live more health conscious whereby reducing the risk of both disease and injury.

    I appreciate the logic used when employing the lottery analogy to both injury and disease, however, it is not a complete picture. Yes, it’s true that anyone at anytime can have a fluke situation that no one can prepare for. However, there is a lot of research out there showing that disease is not only a matter of genetics. Depending on which report you read, anywhere from 75% to 98% of all illnesses are a direct result of how we think. Yes, we can have a genetic predisposition to something, but it often takes a catalyst to trigger that illness or disease. The catalyst is normally a combination of things like diet (food and beverage intake), exercise activity, social involvement and whether we think from a fearful mindset or love-based mindset.

    Also, we cannot look at injury like it’s only an accident. Yes, injury is always discovered in relation to some kind of unexpected event but our lifestyle can make us more prone to injury.

    The harsh reality is that what we can all do within our own ability without relying on those we cannot control is to change or lifestyle. The challenges to this is that it is the healthcare industry and food industry that have conditioned us into the tankard American diet which is a huge contributor to both disease and injury. The knowledge of how to better take care of ourselves is out there and available to everyone but it is so much the alternative to the norm that it usually takes a catalyst for most people to go looking for it. That catalyst sadly is most often disease when it has already struck.

    I personally have dealt with chronic illnesses and even injury for over a decade, nearly two. In my experience I had a doctor tell me my only hope avoiding disability by age 60 was to take $30,000 a year immune system depressant medications. I refused and looked for natural alternatives. It has taken 4 years to find real solutions but I am physically in a much better place than I was then and have not taken a single med for it.

    I can tell you it isn’t easy going against the tide of societal norms especially when it comes to eating out with friends or going to someone’s house for dinner or not spending enough time prepping food and needing to get something when I’m out and about, but what I’m after is personal and lifestyle transformation. I may take two steps forward and one step back but over time the trend is forward and it’s paying off.

    In business one of the best ways to lower cost is to decrease demand. If even 20 or 30% of people in our country started taking some basic, small steps that aren’t even as drastic as the one’s I’ve taken, the results over time would significantly reduce the need for healthcare nationally whereby reducing demand and lowering the cost of care. Then it can become manageable.

    True insurance is there to cover risk you don’t know is going to happen. Think of car insurance or home owner’s / renter’s insurance. It doesn’t cover pre-existing damage so the cost is manageable. The more common it is for people to need healthcare, the higher the premiums need to be. If we look at dental and vision insurance it doesn’t really work as an insurance product because the only people they will lay for it are those who know they will need it. When you have as many people paying premiums as you have people claiming, there isn’t enough money to go around.

    It’s just numbers. Lower the demand and cost goes down.

    If we stopped eating so much processed food laden with chemicals and started drinking more water that is also adequately purified, got more exercise and attended to our emotions and relationships instead of chasing the almighty dollar and excitement, made proper sleep a higher priority, managed our finances better to reduce stress our national health picture would change drastically.


    Comment by mikedrewit -

  39. With respect to prescription drug pricing, 80% of pharmaceutical revenue comes from USA sales, 10% from the Japan market, and the last 10% from all other countries combined.

    If one looks at drug prices around the world it is clear that people in the USA pay significantly more than people outside America due to the fact that those governments require the pharmaceutical companies to justify their price requests and cap the price they can set.

    Japan takes the process a step further as the highest price a company will receive for their prescription product is in the first year it reaches the market. In subsequent years the Japanese government requires pharma companies to continuously reduce the price of the drug as it ages eventually leveling off the decline when it reaches generic drug pricing levels and goes off patent protection.

    While we do not want to eliminate the incentive to fund R&D and basic research for new products and compounds, many of the compounds that are being used today have been funded by American tax dollars through grants and give aways to private companies from the government.

    We should learn from the pharmaceutical pricing models employed by other countries as this would greatly reduce healthcare costs. Just allowing Medicare to negotiate prescription prices like HMOs and PPOs are able to do would be a huge and immediate cost savings to the system with minimal debate in the congress.

    Comment by jordanrosnerjapan -

  40. Hello Mr. Cuban,

    I agree, your proposal is a very interesting one that should be studied by think tanks from both the left and right.

    One additional thought: My wife works as a surgeon; as an outside observer, I would urge policy makers to consider the success of Kaiser Permanente and other Accountable Care Organizations. These companies combine insurance and hospital care into one organization. In that way, they get the most feedback on what procedures are the most effective. Currently, insurance companies act as a middle man & cut costs by negotiating costs of procedures and regulating what procedures are covered. For this, they are able to make some very nice profits; these profits, while an incentive to be a more efficient and therefore more profitable insurance company, do not go directly to improve citizens health care. By combining the insurance company and the caregiver; Accountable Care Organizations are able to collect the best data on what care (procedures, behavior modification, medicine) works the best. Also, they quickly understand and are (from a profits perspective) best positioned to figure out what care is the most cost effective.

    I suggest we add additional governmental incentives to promote the Kaiser Permanente model across the country. This would help harness the free market / profit motive to improve the care of all Americans.

    Thanks for your consideration.

    Comment by Aaron Crockett -

  41. I’m glad to read Mark boiled it down the DNA/Accident lottery. I can see many financially sound friends who can step up to the plate are in a denial they play. More are starting to hit their lotto numbers realizing their mistake.

    This denial is hide a worse scenario for some: If their child is suddenly given three weeks to live, the odds are fair one parent will mentally check out forcing the other parent and siblings to take on greater burdens at the worst time. In the 11th hour, if the price of saving their the family is their fortune, they will pay the Piper.

    I suspect that’s true for Mark as well. The amount of money excuse anyone from their daily lotto.

    I already seen too many friends and family receive their numbers and live a harsher plight due a denial.

    Since I know my time will arrive sooner than later and many friends live in bliss, I became my Mom’s 24/7 caregiver battling Alzheimer’s to understand how we can extend the lower cost of home care.

    Home care is manageable. We’ve done it since the dawn of man. It’s the rare accidents, which prematurely end it in most cases. Using the open market to fix those, we can keep more people from financial disaster when forced to rely on our healthcare platform.

    Here are some considerations I found:

    Home care is an integral part of our entire healthcare platform. Home caregivers are the first line of defense battling 24/7 for free. Most of our health money/resources is going towards watering the leaves not the roots. This is open market fixable…without making the gov’t or industries change.

    A healthcare system is repair business at large. Using management solutions such as those provided by the pharma industry makes business sense. With insurance industry controlling resources and finance industry investing our saving into these industries, these industries have aligned our citizens into Mexican standoff where no would dare to take less because they loose either direction they take.

    What disease and accidents inflict on our citizens is the exactly what every terrorist strives for. Our government has spent 4-5 trillion on the ‘War on Terror’ fighting a terror who’s damage upon US citizens pales in comparison. That’s par for governments.

    These health care issues are solvable by the little guys, we just need to figure out how to get them to step up to the plate before they enter the healthcare system.

    The good news:

    We know our opponent are these systems, not the people. Everyone one I met while helping my Mom did their best to help us. In reviewing the game tapes, it became obvious they were restricted by the systems. All systems from by the same playbook used in a different fields. Having the playbook is our great advantage.

    Entrepreneurs can utilize the entire open market. These systems only control a certain space as well as alter game rules to protect their domain. Their vulnerably is the fact we can play their same game. Their Achilles heel is always hidden by curtain. “Housing prices have never fallen” is a curtain…and those who peeked beat the game. Everything I saw as a caregiver, it’s the same game different field.

    Our main issue is too many are in denial. We have to realize no one is going to take less…..making this an entrepreneurial opportunity that will fix our kid’s future. Or is saving our ‘elbow grease’ more important than saving our kids?

    Quick thought for Mark…
    What about a Shark Tank spin-off where entrepreneurs present ideas to specifically solve issues such as this? Or a Survivor type show where entrepreneur teams are pitted to solve specific social issues….at least something to prime the viewer pump towards creating idea that impact their fate.

    Comment by puwaba -

  42. Something has been nagging at me since I read this and made my original post back on the 10th so I read it again this morning and realized I missed a critical point you made! Your plan is pretty good. Of course it will still need some fleshing out but I am hoping that when you [hopefully] run for President in 2020 (if we’re are able to survive until then) I’d love to see you assemble a diverse team of folks to help you work it out.

    Comment by Tracy Greene -

  43. When neither side is on our side, we need a new side. Blind partisanship is a real problem.

    Comment by Becky Spoon -

  44. Very interesting idea, there are so many ways to go about covering all with insurance and no clear way to do so. Some ideas could be implementing a CORE BENEFIT MANDATED for ALL which is for Catastrophic or just Major Medical (hospitalization), Preventative Services as mandated in ALL Plans currently(preventative covered at 100% regardless of deductible amount), and a basic RX coverage. (paid by a income tax % – for CORE BENEFITS ONLY, where Employer and/or individual coverages are layered on top of the Core Benefit plan MANDATED all have (Auto insurance is mandatory because of the damage and costs that can be put on those involved; the same holds true for Health Insurance) and clearly the model in place PRE/POST OBAMA needs SERIOUS TWEAKS.
    I have been working with employees and now Employer Group’s health insurance for almost 20 years now, but prior to that I was told of Major Medical coverage which was in place in the 80s?
    Where people had Hospitalization Coverage (1 part) and Physician services as another and assuming RX was another. As all are separate coverages and contracts and Hospitalization clearly being one of the most expensive portions of Health Insurance along with RX. The RX costs in our country is it’s own issue as we’ve all learned from the NEWS Headlines over the last 12 months with EPI PEN price raised to some ridiculous price. I have a client who had HEP- C for 20 years and hadn’t done anything about it until 2017 when I put him on an Individual Health Plan with copays for all RX. He’s currently HEP Free, and only paid $400 for the RX’s whereas the Cost in Cash for the medicine was around 75k. I also recall a colleague taking an RX for acne cream which was 5k per month where she paid $35 copay. Clearly the Insurance Contracted (PBM-Pharmacy Benefit Management) rates are necessary for RX as is the Case for Hospitals and Dr.’s. Hospital Contracted rates for services is with Insurance Carriers is the most complex as Each Hospital agrees with each carrier based on specific services. An Example is BCBS has a contract for MRI”s with Hospital ABC for $900, and hospital XYZ for 3k (literally went through this with a client), whereas the costs would’ve been over 4k without insurance. However on a different service, Hospital XYZ has a contracted rate for $900 and Hospital ABC 3k on a different service.
    The point is the Contracted Rates that the Insurance Carriers and/or Government is necessary.

    Mandating Everyone have a Base Line Plan in place where they have access to Contracted Rates for Hospitalization and RX along with Preventative Services which is in place from when your born until Medicare eligible is one idea of many. I have client’s that I helped get Health Insurance that were unfamiliar with it and overall healthy and didn’t understand the importance of getting his Physical and didn’t get one until after 2 years of me “nagging” him to do so in addition to getting his tooth check up. Thus Another Issue, Educating everyone of the point and purpose of Preventative Services which sadly is still not understood by most and is even clear when listening to Politicians Speak noting that people on High Deductible Health Plans can’t even get to see their dr based on Deductibles (PREVENTATIVE SERVICES- Covered at 100%, DEDUCTIBLE IS WAIVED!!- ( link to Preventative Services Listing -

    Some other links that I believe people will find informative
    1) Cost Estimator of Medical and Dental Services based on location via procedure to help people get an understanding of costs for a service – also has a section to determine Cost if covered out of network and via % of Medicare Reimbursement or Usual & Customary based on the Location
    2) RX Cost Look up of most frequently used prescriptions (most states have this) Where you can see 1 RX cost variance can be over 10x within a 10mile radius.

    Just some quick thoughts; sorry if jumbled as well as Grammar/spelling as took a call between and now I have to jump out of here.

    Comment by Tom Sackmann -

  45. Whichever president (if any) has the courage and the integrity to fight for and pass honest healthcare reform that covers everyone equally, reliably and comprehensively from cradle to grave AND saves us a trillion dollars every year….will go down in history looking like a moral hero, fiscal genius…and one of the best if not the best president we’ve ever had (of any race or gender). Obama had his chance but he blew it. He sold us, the truth and the good of our whole out to favor lies and the corporate welfare of the few. That man could sell ice cubes to Eskimos if that’s what he wanted to do. He could have used the power of the bully pulpit to sell what he knew was the truth. Instead he refused (no money in that for him and way too much $$$ to be made by keeping mum). A bigger, badder lie than Obamacare has never been more successfully told. Trump is trying to do Obamacare one better….which means worse….but almost everything seems bass-ackwards here today. Two wrongs are not making anything right but two rights are making everything wrong.

    Comment by Becky Spoon -

  46. 1. Free market: Everything is not a free market good or service. Some things are “captive market” products…over which we have absolutely NO freedom of choice whether or not to purchase. Free market rules work great with free market products, and not-so-hot with captive market ones…at all. Here in the United States we do not seem to be able to tell which are which. We’re just damned lucky we have equal access to fire protection…at all. Fire protection used to only be available to those who could afford it. Protecting everyone equally from fires is not specifically guaranteed in our Constitution. It just makes sense for the “good of our whole” (now an old-fashioned notion). Healthcare protection for all (and our continuing lack of same) is a lot like that (good for everyone as a whole). 2. Added value: If private health unsurance added NO value, that would be an incredible improvement. The truth is, it adds an unbelievable amount of NEGATIVE value to our healthcare system (a TRILLION dollars every year is nothing to sneeze at). In fact this one factor in our equation is killing/disabling/terrorizing/bankrupting our people in numbers no other terrorists can begin to match. It is also bankrupting and crippling our economy as a whole as well as most businesses other than itself. 3. Competition: Our unique profit-driven health unsurance business model makes NO money helping ANYone get medical care. That is how it LOSES money. It only MAKES money by price-gouging healthy people as much as possible while denying needed medical care to sick people as often as possible. Private health unsurance companies compete fiercely to do both (again, adding extremely negative value) while severely LIMITING our freedom to freely choose among care providers (the kind of competition we need to increase, not limit). Their business model is perverse and contrary to the good of our whole. Period. As long as we let proven scorpions keep riding on our backs, they will keep stinging us. I guarantee it. Until we get rid of them, we will never be able to introduce the kind of choice and competition we desperately need but currently lack in the marketplace: the freedom to choose any licensed care provider (who would no longer be able to discriminately provide care to us, because we would all be covered equally under the same plan under the same non-discriminatory and newly transparent rules). When we are born we would be covered. When we die we would not be. Our entire country could breath a HUGE sigh of relief, and private health unsurance corporations would be OK too (they would just have to diversify). And we would not have to keep suing each other all the time over who has to pay what medical bills. We would all chip in together and make sure everyone’s bills are paid…like the Amish do…for the good of our whole. Until we do this we have absolutely NO moral ground on which to stand on the world stage. Vladimir Putin, Fidel Castro and Saddam Hussein all made sure all of their people had equal access to medical care under the law of their land…which makes us hypocrites.

    Comment by Becky Spoon -

  47. Pingback: Some Thoughts on Fixing Obamacare – Shoot Holes in this Please – Being Terrible

  48. All problems have a simple solution. Just set out the use-cases and list out the best solution for each use-case. For me, that means:

    a) I want to see a local neighborhood Doctor at known cheaper prices – this means we need to increase the supply of neighborhood Doctors, reduce the liability/insurance costs for Doctotrs and allow Doctors to recommend a procedure code we need so we can shop for that procedure.
    b) Shopping for common procedures online with full price transparency by providers including local and out of state providers and showing yelp-like reviews from other patients including the price paid.
    c) Availability of generic drugs online from whoever will provide them including government manufacturer if necessary again with full price transparency.
    d) Payment of mandatory taxes to pay for chronic condition care for anyone who is working.

    I don’t need insurance companies, 80,000 codes, Doctors having admin staff, HSAs, tax credits, or al the other BS being touted. I dont need mandatory coverage (except for chronic care which should just be part of normal federal taxes).

    Comment by Paul Redman -

  49. Blah, blah, blah. It is simple. Private healthcare insurance companies, Pharmacy Benefit Managers and other private non-providers (non-medical entities) add no value to the healthcare system and only their elimination (and replacement by a wholly public single payer/insurance) can ensure that we get universal coverage and uninhibited access at the lowest cost. This is where we start and then we use the leverage of this one single insurer, to negotiate prices of healthcare products and services. Yes, it is this simple.

    Obamacare mandated we all buy insurance from profiteering private insurance conglomerates and was in essence a private insurance industry bailout. In addition, the law upended the healthcare infrastructure in the US, spending hundreds of billions of taxpayer monies on all kinds of new programs that allegedly would improve hc systems. All kinds of private contractors, many of them subsidiaries of these very same private ins conglomerates, made out like bandits. And yet, over 30 million people remain uninsured, tens of millions are underinsured (find out-of-pocket costs to high to actually afford healthcare when they need it), over 40,000 die each year from lack of access to healthcare and here we are, almost a decade later (since 2009) rewriting the same script!

    Comment by umabird -

  50. Cmon lose the ‘murica free market BS. Fuck the insurance companies – they are middleman who produce NOTHING of value – insurance could and should be managed by a computer program with close to 0 overhead.

    Comment by stucal (@stucalion) -

  51. Eliminate unnecessary (amoral, overly expensive) middlemen and utilize efficiencies of scale
    (Business 101).

    Comment by Becky Spoon -

  52. We will never be able to create the transparency we need to be able to see who is paying how much for what until we are all united together into the largest plan possible: one. The bigger the pool the better the coverage and the lower the costs.

    Comment by Becky Spoon -

  53. The biggest oversight in this article is the ginormous lack of transparency in pricing from providers. Not just from doctors, but from hospitals. We will NEVER be able to be certain of total costs because hospitals currently do not provide the public with pricing sheets for services. The hospitals and insurance companies know what things cost but the public does not. And there’s a reason for this. If prices for things like surgeries, births, tests, and drugs were made public then a competitive marketplace would take over to drive costs down. This is the number one reason why healthcare costs keep going up. Absolutely no public transparency in pricing. This allows hospitals in the same areas (within several miles from each other) to charge very different prices for the same services. The public now chooses their doctors without regard for pricing because hospitals have removed that consideration from the process.

    Comment by donnie boy (@realdonnieboy) -

  54. This comment is coming from a Canadian. I was born into a system where everyone gets medical treatment regardless. Personally I have been very lucky and in my 50 years, I have been to the doctor very little and fortunately never had anything life threatening. Everyday of my working life I have paid my taxes and paid my Provincial Medical premiums. I have however seen many family, friends and acquaintances require much more care than I. Even when times were tough I didn’t gripe about whats fair, life style choices and who’s paying less because at the end of the day someone I know who can’t afford it may need it. I do business in both Canada and the US and in my opinion we are all good people, it would really sadden me to find out if one of my US customers daughters was sick and not getting the treatment she needed because her parents could not afford it. Our system is not perfect but within the last two weeks one of my oldest and dearest friends was diagnosed with Cancer and has been hospitalized, despite the cancer he is thrilled with the care he is receiving. Regardless of what counties system you adopt or alter to make your own, The fact is every US citizen at one point in their lives will be glad you did. Good luck

    Comment by Robin Francis -

  55. Start by adding the president, congress, all gov’t employees and their families to traditional Medicare (in order to add a younger healthier group that would save the program for generations to come). Sit back and see what they do with their own plan, then let everyone else join without discrimination. I would dare anyone running for public office to oppose this plan…and see how many votes they get. I have documentation showing that traditional Medicare (not counting privatized Medicare “Dis” Advantage plans) runs on 1.6% overhead. When you add the costs for the private Medicare plans, administrative costs shoot up to 6% (almost 400% higher). Private health unsurance takes 20-30% overhead. Obamacare said it limits them to 20% (of an infinite number) overhead…but that’s only after the taxpaying public pays most of their advertising and administrative costs for them.

    Comment by Becky Spoon -

  56. We do not need to worry about private health unsurance corporations. They have platinum parachutes, unlike the tens of millions of us out from under whom they pull our safety net just when we need it most. They can make money any way they choose. All we ask is that they figure out a way (to make money) that is not responsible for more senseless deaths, disabilities, bankruptcies and terrorizing of innocent Americans in numbers that have not begun to be matched by all of the world’s other terrorists COMBINED. Is that asking too much?

    Comment by Becky Spoon -

  57. The idea of everyone having the same plan as the president and congress is political gold. Healthcare justice and equality for all under the “equal protection” clause in our Constitution is also a winner. “Single plan” is a winning frame. “Medicare for All” polls much higher than “single payer” (the worst frame for the best picture) every single time. The fact that a billionaire thinks everyone else should have the same health plan as he does (and the fact that he could save us a trillion dollars every year while doing it) would get you elected President in a landslide. We are SO sick and tired of being LIED to by CORRUPT politicians on BOTH sides.

    Comment by Becky Spoon -

  58. Any CEO who chooses to use an amoral, unreliable, cruel and inhumane middleman (private health unsurance corporations) at 20-30% overhead when there is a far more humane and reliable one (traditional Medicare) that only uses 1.6%…should be FIRED.

    Comment by Becky Spoon -

  59. Do the math. In 2015 we spent $3 trillion or 18% of our GDP and left 30 million people completely uninsured, plus tens of millions more dangerously and unreliably under insured by proven amoral scorpions…’er…private health unsurance corporations who put profits before people and have NO mercy. The next closest nation covered everyone reliably and comprehensively from cradle to grave at 12% GDP (one-third less). One-third less than $3 trillion dollars is $1 trillion dollars (or $400 billion more than our military budget) in savings every year, just by doing the right thing morally for our people and the good of our whole. Uniting everyone into the same not-for-profit public plan is a moral and fiscal “no brainer”. One nation, one plan….with healthcare liberty and justice for all (like what is supposed to be guaranteed by the “equal protection” clause in our Constitution). The bigger the group, the better the coverage and the lower the price. Follow that fact to its logical conclusion. A sad joke on us is that the Clintons know this and refused to represent it (because there is no money for them in healthcare justice for all). Thank you Mark, and God bless you for this.

    Comment by Becky Spoon -

  60. I’d like to see it expanded to more than just chronic illness (physical & mental). I think a basic level of healthcare should be available, and if you need extra coverage, you have the option to pay extra for it. This is where Canada gets it wrong. What I’ve seen in Canada is a mandate that everyone receives the same care. I think this is off base. I think, if you can afford extra, go for it. Korea does this, and it seems to work very well. It’s the model that you see in U.S. education, personal protection and retirement planning. Basic education: covered by public schools. If you want more, you pay for it. Personal protection: you have the police. If you want more, you pay for it with a personal security system. Retirement planning: social security. Not good enough? Get a 401k or IRA. I don’t know the history behind our nation seeing education, personal protection and retirement planning as a right, but not healthcare.

    Comment by Dann J. Sytsma -

  61. Universal coverage is a grand idea. It is humane and it will make everyone feel good for a while – until rationing has to be implemented because there are not enough service providers to provide universal coverage. The other issue is that the cost to provide universal coverage will be paid by the upper 50% of wage earners and most notably the top 20% of wage earners will end up fitting most of the bill.

    In the US we need to fix two problems first: 1) Hand-cuff the Federal Government so that they stop running billions and billions of budget deficits – pay off the 19 trillion debt we have and 2) get America back working – get the lower 50% of wage earners decent, steady jobs that allow them to really live, pay taxes and be a part of the American dream.

    Comment by Herschel -

  62. While I appreciate the thought that has gone in to this, I find it extremely difficult to place ANY faith in the notion of a government run program solving anything.
    This has been proven time and time again. Look at what the politicians have managed to do with Social Security as just one example of mismanagement.
    I am completely horrified at the notion of some low-level petty bureaucrat making decisions regarding my health and well-being.

    Comment by Corky Pringle -

  63. Mark,

    Until you reduce costs, healthcare is an insurmountable problem. Giving Americans “peace of mind” on catastrophic issues is a good idea, but Obamacare, TrumpCare, and your proposal (however well intentioned) will fall way short of the mark unless you focus on lowering costs first.

    For starters, Medicare has the right infrastructure and the best prices to accommodate your plan for universal care for catastrophic issues. Risk pools could accomplish the same thing if applied to catastrophic or chronic illness. However, if you don’t change the underlying axioms of the system and focus on costs, you run the risk of government deciding, “who gets care…and who doesn’t?”

    Consider this…

    Today, we spend $3.5 trillion annually in our healthcare system – almost $10,500 for every man, woman and child in the United States – and 17 percent of the U.S. GDP. With the new Republican healthcare plan, we can expect continued double-digit premium increases, along with increases in deductibles and fewer benefits. At this rate, healthcare will reach 23 percent of the GDP In the next 10 years. Economists know this isn’t sustainable without a 90 percent tax rate or ballooning debt. In this system, if you cover catastrophic issues, there will be no option other than limiting access to care.

    So what causes the high prices of healthcare? Any doctor will tell you their income is lower today than 10 years ago. But how can that be? How can we be spending more while doctors are earning less? The answer is simple: dramatically increasing insurance costs, administrative costs, the cost to process copayments and deductibles, government regulations, reporting requirements, waste, overuse, and yes – even fraud and abuse.

    We don’t have a $3.5 trillion healthcare system. We spend about $1.5 trillion on healthcare – the rest is wasteful, nonessential costs.

    Find a way to eliminate the waste and reduce costs from $10,500 per man, woman and child to $5,500. This would create a domino effect – more employers would provide healthcare to their staff, more people could afford individual plans, government would have the resources to provide for those most in need, and access would improve dramatically.

    Now the reasons “They” – the status quo – (the existing system, insurance companies, government) can’t really cut costs……

    Government-Run Programs: I spent 10 years in political office. It is very difficult to create efficient departments in an environment where government employees and the vendors who profit from government programs directly impact your odds of re-election, In healthcare, government employees, insurance companies, doctors, hospitals, pharma, all have become experts at dark money campaigns. The current system is very profitable for them – they don’t want to make changes. Innovators and disruptors are unwelcome. It is very difficult for government to reduce costs and increase service amid special interests.

    They Limit Access to Care: Status quo players reduce costs by requiring deductibles and copayments, which limit access by making it more difficult for people to get primary and routine care. If you make it easier for people to access care easily and affordably, you will reduce costs dramatically over time.

    They Create Unnecessary Regulations that Increase Costs: Ever wonder why a doctor takes your weight? Because an insurance company can recoup payment if the provider doesn’t fill in this section. It’s one way of making sure the patent had to come into the office. When you use insurance to pay for primary care, the doctor must pick one CPT code from among more than 85,000 codes. Roughly 30 percent of the time these claims are rejected, increasing the administrative burden on both the doctor and the payer. This same concept is true with copayments and deductibles.

    They Limit Transparency: For patients who learn they have cancer, price is the last thing they think about. I’m not saying that hospitals exploit patients in crisis, but make no mistake: hospitals make a lot of money off the fact that these patients rarely ask about the costs. No industry is less transparent than healthcare. Prices between hospitals and insurance companies are rarely disclosed. No real competition can exist without transparency.

    They limit competition: Hospitals and health systems are buying up doctor’s offices at a record pace – even though hospitals lose between $150,000 and $300,000 each year for every doctor they hire. Why would they do this? For quid-pro-quo referrals. For example, tests and procedures performed in a hospital cost 10-30 times more than the same procedure done in an independently owned clinic or lab.

    They are incentivized to increase costs: Imagine an environment where an insurance company boasting 30 percent of the nation’s healthcare market actually decreased costs. Today, these insurers are limited to 15 percent profit. If they lowered costs, their profits would follow suit. Imagine the effect on their stock prices. While this seems counterintuitive, there is no real incentive for big insurance companies to lower costs, and the same is true of hospitals and pharma.

    So what is the solution…..

    The healthcare game is rigged. The best way to win is to change the game.

    Today’s game is to buy health insurance. But health insurance is not healthcare. For employers and individuals, a better game is to buy healthcare first, and insurance last.

    Take Uber for example. Uber increased demand while at the same time increasing supply. They created new capacity in the market place. The traditional ride share industry was dominated by the taxi industry, and 50 percent of their market was airport related. UBER went after the underserved market – like night club drinkers – to increase demand. They found drivers who would use their own cars to increase supply. They lowered costs along the way.

    Healthcare needs to be IED. Focus on the underserved market – people who have no coverage – and increase providers on the supply side. Add technology, and lower costs, and you will have begun the process of transforming healthcare.

    Redirect Health has thousands of members and hundreds of businesses that have 50-60 percention reductions in claim cost based upon some simple concepts. Those include:

    Supply: The resources in healthcare are mismanaged today, leading to a physician shortage. Focus on what people really want. The healthy 90 percent who spend 10 percent of the healthcare dollars want convenient, easy access. The 10 percent who spend 90 percent are sick and afraid. Reduce the time that doctors spend on the 90 percent while increasing convenience, and they can then spend more time on the 10 percent. Give everyone 24/7 access to a doctor.

    Demand: According to the Social Security Administration, 50 percent of American workers make less than $15 per hour. Affordable healthcare is 9.5 percent of the average worker’s income. The math just doesn’t work. Why would a person who makes $30,000 a year buy a product that costs $800 a month – $9,600 a year – with a $6,000 deductible on top? The simple answer is they don’t. Give them a product they can afford and use, and you change the demand side. Here catastrophic coverage provided by the government would help. But, if you provide this group with better care at a cheaper price, you will disrupt the other segments of the market, too.

    Competition and Place of Service: Change the place of service and you change the price of the product. For example, an MRI may cost $4,000 at a hospital, but just $400 at an offsite imaging center. Compare pricing before moving forward with any procedure .

    Eliminate Copayments: Decrease deductibles and eliminate copays for routine health services performed outside of a hospital setting. Make primary care, physical therapy, labs and other preventive testing services easy and inexpensive.

    Focus on the 10: Put an extra focus on the 10 percent who spend 90 percent of the money. Creating a care plan and working with the patient to implement this plan can help you avoid very expensive hospital costs. In fact, focusing on this population will yield the greatest healthcare savings.

    Reduce administrative costs. Create fewer rules and regulations that don’t benefit the customer.For example, 85,000 CPT codes do little to serve the customer. Adding audit and recoup costs to routine services creates higher administrative costs.

    Incentivize Employers: Introduce a model where that rewards employers and their employees for saving money on healthcare. Give them the savings.

    Demand Transparency. Employers plans are much better at demanding that vendors be transparent on pricing. But government can play a role. If a hospital won’t post rates and tell their customers their price in advance of a service or procedure, force them to live with Medicare Rates.

    Risk Pools for catastrophic claims. Insert your idea here.

    Comment by pauljohnsonredirecthealthcom -

  64. Good article.. are you saying you think every single person should be covered by the government and that we all pay it basically as a tax to cover the coverage and that no one would have a higher or lower % of coverage it would all be the same across the board? That’s actually a really good idea. We all need the same thing.. every single person. If there was an umbrella that covered all of us in the same way I would totally go for that. I suppose that would eliminate the need for employers to provide insurance options for their employees and thus would save the companies money / tax right offs. Its actually brilliant because even the elderly.. the homeless.. all of those that don’t have the option or funds to pay for insurance would have it. That could actually help with high costs and possibly lower it at the physician or medical facilities due to the coverage being paid and not having to collect unpaid medical expenses or absorb all the unpaid expenses and then having to charge higher rates to make up for unpaid bills.

    Comment by Michelle Nichols -

  65. I owned a consulting firm from 1990 – 2003 that at its peak had around 25 employees. Most were in California, but I had people across the US. I bought insurance for the whole company, and every year my premiums went up, sometimes by 35%. My health insurance bill was much higher than my taxes! I went from covering employees and their families to employees + 50% of family coverage to covering employees only to charging employees a copay. It was my biggest expense other than payroll itself. So health care cost increases predate the Affordable Care Act by a lot.

    When I first started the company in 1990 and had no employees, I tried to get insurance for my family. I remember getting a letter congratulating me … they were prepared to cover me, my wife, and my 3 year old. But not my healthy seven year old daughter. What kind of fucked up system is that?

    One of the things the Republicans keep talking about is allowing for insurance across state lines, as if that’s a magic formula for cost reduction. It isn’t and it won’t, and other people have written more knowledgeably on that than I can. But one thing I DON’T hear much talked about is allowing for broader association coverage nationally. I was always frustrated that I couldn’t join a national association of small businesses that purchased insurance at the same rates and coverage as a national company like Ford or Apple or anyone could.

    That said, the best form for reducing insurance costs is to wipe out the middleman entirely. And that means single-payer. I like Mark’s creativity in trying to frame this in order to provide the political cover to maybe make it happen. There isn’t a single example anywhere on the planet of an affordable, cost-effective private insurance market. Not one. But there are plenty of examples of public coverage both affordable, cost-effective, and with much better outcomes than in the US. Canada, UK, Japan, France, Sweden … the list goes on and on.

    Comment by Chief Strategy Officer -

  66. I love this creative suggestion. Big question I have is how is “chronic” defined and certified. And, please run for POTUS in 2020.

    Comment by Dan Coleman -

  67. If anyone cared to notice, Obamacare introduced rent seeking behavior on steroids (Pharmabro). The Feds should dismantle Obamacare and expand Medicaid/Medicare for all. Expand HSA’s, and allow healthcare expenses to be tax deductible! Losses can be carried forward until some determined amount. Insurance companies are creating a cluster f* of a problem. Employer provided healthcare coverage needs to go bye-bye. Read Milton Friedman’s Four Way to Spend Money!

    Comment by Chris Cachor -

  68. By removing the personal mandate, we are typically going to remove the younger, healthy people who feel are invincible. That means that the population covered by the insurance would be more “risky” to the insurance. So premiums would go up – I can’t understand how they are going to come down. No one – Democrats or Republicans are talking about this issue.

    Comment by Vivek Taneja (@vivek_taneja) -

  69. Free market (sort of) based on preventive care paid for out of pocket (either individually or by your company) using health savings accounts and PRE TAX $$. Offer catastrophic coverage as an add-on or offer gov’t program without big insurance companies managing. Break up the big insurance companies and deregulate. They are designed to screw the patients wherever possible. Unfortunately its more complex that just a single payor system. The Insurance companies and drug companies must be brought to heal or all we will face is larger and larger premiums with less care. We must deregulate the industry and let the free market work. Ideally the entire program would be run and managed by Gov’t unfortunately our gov’t has proven its not capable.

    Comment by Doug Reichel (@GondolaGolf) -

  70. First thought:
    People using ‘pop up pharmacy’s’ or ‘mail order pharmacy’ as some others noted in comments above may be able to get a cheaper price on drug cost, but that cheaper price also comes with increased risk since those drugs entering the US may not be inspected to the rigor that the FDA would require. For example, many US people elect to buy their prescription drugs from Canada in an effort to save money. While that may seem like a great idea, the “pharmacy’s” providing those drugs to consumers may appear legit, have a nice website etc, but more often those pharmacy’s are often just a pass through middle man distributing drugs that often come all over the world. Health Canada won’t inspect those drugs to ensure compliance for the appropriate amount of API (the Active Pharmaceutical Ingredient) if those pharmaceuticals are not intended for Canadian patients. The FDA does not have the resources to inspect Canadian drugs/pharmacies to ensure proper drug composition. So what ends up happening is that nobody inspects those drugs, US based consumers buy them thinking that they are getting the same drug for cheaper, when in reality they may be getting the drug with some or NO API that they are supposed to be getting. Often those ‘drugs’ are cut and pressed with harmful materials, such as drywall. So perhaps high drug cost in the US is also associated with the increased safety of the drugs here in the US. Our pharmaceutical industry manufacturing facilities are inspected with incredible rigor by FDA and others to ensure manufacturing happens, and drugs are made in the proper GMP environments with appropriate formulations to ensure safe and effective drugs for all. In order to invest in, and keep manufacturing facilities up to par with appropriate FDA guidelines, US pharmaceutical manufacturers invest billions in their facilities, processes and people to make that happen. All of that costs money,…to the tune of billions of dollars. Let’s also remember, that it costs billions of dollars in R&D, product development, clinical testing/trials etc to bring a new drug to market. What incentive would any pharmaceutical company have to invest and risk the billions of dollars it would take to get a new drug to market, if we told them that the end sales price of their drugs would be slashed to a fraction of what the sales price is today?

    Second thought:
    Patent protection allows for ~20 years of protection from application date…so if a large pharmaceutical company files a patent as soon as they identify a new compound that has promise for a new therapeutic, and then it takes 10+ years or longer and billions of dollars to get that drug to market, then that means they only have a handful of years years left on the patent protection to recoup the multi billion(s) dollar investment before the generic and “me too” companies come in and take market share. So basically the big companies, would have to take all the risk: ie, prove the science and formulation, clinical results and global market demand for commercialization. Perhaps patent law should be changed around this to allow more time /flexibility for pharmaceutical companies to recoup their investment. If they have more time to recoup their investment, perhaps they can reduce the price of the drug since they can amortize their future revenue over many more years than is currently allowed.

    Comment by Chad Pannucci (@chadpannucci) -

  71. Chronic health problems alone, such as cardiovascular disease, diabetes, obesity, cancer and kidney disease account for more than 75 percent of US healthcare spending. That’s not even including catastrophes, end of life, or intensive beginning of life care. Basically you’d end up with people paying for at least 90% of healthcare through taxes anyway. It would be simpler to pay for ALL healthcare through taxes and not have to argue over what’s chronic or catastrophic. On top of that, people could buy supplemental insurance like they already do for Medicare, or like people do in France, which year after year has one the highest rated healthcare systems in the world.

    As for who would lose, single payer would save around $500 billion on administrative costs, so whoever’s doing those jobs would be the biggest losers. Doctor compensation is something like $250 billion for one million doctors, so even if they worked for free that would save half of what would be saved from dumping excessive bureaucracy.

    This analysis from Incidental Economist is from 2010, using 2006 numbers, but it’s still not far off the mark.

    Comment by Dale Greer -

  72. One of your questions is whether physicians can accept lower reimbursement? In 1996, physicians reimbursement decreased by 25% almost across the board. In 1998, reimbursement dropped another 20%. So 45% in 2 years. Malpractice insurance stayed steady for a few years but by 2000, most of the tort caps expired, so malpractice premiums were again on the rise. Overall Costs have increased since then, but minimal increase reimbursements occurred. Medical school costs have increased 200%. Currently, over 72% of physicians are hospital employees because they can not make ends meet. Most physicians graduating from medical school today will never be able to pay back their loans. After a minimum of 12 years of schooling, taking the responsibility for people’s lives every minute of every hour they practice their craft and no longer being able to pay their malpractice insurance ( $50- 150,000 and for the electronic medical records we are mandated to use ( not to mention $675 every year to stay board certified, $650 every 2 years to maintain our lisense, $500 every 2 years for our DEA lisense, $500 every year for every hospital we have the privilege to bring patients too, the cost of continuing medical education, and then being reimbursed $60 of that $300 we bill for a 25 min visit; no, I don’t think doctors can get reimbursed less.

    Comment by Lisa Rubin -

  73. If major medical is covered by what Mark is proposing. I would build a platform that allows the doctors to go direct to the customers and leave insurance companies out all together. I am sure they would not like this but oh well. If you were able to get a group of doctors together that covered all non major medical and everyone of there patients paid them $100 a month I would think that they could cover a lot more of there patients issues and on a more regular basis. Its basically cutting out the middle man (insurance companies) there only true purpose is major medical.

    My insurance went from $700 a month to almost 1500 a month with Obama Care being self employed and a family of 4 and I still have to pay deductibles and co pays. That’s 18k per year that I pay to the insurances companies and I still got a bill from the doctor the other day for over $500. So to me whats the point. I would rather pay $700 per month again and give it straight to my local doctors and say just cover everything for my family for the year. I would assume that is way more then they make off me now after there discounts they give the insurances companies.

    Those discounts are just fluff anyway. Its like the company that marks everything up so they can have a sale. The doctors mark everything up because they know they have to give a huge discount to the insurance companies who keep 90% of the money anyway from the premiums.

    I would think with all the technology it would be easy to create a local doctor group plan that can cover all non major medical. Maybe its almost like a HSA but for doctors. You pay into the HSA and all doctors from the group get x amount per month a lower amount but something. Then the rest of the money stays in there for specific visits to specific doctors. If you see a doctor they charge the special HSA for that visit.

    Just thinking off the top of my head here but I think it can be done in a much better manor then it is now. Its probably one of the only major markets that have not been disrupted and definitely needs to be.

    Comment by Chris Rubini -

  74. This really turns on its head what the insurance industry has been saying for decades. They say that for health insurance to really be “insurance,” it should only cover catastrophic expenses, not the costs that are predictable and budgetable (although your proposal leaves out some truly catastrophic costs). The problem with this and your proposal is that there are a lot of people who truly can’t afford those costs, no matter how predictable they may be. Especially the cost of drugs, but even a run-of-the-mill doctor’s office visit these days can cost upwards of $300.

    So, one key omission from your proposed plan is helping low-income people afford basic healthcare. But I agree that it is time the government steps in and actually provides coverage. Otherwise, only the rich can have it.

    Comment by Kathy Dobrzynski -

  75. Comment #233:
    Mark – thanks for stepping in into this.
    #1 – Your Q: Who takes less? My answer: no single stakeholder. Reduce costs by (a) pushing free market forces to eliminate inefficiences (b) using government regulation to eliminate monopolistic pricing (I like your MFN idea)
    #2 – Very roughly, healthcare costs comes in three flavors – catastrophic (e.g. cancer, organ transplant), chronic (e.g. high cholesterol, asthma), and casual (e.g. flu, bruises). I like the notion of the government being the payer of last resort for catastrophic. I think costs for chronic and casual issues can and should be covered by individuals directly or indirectly through insurance pools/employer subsidies/philanthropy etc.
    #3 – The issues of whether everyone should pitch in for healthcare (outside of paying income tax) or if the healthy can opt out, and whether no one should be denied health insurance can be argued on both sides and will never be settled with overwhelming consensus, but instead by the political winds of the day. We don’t do national referendums in the US, but that would be one democratic way to resolve it.

    Comment by Raj Sehgal (@rsehgal99) -

    First off, this is not a Republican, Democrat, Liberal, conservative, LGBYT, green, TEA party or whatever group of the month problem. It is personal, it is real. Being both, figuratively and literally, a question of life and death. Reflecting on the timeless words of Patrick Henry, “Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty or give me death!” Words spoken in 1775 spurred by an overreaching, bloated, unfair government (sound familiar) are still is relative in this debate. Letting the government decide how medical services are paid and rendered means that YOU give up your personal freedom. Dear reader, as one that has defended your freedom, I am uniquely qualified to state, unequivocally, that you were worth it, that freedom is expensive and should not be cheaply given away because once it is you will be a prisoner to the whims of those in power. If upon reading the preceding, you now have the urge to spontaneously give me the thumbs down, dear reader, I now know you are not serious about a discussion on medical reform, rather, you are blinded by your political agenda. I further implore, please continue.

    The problem is not how do we pay for insurance, but rather the scope of services we pay for. Fundamentally the medical insurance business and how people view medical insurance is all wrong. By way of example, consider your vehicle, you carry auto insurance for when the vehicle has a catastrophic crisis (i.e. a crash, stolen etc.). Your auto insurance premiums do not pay for maintenance (i.e oil changes, new tires, belts or hoses). The point is that you have chosen what type of car to drive, you choose how to drive it, when and where you go to get it serviced. You also shop around for a good mechanic with affordable prices, and you also get regular oil changes because as much as you like the mechanic, you really don’t want to fund the purchase of his new boat! Yes, I know that there are companies that offer “maintenance and service insurance” that you pay an extra monthly premium on that cover services. I’m not being glib so please stick with me. The corollary here is that medical insurance is used as an all-purpose means of paying for every kind of medical procedure (catastrophic, routine, elective).

    Let’s look at the medical system from a strictly management perspective. In the business world it is widely accepted that QUALITY is directly related to three aspects: SCOPE, TIME, COST. If you change any one of the latter it necessitates a change of the other two or you impact QUALITY. The SCOPE of services we expect for “standard” health coverage is quite broad and changing, from a strictly business management perspective, it follows that an increase SCOPE necessitates a corresponding increase in COST and TIME (i.e it takes longer to get something done). Therefore, with the prevailing view of health insurance scope paying for every medical procedure and everyone why we are not surprised that the cost is increasing and time required to get a procedure increases and quality of care decreases?
    Let people chose the level of insurance they want that fits their scope and budget.

    With respect to government edicts on health care, they should ONLY be setting objectives for States not mandating or prescribing specific actions. It may come as a shock to the DC insiders, but believe it or not, the folks in DC are not the smartest folks on the planet. Consider, a successful business man (Mark Cuban, Donald Trump, Warren Buffet), they are succesful (most of the time) because they are smart enough to know he cannot do it all he must TRUST others, set objectives, and support people in their work to achieve the stated objective. Along this line of reasoning, here are objectives of the medical system for your consideration.
    1. No one may be denied service for life threatening or catastrophic events (we already have this one)
    2. Pre-existing conditions can not preclude you from getting insurance. (Available to all, if they choose to purchase)
    3. Insurance available across state lines. (Increase pool size and competition)
    4. Government may not compel you to purchase insurance. (Free will ensures competition, instills supply and demand, constitutional)
    5. Government may not direct insurance companies, other than item 1, what they cover or do not cover. (Free Market, Free Choice)
    6. Government may not set prices for insurance or procedures. They may fine medical facility or doctor for violating reasonable & customary charges as established by the individual states. (free market)
    7. States may choose to implement per capita “Cost Sharing” insurance programs for the coverage of catastrophic occurrences to prevent financial ruin.
    8. Treatment of Non-Citizens, without insurance will be billed to their respective countries for reimbursement in the form of goods or cash. We will do the same to other countries. Albeit America still has the best health care in the world)
    9. Alternatives to non-traditional insurance (i.e. Consigner services and MEDISHARE) will be encouraged and supported.
    10. Individuals selecting not to carry catastrophic insurance own the consequences of their choice including financial ruin.
    11. Insurance companies may define dependents with the age of emancipation as given by individual states. (People you’re not a child at 26! Relax, children with life long medical issues should be covered for life, those whose only issue at 26 is one of motivation to be self sufficient should not!)

    We are humans and as such we are not perfect, thus the first step is to accept and admit that we can never create anything perfect. The greatest gift we as Americans have is freedom of choice. For a solution to this modern problem to be equitable and reasoned, no one must delude themselves (politicians included) that they have the answer. No, this solution, to be successful, must be rooted in truth and honesty laid out for us in the Declaration of Independence. We must return to and find solace therein. Please forgive in advance my interjections given for clarification of my interpretation.
    All men are created equal, that we are endowed by our Creator with certain unalienable Rights, that among these are Life (government may not kill you or place life in jeopardy), Liberty (ensuring free choice and will. The government may not compel you to do anything – like buy insurance) and the pursuit of Happiness (Note this is the right to pursue, happiness is not a guarantee). That to secure these rights, Governments are instituted among Men (Yes, not PC but does mean all people as demarked by capital M), deriving their just powers from the consent of the governed (ME and YOU),….
    What we can do is to work together to ensure that individual freedom is defended and honored in all aspects of our lives. Removing barriers, needless regulations, and mandates will foster a return to common sense, innovation and natural efficiency.

    Comment by Jim Poorbaugh -

  77. What you propose is basically Medicare for all. A good idea. Most of us on Medicare have affordable supplemental policies. But if this is to be the case, then we have to start by subsidizing doctors in medical school. They must go to school for free and then work for the government. No $200K student loans to repay. Rein in the drug companies. Get rid of the insurance companies with their hands out for blood money on the backs of sick people. (Reference the CEO who said they were not in the business of helping sick people, they were in the business of providing profits for their shareholders.)

    Comment by Liz Cratty -

  78. Mr. Cuban,
    I have much respect for you, having watched how you operate on the tank, week after week. I read your article and while I believe that there are certainly some valid points in it, I also believe that you are missing some other points that need to be addressed. I know that there are those who posted directly to here on your blog post and those who have posted directly on LinkedIn. Unfortunately, my comments back are too long for LinkedIn, so I am posting here and hoping you will, indeed, read these comments.

    Here are some of the issues that a social-economically disadvantaged, disabled (due to chronic illnesses, degenerative issues, and genetic issues) female who has been dealing with the health care system most of my life.

    Issue number 1-Health Care has become a business. Doctors are no longer able to spend the time necessary to truly get to know their patients. Instead, the company who owns their practice, and often the nearby hospitals, dictate how long they are able to spend with their patients, which is, more often than not, 15 minutes and few doctors are willing to disobey these directives.
    Issue number 2-Insurance companies place barriers between patients and medications that are often necessary, placing them in higher tiers or eliminate them from their formularies altogether. Some of these medications could help patients from developing further health issues, yet insurance companies do not seem to recognize this.

    Issue number 3-(and you did address this in you post)-Insurance copay’s and deductibles make having insurance almost laughable. I just got home from a 4 day stay at the hospital after a bout with acute pancreatitis brought on by one of the medications my doctor was forced to prescribe me after the insurance company stopped covering my previous medication. Those 4 days alone will cost me over $1000, not including the ambulance ride, and any additional charges that were incurred that I am not aware of. I pushed the doctor to release me earlier than I probably should have because I knew that I probably would not be able to afford the already mounting bills. While this may not seem like a lot of money to you, for someone like me, it is a fortune.

    Issue number 4-Pharmacutical companies.-They have been allowed free reign to charge outrageous prices for medications. While life-saving medications life epinephrine have been in the news and are in the forefront of people’s minds, this is happening across the board. If I did not use my insurance companies “mail order” pharmacy-something that I am not very comfortable with-I would be paying several hundred dollars a month on necessary medication. If I had no insurance, I would be paying thousands of dollars every month for my medications.

    What is the solution to these problems? I do not know, but I do know that I am not alone in this conundrum and it is people like me who will suffer the most, regardless of what happens with the healthcare system, unless these issues are addressed and fixed.

    Mary Ann Halstead

    Comment by MaryAnn Halstead -

  79. Two problems…(1) the government cannot be the single payer because the government is only made up of citizen taxpayers which you advocate to “share” the costs / you can’t “share” the costs when over 1/2 of the citizens don’t pay any taxes at all & actually receive $ instead. (2) you completely discount the power of free markets; truth is there is no competition between insurance & drug companies today.

    My counter proposal to you…
    (1) reform the tax code 1st to create complete fairness on funding this and all government spending (see Move the tax burden from income taxes & loopholes to a consumption tax (exemption us to poverty level), and broaden the tax base from 100M income earners to 350M spenders.
    (2) AFTER fixing tax system, implement government catastrophic coverage you outline for any event/chronic condition that exceeds 1/4 of a family’s annual income + 1/10 of their net worth. Must have a simple form with proof for this coverage to pay. Have to have these “buy ins” to avoid fraud & abuse.
    (3) With catastrophic covered, get government out of the way & let free market take over. Slash the regulations that protect monopolies & watch the price for regular needs (I have a cold, I broke my arm, etc.) fall through the floor.

    Comment by Ken Evans -

  80. Mark – thanks for taking the time to write about this important subject with some common sense. One night back in 2009 I was so frustrated with the direction and complexity of healthcare reform conversation, I decided to write what I thought was my common sense solution to the problem. It manifested into a recommendation letter which I wound up sending to each member of the Senate Health Committee.

    My recommendation was practically identical to what you’ve articulated in your post above. Overly simplified, 100% of consumer’s would pay a federal tax for catastrophic health insurance coverage (the Federal government is already the Payer today for the old and indigent) which would allow the private insurance market to operate without the actuarial risk of pricing premiums to account for outlier conditions (e.g., cancer treatment, which drive the majority of healthcare costs today. I believe this would control cost increases for Employer Group plans, as well as finally make the Individual insurance market premiums palatable.

    I believe that no U.S. resident should have to go financially bankrupt due to what you’ve categorized as the ‘Genetic or Randomness of life lottery.” While I’m not a believer in broad economic safety nets, I do believe that catastrophic health situations should deem more economic support from our government. The fact is, far too many vibrant, productive contributors to our society are physically and financially hampered by “bad luck” when it comes to their health. Why should a 40 year old diagnosed with cancer, who may happen to not have health insurance at that time, be pushed to the brink of bankruptcy; when in comparison a 65 year old who qualifies for Medicare has a federal insurance program to fall back on? Not to sound callous, but from an economic productivity perspective, we as a society should recognize that the 40 year old represents an opportunity to treat someone who can continue flourishing as a productive member of the community – and incentive the system to do so.

    Again, I know this may sound like an overly simple solution. That biggest problem is that it requires a fairly large deviation from the status quo and would require everyone to acknowledge a new federal tax (although it could be lumped into FICA taxes).

    Sorry for the long comment reply – anyone who would like to continue the conversation or read my paper can reach me at

    Comment by Greg Bergamesco (@GregBergamesco) -

  81. I have not read all of the comments so I apologize in advance if mine are repetitions. I think the best course of reform CANNOT go through Washington DC. There is too much ill will and spitefulness within Congress for real deliberation and consensus to occur. As their roles have basically devolved into PR positions for competing special interests, collectively, they no longer seem capable of advancing laws in the best interest of the country. Therefore, I think the best course of action needs to go through us, the citizens.

    We need to be both destructive and creative. We need to stop thinking in terms of improving the processes but rather change the very nature of them. We need to stop looking for a health care solution within the same political parameters that have constricted both innovation and benevolence. In a way similar to the disruptions in some many other industries that are based on different models like peer-to-peer and crowd sourcing, health care needs fresh eyes.

    Mark, such a disruption needs a catalyst to drive the change and steer the transformation. Given your ability to challenge, to innovate, to encourage and to lead, (not to mention your strengths harnessing data and technology) perhaps you should find a bunch of people to handle your current responsibilities so you can dedicate more of your time to being that catalyst.

    Comment by Dec Larrey -

  82. I don’t have anything to add. But I’m a person who is disabled and has one genetic disorder, two degenerative disorders, one immune disorder (RA) and one illness which would be preventable if not for the others. I’m currently tied up (for going on 5 years now) in fighting the government for the disability I’ve been paying for with my taxes since I was 16. A lot of the solutions people are tossing about don’t really work for people like me who have no income, rely on SNAP for food and rely on Medicaid transport to get doctor appointments. I literally have nothing of value outside of a few personal items like the laptop which I have to have so that I can conduct certain business and research medications and treatment plans as needed. I’m having to live with friends while all this is going on and I don’t have family I can trust to help me or who would likely be willing, either. So, obviously, I’m hoping for the people who can change such things to keep in mind that we don’t ask to be sick. We don’t ask to be poor. Up until I was laid off from my last job, I basically pushed and pushed until I made myself become quite ill from all the pain and other things my body was dishing out. I’m not lazy. I WISH I could work and not be stuck in the same four walls day after day. But if they remove me from Medicaid, I will have a limited shelf life of 2, maybe 3, years tops. Left uncontrolled, all of those illnesses together will crash my organs in a rather slow and painful way. So my life literally does hang in the balance on this issue.

    Comment by Jolie Bonnette -

  83. Some of us have been advocating for Universal Health Coverage for a long time. Some of us have even written books advocating UHC, so I’m literally all-in. The challenge, however, isn’t as much about convincing the American people as it is getting the monied interests out of the for-profit Business of healthcare. In this sense, all the segments of the industry are complicit. Payers, providers, pharma, med dvc manufacturers, suppliers (including EHR ISV’s) all extract enormous quarterly profits from this medical-industrial complex ($3.6 trillion this year w/ over $700B in waste!). Lawrence Lessig said it best just before the first presidential debate last year: “You know, when Bernie was talking about single-payer healthcare people rolled their eyes. Not because it was a bad idea, but because there’s no chance [in hell] to get single-payer healthcare in a world where money dominates the influence of how politicians think about these issues.” When will this change? I can’t predict that, of course, but I can tell you that we’re further away from BHAG like UHC with an administration that’s hell-bent on “dismantling the federal bureaucracies”​ and forcing the states to fend for themselves. The only way UHC happens is at the federal level – not the state.

    Comment by Dan Munro (@danmunro) -

  84. Hi Mark, great idea. The only fear I have is that insurance companies will now jack up the prices to take care of these terminally ill folks and people who met with an accident, so that they can make sure to deplete the entire extra tax collected from each american citizen and in 5 years the prices will be so high that we will need to increase the tax collected to fund this.

    Comment by Varun Nb -

  85. Interesting thoughts Mark! I have not gotten through all of the other comments, but I have a simple suggestion that might be easily added to the conversation. Regardless of your politics, if you want the national health insurance program to be fair and comprehensive there should be a requirement for ALL Federal and State employees to have it exclusively as there insurance program. Senators, congress representatives, all armed services, postal workers, anyone associate with the government. The President, his family and all of his cabinet members. Now all of a sudden what is trying to be rushed into existence will need to be looked at a little closer and a little harder because we make it personal to the people who have the responsibility of getting this important program in place. We also insure that we have a large base of diversified Americans represented and dependent on the program. Thanks for starting this conversation. Tom

    Comment by Thomas Dougherty -

  86. Thank you for the valuable dialog! It’s going to take forever to read all of the comments, but the discussion is valid and valuable, IMO. Two things quick came to mind for me. First, some if not all insurance companies used to be not-for-profit. This certainly took the hefty stockholder dividends and CEO bonus out of the mix.

    Second, if insurance companies are allowed to withdraw from a state market, they should not be able to continue to operate at all in that market.

    The thing that interested me is how United Healthcare is creating rewards for taking care of your health. My 87 year old mother and 92 year old father are given $25 gift cards to get a full physical every year. I believe this type of incentive would work with millennials, which is the portion of the population we need in the healthcare system to balance out the risk. Right now it is cheaper for many to pay the tax penalty than to get the insurance.

    Those are my thoughts for now. I’ll enjoy reading the sum total of proposal and comment for further insights.

    Comment by Melinda Lockhart -

  87. Well I have invested basically all of my time since 2008 doing research on how to fix this. Along the way we came up with a consensus solution. Essentially the comments are really, really good, give yourself a pat on the back.

    Here is some brief history, heath care reform started out in the 1890s. A great deal was learned and applied, still despite innovation health care has been about 30 years behind other disciplines.

    In 2004 HHS created the national coordinator that was supposed to solve the well known by then problems that went along with creating an Internet based utility to manage health care technology.

    By 2008, Shirky, when the problem was still interesting, said that up to that point, Pre-Obama, all the pilot designs were guilty of “magical thinking”

    To avoid the massive billion dollars losses racked up by the NHS consultants who could not deliver the simplest of systems, the focus was shifted to loosely organized agile development groups. We avoided those losses, but the focus by Obama was essentially the same as before, to negotiate a business layer solution, namely the ACA, while trying to get evidence to deliver precision medicine, which meant a huge data burden on doctors.

    So fairly if you spend 17.8% of GDP and 10k per person that is enough to get really good results compared to other countries. But we don’t get those results, and other counties spend a lot less.

    Health care costs, not insurance makes health care unaffordable.

    The Mayo clinic famously said the problem with the US health care system is that don’t have one.

    So one has to attack this as a country wide system that can be implemented using the Internet. We already knew this in 2004, but the stakeholders were trying to keep their companies from being disintermediated. The ACA has some good and complicated points that attempts to balance these conflicts, but because it was a business level compromise of scarce resources, is a jenga tower requiring a deft touch as to what can be removed without collapse.

    Of course there are ways to organize all the information in the health care system in a simple design that was rejected precisely it already solves the problem in other countries. This means that the problem will never be solved, because the economic players don’t want a solution. Yet there has been substantial progress beyond the magical thinking.

    We have a plan but it was blocked. Now is the time to reestablish the doctor patient relationship like it was before it became big business. But with the added information capability of the Internet which can redo Healthcare like the stakeholders requested in 2004.

    Done efficiently this can lop off about 30% in costs due to built in inefficiency in which the current players tacitly agree and appear as higher premiums.

    Comment by diningphil1 -

  88. Banning sugar would take care of everyone.

    Comment by Brendan John -

  89. I actually think this is a good idea. I have been saying that the IRS needs to be more interested in actually generating revenue from free enterprise instead of taking money out of individual paychecks. This would be a good way for the IRS to get revenue in another way. This is actually the best idea I have seen so far.

    Comment by themaggied -

  90. More and more, I’m in favor of single payer, period. But I’m sure there would be room for people to still buy other insurance as they do in other countries, such as England. And a very sensible place to put public dollars is prevention. Some expensive chronic conditions or emergent situations can at least be mitigated by prevention, but our health care mindset is that I can do whatever I want to wreck my body and then the doctor is supposed to fix it with a bunch of expensive technology. Why not focus on helping people avoid the break down? Why not compensate physicians who do this? Why not focus on making sure people have a primary care physician and reduce the number of visits to emergency rooms for non-emergencies? Why not work on innovation to make primary care accessible in a way that works with people’s lives even if they don’t have the sort of job where they can take off half a day to see a doctor across town? Insurance is not the only thing we need to be talking about.

    Comment by Susan Martins Miller -

  91. I think that instead of monthly tax credits to pay for the premium, they amount should go directly into a Health Savings Account. This would incentivize people to seek lower cost policies, especially over time, as the HSA grows. It would also incentivize people to make smarter choices to avoid having to use their HSA.

    Comment by Bill Mariano -

  92. I think the whole point of America is missed here. America is the “land of OPPORTUNITY”. The opportunity to have a better life and the opportunity to rise to the top. Equal playing field, equal opportunity, not equal benefits. It is my responsibility as an American to make my dreams come true and my responsibility to EARN what I receive and to make a good life for me and my family.

    The biggest problem in this country, the world, and with the entitlement mentality is that people (in general) don’t take responsibility for their own actions anymore. They expect… (you fill in the blank). It is not the government’s job to provide healthcare to it’s citizens. It is the government’s job to keep us safe and collect taxes for infrastructure, etc. That’s it!

    Oh and by the way, when the government gives out entitlements, it is really the taxpayer’s money. Let’s not forget that it’s not FREE.

    Mark, I respect what you have achieved in your life, but if you feel that the government should provide healthcare for it’s citizens, maybe you should lead the charge and pay for 100% of your employees’ healthcare costs. And better yet, all the business owners that have worked so hard at building their businesses by the “sweat of their brow” should pay for all of us. They can afford it can’t they?

    Comment by Brian Hudson -

  93. Marc, thanks for asking us. We can solve this! The question that we should be asking is what’s the problem, not who loses or takes less. We all know the cost of ACA/Medicaid/Medicare are too high to sustain without draconian tax increases. So we have to focus on the root cause of the health issues that are driving the costs, first. Like a business person, If we Pareto chart the health issues biggest to smallest, we can start to work on how to fix the American Health Care problem with prevention or early diagnostic testing. Start with Diabetes. It’s mostly preventable, sometimes reversible, and mostly controllable by our lifestyle, what we eat, and what we drink. Here’s some stats from the American Diabetes Association website.

    Prediabetes: In 2012, 86 million Americans age 20 and older had prediabetes; this is up from 79 million in 2010. The numbers are getting worse, but I don’t have the latest figure, so I will use these. Updated March 6, 2013 $245 billion: Total costs of diagnosed diabetes in the United States in 2012 $176 billion for direct medical costs $69 billion in reduced productivity. Hypoglycemia: In 2011, about 282,000 emergency room visits for adults aged 18 years or older had hypoglycemia as the first-listed diagnosis and diabetes as another diagnosis.

    Hypertension: In 2009–2012, of adults aged 18 years or older with diagnosed diabetes, 71% had blood pressure greater than or equal to 140/90 millimeters of mercury or used prescription medications to lower high blood pressure.

    Dyslipidemia: In 2009–2012, of adults aged 18 years or older with diagnosed diabetes, 65% had blood LDL cholesterol greater than or equal to 100 mg/dl or used cholesterol-lowering medications.
    CVD Death Rates: In 2003–2006, after adjusting for population age differences, cardiovascular disease death rates were about 1.7 times higher among adults aged 18 years or older with diagnosed diabetes than among adults without diagnosed diabetes.

    Heart Attack Rates: In 2010, after adjusting for population age differences, hospitalization rates for heart attack were 1.8 times higher among adults aged 20 years or older with diagnosed diabetes than among adults without diagnosed diabetes.

    Stroke: In 2010, after adjusting for population age differences, hospitalization rates for stroke were 1.5 times higher among adults with diagnosed diabetes aged 20 years or older compared to those without diagnosed diabetes.

    Blindness and Eye Problems: In 2005–2008, of adults with diabetes aged 40 years or older, 4.2 million (28.5%) people had diabetic retinopathy, damage to the small blood vessels in the retina that may result in loss of vision.

    Kidney Disease: Diabetes was listed as the primary cause of kidney failure in 44% of all new cases in 2011.
    In 2011, 49,677 people of all ages began treatment for kidney failure due to diabetes.
    In 2011, a total of 228,924 people of all ages with kidney failure due to diabetes were living on chronic dialysis or with a kidney transplant.

    Amputations: In 2010, about 73,000 non-traumatic lower-limb amputations were performed in adults aged 20 years or older with diagnosed diabetes.
    About 60% of non-traumatic lower-limb amputations among people aged 20 years or older occur in people with diagnosed diabetes.

    Sorry for all the stats, but it shows you where the problem begins and how it balloons. Diabetes is mostly preventable, some times reversible, and certainly mostly controllable by our own lifestyle, what we eat, and drink. Focus here and we can drive down the cost of health care. It starts with prevention. If you want to know more e-mail me at

    Comment by Steve Koufos -

  94. The problem is high cost of care and inefficiency in care delivery. The high cost is responsible for 90% of the problem.

    High cost:
    1. 30% of care provided is useless or harmful (unnecessary tests, futile treatments tc)
    2. Defensive medicine that has poisoned an entire generation of physicians as a result of runaway frivolous malpractice claims
    3. Largely fee for service system that drives volume over quality and outcomes
    4. High cost of medications and medical technology designed to generate value to investors
    5. Unreasonable end of life care decision making by both providers and families

    Covering everyone will bankrupt the entire system if we fail to face those five factors.

    Comment by Alexandre Andrianov (@alexmd2) -

    • Unreasonable end of life heathcare swings both ways. Back in 2010 my parent was gravely ill due to low electrolytes. The healthcare hospital rep asked me if I wanted to take my parent home for end of life hospice care. I said no, fix their electrolytes. It’s now been 6 and 3/4 years since then and my parent is alive and happy.
      On the other hand, when I attempted to enroll this same parent in a MediCaid Home Health Care program, the state reps repeatedly lied to me as to how the program worked. The lying directly led to my defaulting on my credit cards. Even though I had taken care of my other parent and agreed to home hospice care for them, which possibly saved the “system” hundreds of thousands of dollars, I was now being called by debt collectors.
      One debt collector recounted how their own parent had run up a 10 million dollar healthcare bill (in Canada) over the final 60 days of life because the debt collector chose to not take time off of work to provide home healthcare for his parent. I was now being dragged through the mud and had my credit rating defiled for seven years for saving the healthcare system hundreds of thousands of dollars, in part by a debt collector whose own parent cost the healthcare system 10 million dollars.
      So yes, end of life management is all over the place, but the ones that are the most honorable and respectful tend to get the worst financial result for doing the right thing.

      Comment by Alessandro Machi -

  95. So let’s say this happens – we move to a single payer system for catastrophic coverage (hurray!) so this portion of insurance is covered for everyone at a relatively low cost due to the large pool of participants – all US citizens. It’s clearly not going to be the lowest possible cost, as those who choose to take on more risk with their bodies – daredevils, violent offenders, etc. – are all included in the pool is everyone who doesn’t take care of themselves (and now have less of a financial incentive to do so). So a single payer system for catastrophic coverage may make sense, I’d still prefer that those who opt to live a riskier lifestyle pay in with higher premiums, why wouldn’t you?

    The basic concept of insurance is to price for risk. One way to drive down expenses is to reduce aggregate incidence of chronic diseases — at least where known risk factors are under the control of the individual. Should smokers pay more than non-smokers? You bet. How about people who choose a sedentary lifestyle and are obese? Certainly. High rates of alcohol consumption? Yep, you should pay more too. We have driver’s tests, why shouldn’t we have annual physicals included in this new system and introduce standardized, risk-based, pricing for all for even non-catastrophic events? Well, this also leads us towards a single-payer system for non-catastrophic coverage so we’re considering nationalized health care. I don’t think we have the stomach in capitalist America to pull it off.

    Is the employer-based system fundamentally flawed? Of course, but it’s another result of trying to engineer outcomes through the U.S. tax code. So let’s assume that we’re not turning it off anytime soon. What we can do is enhance and improve the system we have at the edges:
    – mandate all citizens carry non-catastrophic coverage at some minimal level – just like proof of auto insurance required for registration. No insurance, sorry you’ve lost your citizenship.
    – annual physicals for all – risk-based pricing based on controllable risk-factors regardless of who’s paying
    – more reasonable compensation for physicians and everyone involved with assessment and care delivery
    – higher scrutiny of the perverse financial system involved with pharma R&D where the Federal government is funding fundamental research through NIH but derives negligible benefits from favorable findings that result in eventual commercialization and protection of drugs via patent
    – national focus on efficiency of care – just because we have available all types of diagnostic tools and tests doesn’t mean that we should use them all unless we need to. Unnecessary diagnostic costs are real.
    – get people to think about planning on both the health/wealth sides for older age. Let’s be honest, medicare and social security just aren’t going to cut it. Yes, I favor auto-opt-in to 401k plans. There, I said it.

    More generally the system of coinsurance and copayments hides the true cost of care from individuals. It’s analogous to new car with a warranty, people don’t know / don’t care about the actual cost of repairs. High deductible health plans increase awareness, for sure, but maybe we should consider much, much higher deductibles – $10/20K/individual. We can prefund them in savings accounts – mix of federal, employer and individual payments in – but if people actually had to pay they’d be more careful about how they choose to consume services. That visit to the ER for a sore toe is going to cost you, less in your healthcare savings account!

    Without annual physicals (push to healthier lifestyles) and increasing awareness of the true cost of care (higher-deductibles / copayments) we’re just trying to push bigger and bigger piles of dust under the rug. That’s the basic problem with whatever plan we have in place, we’re dealing with the symptoms and not addressing root causes. Until we address root causes it’s not going to be possible to come up with an affordable system that works.

    Comment by Vineet Madan (@vimadan) -

  96. Mark – kudos to you for outlining the concept, providing some fundamental precepts, and opening the forum to the masses. Here are my precepts:

    1) Healthcare is a right to those who are unable to care for themselves, have drawn the short straw in the genetic lottery, and find themselves in an unfortunate accident.
    1a) As a result of 1), all people MUST have some form of healthcare insurance, at a minimum. catastrophic insurance to cover diseases like cancer, heart attacks, etc., and unfortunate accidents. This is like life insurance, only for you while you are living! I call it “living life insurance.” Call it a mandate. Call it whatever you want, but it is unacceptable for people not to have some form of coverage. If you drive a vehicle, you have to have auto insurance. If you live and breath, you should have health insurance. Period.
    2) Get rid of the whole health insurance through employer system and make it available on the open market, subsidized through tax credits for premium payments similar to now how you don’t pay taxes on health premiums in your paycheck.
    3) Allow purchases of health insurance across state lines, even internationally to that end.
    4) Allow individuals to join in healthcare networks through associations, local non-profits, etc., who would then be tasked with getting insurance rates with insurers based on a pool of covered people, Who out there doesn’t belong to some form of association?
    5) Make insurers negotiate with “medical system” providers (vs. one on one with providers) to which providers are a part of.
    6) Get rid of requiring consumers to purchase Rx drugs through a pharmacy or other middleman. If you want drug prices to come down, allow consumers to get drugs directly from the drug companies who are connected to a network to which the healthcare providers submit their authorization for dosing.
    7) require al healthcare providers to post prices for services. We require every other retain operation to post prices so the consumer can decide what to get, why not require providers. It is unacceptable for healthcare providers to not inform the patient of what services cost.
    8) Incentivize the hell out of health savings accounts.
    9) Put the buying decision and responsibility in the hands of the patient (or his/her family) based on pricing, care, etc., and incentivize the patient to only request what services they need. With insurance currently, folks rack up hundreds of thousands of dollars since “the insurance company is paying” which is a perverse system.
    10) Incentivize and REWARD healthy habits through premium reductions, credits, etc. Such habits include no smoking, no excessive drinking, not speeding in your car, cycling, regular exercise, walking, running, etc (all of which can be monitored through fitness devices, like the FitBit). Currently, a significant chunk of our healthcare dollars are spent on diseases and injuries caused by being overweight! I don’t have anything against overweight people, but let’s face it, we are all subsidizing their health care dollars.
    11) End of life/critical life support – a very difficult ethical and religious topic, but one that cannot be ignored when it comes to healthcare. I honestly don’t know what the answer is, but this is the elephant in the room and one that needs to be dealt with. Say I’m 90 and I get cancer. Do I tax the system with the cancer treatment cost to extend my life (what quality can it be) by a few more years or even months/days? Or do I accept my fate and live my last days with dignity and turn myself over to God? Is it 90? 100? 80? Those are very difficult questions, but again, we need options and the option can’t be yes, we treat everyone no matter what age no matter what cost because “life if too precious.” This could be where your catastrophic / living life insurance policy kicks in and you tender it for care?

    Incentives, Fee market. Choice. Competition. Compassionate care. Common Sense. All concepts that should be the foundation of care in our healthcare system.

    Comment by Paul Dubsky -

  97. Mark — this is fairly similar to a number of other countries’ health systems. For some reason, the one that keeps boiling to the top in my head is Italy. The “basics” (chronic/catastrophic illness and personal injury) are provided by the state and through state-run facilities. Private facilities also exist, but these involve additional cost (like staying at a JW Marriott hotel costs less than a Courtyard), and, essentially, just provide better amenities and quality of facilities. The physicians and medical care provided is identical as it is all paid for by the state.

    Comment by Mike M (@mmmsmiles) -

  98. This is not a novel idea, and compromise will likely be necessary. While this model is much better than “Obamacare” or what the Republicans are now proposing, isn’t the most obvious question whether or not the insurance industry adds value to the delivery of healthcare?

    Comment by Steve Hough -

  99. I’m a 35 year old cancer patient that paid more than 26K out of pocket last year alone. Here’s the kicker, I have a chronic cancer that is very rare for people my age- bone marrow cancer. The prognosis is chemotherapy daily for the rest of my life or until someone comes up with a cure. My chemo is just over 17K for a months supply- I don’t have options, I take it or I die. I was diagnosed in October of 2009 on accident- (routine physical – aka- PREVENTATIVE CARE). The result- a chronic condition where I am forced to take poison every day.

    Pre ACA- my chemo was $30 a month, premium was $1000 for my family (platinum type plan), deductible was 3K, OOP max was 6K and in AZ we had 3-4 choices of carriers.

    Post ACA- my premium- $1500 for my family, deductible is 7K, OOP max is 15,500 and my chemo is $7000 dollars in January until I hit my deductible then its $50 per month. The coverage for the only plan I have available to me in AZ is far worse than pre ACA- the only carrier- UHC.

    Mark, here’s what I see- When you purchase auto insurance and you need to use it- you go to a shop that your policy covers, an adjuster comes out to make sure that the work needs to be done that the shop says needs to be done- the shop does the work, the adjuster follows back up to ensure your care is healed. Why is this not done in healthcare?

    Now, I’ve had to force myself to become (literally) an expert with health insurance and medical billing. I’ve learned all the tricks. For example, providers have learned to make their living and to actually get paid, they have to bill back to the insurer codes that represent enough margin to stay alive. How do they do this? Well since everyone uses the medicare thresholds- doctors know if they bill something @ 10K, and the insurer will only allow 5K, then they will yield a 50% margin. Providers have lists of these margins that they use to bill by. I’ve witnessed this first hand in my own medical professionals offices. By the way, dont even get me started with oncology. Those poor doctors I believe are getting the brunt of “the short end of the stick”.

    Here’s the other issue I see. Where is the incentives for providers and consumers when they solve problems that as a result- lower the cost of healthcare? As an example (read Harvard Business Review Article from July-August- “How to pay for healthcare”) Intermountain Healthcare started seeing a huge increase in stillborn deaths. The surgeons at that hospital started researching possible causes. They found out there was some type infection causing this- they solved the problem and saved the insurers millions of dollars. The problem? The millions they no longer get to bill the insurer is pulling money out of their pockets- where is the incentive to reduce the cost of healthcare if all the insurers are doing is pocketing the savings?

    Never in a million years would I have imagined now having this amount of credit card debt as a result of my health. Like most, I believed I was invincable until one day, getting a physical (and thinking I was taking preventative measures) I walk into the hospital with a white blood cell count of 17,000 feeling perfectly fine- and walk out with a rare form of chrinic cancer.

    The good news- there are many others in worse health than I am- keep your head up!

    Comment by Ryan Romero (@spyseeromero) -

  100. You are correct in the sense of how complicated a system we have today. The worst thing to be in this Country is completely uninsured; and not even have access to pre-negotiated and discounted medical services. Why? Well, without network discount rates, providers/hospitals/etc. can bill anything they want to you for their services. I am a firm believer that we can effect real change in the coming years; however, we must realize a few key points; 1) We need a transition period to whatever is next; and it needs to account for the nearly 80 million Baby Boomers turning 65 and going on Medicaid in the next decade, about 30% of the Country, leaving a small Gen X in their 40’s and 50’s and a very large, similar to the Boomer generations, generation of Millennial, majority being in their 20’s. Holistically speaking, claims drive costs; and with such a huge generation shifting to Medicare, it could destabilize the system. Our system was founded on Employer-based coverage; and it needs to remain a major stabilizer, for the intermediate period, no matter what we transition to in the future! An issue with comparing to Single-payer systems is that they are ‘systems’, meaning the government handles everything from paid college and medical school to providers, to facility operating expenses and management salaries, and it’s not that easy to sue the government if something goes wrong. As a first generation immigrant, I hear relatives speak of the challenges regularly; however, those systems still have private-pay systems for those that can afford it; and do not want to wait for care. PPACA was a great first step; however, there are many issues with it too. There are many popular features I expect we will keep; but there are issues to address. The implementation has been extremely challenging; and technology is part of the issue, as PPACA relied too much on the assumption that legacy systems (10~20 year old goverment and corporate systems) could easily be ‘plugged into’, resulting in many challenges. Technology should have a significant impact in many ways; as long as those developing the technology are sensitive to how different the healthcare world is today, from legacy systems to privacy issues. Technology should start by focusing on educating and connecting people to existing resources. New resources will be developed and catch up, like Tele-medicine, which is still not available in many States, due to State Regulations. I can go on-and-on about all the different aspects; however, this message would turn into a novel. We need a a long-term plan, with short-term steps, and a checklist of items to get us to where we need to be, based on the expected timetable to address each issue. I am optimistic for the future; because PPACA has given us a good start…but there is a long way to go; and addressing the Baby Boomer population as they migrate into Medicare is quickly becoming issue number one, as they are currently between age 536 and 71, with half between 57 and 61! This means a huge shift of claims costs from Commercial Plans and provider contracts to lower Medicare provider contract rates. Food for thought…

    Comment by Antonio Pinto -

  101. Having worked the business side of oncology, as you probably know the largest pay-outs are in the last few months of a person’s life whether or not they have cancer. In contrast, when my father, a physician himself, refused chemo knowing the efficacy in his case, he saved both the insurance pay-out and personal pain. End-of-life (except for the few who needlessly decide to pay out-of-pocket) does not need to be so miserable for everyone while also crashing the system.

    Comment by GP Rowe -

  102. I think the question is “will lawyers take less?”…

    Comment by rlorenzon -

  103. I’m no expert either but i do agree with allowing each of us to purchase an insurance policy across state lines. Also, how about putting a cap on profit for insurance companies. If they exceed a certain threshold, all policy subscribers receive a rebate.

    Comment by Patti Smutzki (@psmutzki) -

  104. The root issue that you correctly address but do not explicitly identify is that the goal of Insurance Companies and Health Care Providers is to provide returns to their shareholders (make money). The goal of health care is to make people healthy. The system is at odds with itself and the incentives are wrong. Your solution, a single payer system designed to prevent catastrophic illness, should add basic preventative care, which should help prevent catastrophic illness, then the market can handle the rest.

    The biggest issue with this solution is you will have to tear down many long standing institutions with heavy influence to get it done. Our politicians do not have the fortitude to stand up to big money industries.

    Comment by Brad Nichol -

  105. Healthcare should be front end loaded not back end loaded. What I mean by that- Wellness Clinics on Corporate Campus’, Universities, neighborhoods and borough’s- that use cutting edge technology to design wellness programs for every employee, student, citizen & immigrant. A healthy diet solves numerous diseases (including some forms of diabetes)- one component of the wellness clinics would be to design a diet plans specific to the genetic make-up of the “patient” and then create an accountability program geared to it.


    The reason why current Healthcare & all insurance related subsidies are ineffective; they are REACTIVE not PROACTIVE. COSTS ALWAYS RISE WHEN A PROJECT HAS TO REACT INSTEAD OF PROACTIVELY PREPARING…

    Comment by Sam Pace Van Amburgh -

  106. The only thing I think I would add to this is that to my knowledge, medical care is the only industry in America where you walk in, receive a service, and walk out with absolutely no clue what the care actually costs. And doctors and hospitals are reluctant to tell you, since they have a web of pre-negotiated deals with insurance companies across the country. Try asking a doctor what his or her services will cost, without telling them what your insurance company is. To your point, Mark, it would not be hard for a doctor to determine what his or her time is worth, ‘do the math’ and decide what the rate should be. And charge that rate. Same goes for equipment like MRI machines. They know how much the machine costs, and how many patients they need to see to turn a profit, so why is it so damn hard to publish a cost without insurance? I guess we need extreme transparency in costs for medical care and services.

    Comment by jtjacobs2000 -

  107. As a cancer survivor/ 4 chemos / a lot of surgery (and healthy now). Why is it that we do not address the cost vs profit gained by hospitals? For example…Why is it that hospitals can bill astronomical fees for a roll of toilet paper and Starbuck’s gives it away for free? I know Florida Hospital grossed in the billions for the past 5 years, and they are still building. Tax exempt? Non-profit? Can you please address Mark? The real problem… medical fees, services, and products are not regulated. What do insurance companies have to gain by playing in this market? It’s a band-aid, and the real wound is festering.

    Comment by margaret o'rourke (@MODinc) -

  108. What happens to medicare/Medicaid in this system?

    Comment by jennifer mcgrath (@jennmcgrath4) -

  109. Pingback: Mark Cuban Just Responded to Trumpcare with a BRILLIANT Solution | MEDIAVOR

  110. Your proposal would make it a lot less stressful for me and everyone who has a chronic, life threatening disease that’s being treated with high cost, life saving drugs.. I receive ongoing treatments for stage 4 breast cancer, this is the protocol for the remainder of my life, these drugs cost $8400 every 3 weeks (which the insurance company has covered 100% since my diagnosis in 2015).. As a self employed person, who purchases health insurance through the Obamacare exchanges, I’ve seen my deductible and out of pocket expenses sky rocket to a point that if they go up any more I will not be able to afford it. Now with the changes that are being or trying to be made to the current program, I have little confidence that I’ll have access to affordable health insurance after this year, due to either the changes the Congress makes to the ACA or even if left unchanged….I’m doubtful that insurance companies are going to underwrite the sick pool of people who want to be covered through the exchanges, resulting in the possibility that no insurers will enter the exchanges for 2018 or the ones that do will charge very high premiums, deductibles, and out of pocket expenses. I do not qualify for Medicaid because I am able to work and own a home. I do not qualify for disability because my cancer is in complete remission (thank goodness)….if you’re on disability for 2 years, you can qualify for Medicare. I think that those of us who are on life saving drugs to keep us alive that we should be able to qualify for Medicare or a government program. Thank you for continuing the discussion for those of us who are the most vulnerable to losing our life saving healthcare, it’s a matter of life and death and your plan would save many lives.

    Comment by Carol Sherr Brooks -

  111. I like it! This is great! This is the only idea that makes sense and the majority of the public, R or D would go along with it. How do we get Congress and #45 to agree?

    Comment by Linda Morris -

  112. Pingback: Mark Cuban Acaba de Responder al Trumpcare con una BRILLANTE Solución

  113. Julie Clark, health care worker for 30+ years has written an excellent article on fixing health care and comes to similar conclusions as you Mark except with more detail “from the inside perspective” of the medical world. She gives 10 specific “cures” for healthcare. It is posted on and she agrees with you, the best healthcare systems in the world are single pay systems where citizens are treated as if health care is a privilege and a right. Those nations who do it this way have superior public health.

    Sadly the alternatives so far out of Washington DC will only lower coverage and increase costs. TrumpCare or Ryancare will likely double or triple the cost of medical care plus bankrupt many hospitals in the USA. Ryancare caters more to insurance company profits than to keeping people healthy. Millions will fall out of service and be left to fate. And TrumpCare/Ryan-care offers a “tax credit” and as an incentive…are they being cynical or crazy. People sick and dying mostly don’t have tax problems or the income whereby a tax credit is relevant. Julie has sent her ideas to Donald Trump and we hope that he and Paul Ryan are listening. Keep up the good ideas Mark.
    Ben Boothe, Sr.
    Business owner The Boothe Companies
    Publisher BootheGlobalPerspectives

    Comment by benboothe -


    No one seems to have mentioned it yet at length, but specialists in America make exorbitant salaries when compared with literally every other country. Why? Supply and demand is out of whack. The AMA exists primarily to preserve high doctor salaries, with research/patient advocacy coming in a distant second.

    The number of specialists in this country (supply) has been woefully inadequate for decades, yet the demand for specialist care has only increased every year. The number of medical school slots hardly changes, and supplementing the workforce with immigrant medical labor has been a stopgap but mainly ineffective solution.

    Double the number of specialists, either with immigrants or preferably with more American doctors, and maybe the price they charge or the market will let them charge will be cut in half. Physician/surgeon labor costs are a huge part of hospital expenses, much more so than hospital management salaries.

    Of course the other stakeholders, drug companies and insurance companies, overcharge by an arm and a leg due to faulty regulation but that seems pretty obvious to any observer.

    Everyone keeps talking about a free or transparent marketplace, but it won’t happen until the supply of medical care providers (specialists in particular) isn’t artificially constrained so that even the bottom 1% of these people make twice what an average Canadian or British specialist makes.

    Comment by n smith (@longhorn3000) -

    • Are doctors paid too much? Hard to say. Doctors spend anywhere from 6 to 8 years going into debt while gaining their education, then have to intern, then have to try and gain a foothold in some community or be the underling in an existing doctor’s office. For women the amount of time needed to becoming a doctor and establishing a practice can mean forgoing having a child.
      Then there is the issue of how much do doctors help. If a doctor is paid 200,000 dollars a year but they prevent millions in higher healthcare costs by properly diagnosing medical conditions sooner rather than later, plus the added work productivity that results, can we say with certainty that doctors are overpaid? Plus, if they do make a mistake, suddenly they can be sued and even if they are insured, risk losing their malpractice coverage after just one or two lawsuits.
      As for doctors coming to the U.S. apparently there are already 800,000 doctors from other countries in the U.S. practicing some type of medicine or surgical skill. Maybe Trump wants a ban on international travel to keep these doctors in the U.S. (that was a joke).

      Comment by Alessandro Machi -

  115. Hey Mark I have been trying to put your idea, into the heads of all the network hosts of CNN so they could pose the question, to someone in the Republican party, as well as Bernie Sanders. Here is the thing as long as you use insurance companies for your healthcare you will always have a problem with the premiums. The insurance companies expect to have a high percentage of people never use the insurance as in the case with car insurance and home insurance and extended healthcare like chiro., physio,, vision care, dental care and prescriptions. If too many people use their healthcare the insurance premiums will go up. The reason the Obamacare went up so high was because people are sick and they are going to use the insurance because they need it so naturally the insurance companies were not making any money and in order to do so they raised their premiums. It is a no win situation.

    By setting up the government healthcare system, the doctors would bill the government for the costs and the people would be paying the premium in taxes; which of course some times requires a monthly premium.
    Here in Canada, we in Alberta where I live, used to pay a premium for a family of around $400.00 a month and then they decided not to charge us anymore, so we don’t pay any additional premiums anymore.

    All the costs for visits to General Physicians, Surgeons, Psychiatrists, Cancer specialists, Orthopedic Specialists, Neurosurgeons and Neurologists are covered, so you can go to whichever doctor you want to at no cost, with the exception of some Podiatrists and Plastic surgeons. Surgeries are free as long as they are not for esthetics such as face lifts, tummy tucks that sort of thing, but breast reductions would be covered if it was done for health reasons. The cost of hospital stays are included except when they are in a hospital that has 4 or 6 bed wards then the semi-private rooms with only two beds or private rooms are at an additional cost and the ward rooms with 4-6 beds are free, If the hospital has only 2 beds in all their rooms then they are free.

    Insurance is used for the services I mentioned and the cost for ambulances, so prescriptions, Chiropractic, Physiotherapy, Massage Therapy, Dental and Vision care as well as some cover the cost for the upgrade to the semi and private rooms, casts, splints and such. This is the type of insurance, the companies supply the employees and it is there choice to chose, if they wish to have coverage. So here in Canada everyone is entitled to have medical coverage and the people who are unemployed also have coverage for the basic dental, prescription, vision care and ambulance for free. We also have free disability coverage for people who are severely handicapped. It is not much but it is better than nothing. Seniors get some coverage for prescriptions and things like hearing aids vision care for free and safety equipment is supplied for living such as walkers, handrails in the bathroom as well as other items.

    This is something you need to adopt in the US so no one has to die needlessly because they can’t afford insurance. This is the kind of healthcare they need so no one suffers needlessly. Of course it is not perfect and due to some cutbacks to healthcare funding to the provinces we do have long waits now because the hospitals closed some of their wards to meet budget restraints and have less staff and so on, but those who have life threatening illnesses, requiring surgery or required to stay for medical care, get in first and the elective surgeries like Knees or hips have longer waits but it is still good because we can pick the better doctors, we just have to wait longer because they have more patients. Those who can afford it drive to the states and pay for it so they can have the surgery sooner.

    By the way I tweeted DT and told him off for you. I told him that you had more intelligence in your little pinky and doesn’t need your help in business for sure! 🙂 Sorry for rambling but I think you are way smarter than he is. I think he was a lousy business person and he knows nothing about running a government. He filed for bankruptcy 8 times, that does not constitute a smart businessman.

    Take Care and keep up the good work on the Shark Tank I love watching you guys.

    Comment by Denise L'Heureux (@DeniseLHeureux1) -

  116. Serious/chronic illness are ~80% of healthcare spending. So your plan is 80% single payer, unsure why don’t you make it a 100?

    I still like the idea.

    Comment by atotic -

  117. As was stated above by John Willsey, follow the Japanese model.

    I recall reading that in Japan their toilets actually assess their waste for possible medical issues. Maybe their toilets actually flash a digital code whenever the dispensed body waste is out of whack? The U.S. government should basically be giving out these super monitoring toilets at the lowest price possible.

    Having logged over 100 days in hospitals as an unpaid family caregiver for ailing / recovering relatives, one of the issues that I found intriguing is the need to get patients to sit up, in a chair, as part of the recovery process. I’m convinced that people die or take longer to recover in the U.S. because they lay in hospital beds almost all day long when some of the time they may need to be rousted throughout the day for “sitting up in chair sessions”.

    It turns out that nurses cannot place a patient into a chair and then leave them unattended, so the patients sit in bed instead. Even when the hospital bed is partially upright, it is not the same thing as actually sitting in a chair. Ironically, when guests visit the patient, the guests all take the chairs and the patient still sits in the bed.

    My three suggestions are, Effective monitoring via toilets may catch medical issues sooner rather than later, Home Healthcare is essential to reducing emergency room and hospital visits, and Home Healthcare aides who earn significantly less than trained Hospital staff can double as additional Hospital help to get patients sitting upright several times throughout the day. Shorter but more effective hospital stays can help reduce the overall cost of Healthcare.

    Two more issues, Warfarin Management as in the dosing up and dosing down of patients because of the need for surgery needs to be more aggressively monitored so that patients are not left on temporary updosing levels for too long.

    and finally, relaxing EPA standards will raise healthcare costs. The reporting of water contamination should be rather easy and straight forward and should be a Homeland Security issue that is prioritized as highly as preventing terrorism.

    Comment by Alessandro Machi -

    • Good luck with the E.P.A. This administration wants to dispose of it completely by the end of 2018.

      Comment by vinnythehack -

  118. I’d rather pay for preventative care out of pocket and have health insurance for catastrophic events (cancer, serious illnesses not caused by a poor life style). Someone mentioned bloodwork for $500. That’s crazy. I can get a complete blood profile at various local hospital’s wellness checks $25-30. Once bloodwork runs through insurance, the price skyrockets. I buy on the exchange now and one of the plans offered had diabetes in the plan’s name. Diabetes is becoming an epidemic in this country and we need to prevent it first to keep costs down for everyone. The focus should be on prevention with direct pay primary care physicians who actually take the time to listen to you, instead of the usual 6 minute insurance allotted time. (I have a physician relative who said 6 minutes is the norm) Physicians spend an inordinate amount dealing with insurance. This certainly isn’t helping anyone’s health. I’d rather pay a direct care facility a reasonable fee and have other health insurance for something catastrophic. Direct pay is starting to catch on in various areas of the country. Time magazine had an article about it in their February 6th issue. I’ve never liked paying for people who eat crap, never exercise and practice poor health habits, but you’re always going to have that problem. Maybe there should be some monetary incentive to be healthier.

    Comment by Barb Galligan Havens (@BarbJHavens) -

  119. The biggest problem? Getting it passed. American politics is ruled by special interests, and those special interests – insurance, health technology, and pharmaceutical companies, as well as others will fight this.

    Defeating the special interests will require a mass movement. That mass movement must do two things:

    1. Bring unrelenting an unbearable pressure onto Congress and the President
    2. Reform American politics to encourage pragmatic, not partisan, thinking. There are lots of mechanisms to do that, including non-partisan redistricting, automatic voter registration, getting special interest money out of politics, right-sizing Congress (it hasn’t grown since 1912), alternative voting methods, and more.

    Then, we can achieve single payer. The only other option is to turn Congress and the Presidency blue simultaneously, and that’s not likely; especially given the red state bias in the Congress.

    Comment by Jay Wyss -

  120. @ProtonicsTech – Life and staying healthy if tough enough – who really wants to worry each year, not alone each day, whether they have sufficient health insurance to survive – Going to a plan as suggested by Mark would take a huge load off of all of our shoulders, and let us concentrate on the rest of our life!! 🙂

    Comment by ProtonicsTech (@ProtonicsTech) -

  121. Maybe Rick can help..

    Sent from my iPhone

    Begin forwarded message:

    > From: blog maverick > Date: March 8, 2017 at 5:30:25 PM EST > To: > Subject: [New post] Some Thoughts on Fixing Obamacare – Shoot Holes in this Please > Reply-To: blog maverick > > >

    Comment by bmoertle -

  122. For Those Individuals Who Can’t Afford Health Insurance.. the reason is probably tied to those things Mark Cuban mentioned in the blog – genetic lottery and wrong place/wrong time… Left with a medical condition that necessitates more frequent health management visits and treatments, the premium for your health insurance may be higher than you should be expected to manage. For these individuals, I say that we consider GOVERNMENT COVERAGE = DISABILITY… There’s full disability… limited disability… but the bottom line is that those individuals health care needs would be managed by a government healthcare program and not part of the “business” of health insurance coverage.

    We have MEDICARE in place, currently and I don’t see a need to change anything there since it is a respected program and much of our population relies on it.

    Bottom Line:
    1) Regulate Health Insurance Companies For Ethics And Transparency;

    2) Disability Insurance To Those That Can’t Afford Health Insurance Under The CORRECTED Insurance Model;

    3) Medicare Insurance For The Elderly….

    THEN, we begin the process of PROACTIVE HEALTH MANAGEMENT… WELLNESS PROGRAMS… The 2nd Phase Of What I See As Our Needed Healthcare Reform…

    If we can get our adult population into regular care, affordably, we can reduce the population with chronic illness/disease. I believe, in majority, that random events are not what drives healthcare costs. Lifestyle choices – which could be improved upon with more frequent health management visits and education – are what drives those costs.

    Right now, we operate “BEHIND THE PROBLEM”… We need to get ahead of the problem!
    … ADULT…. regular check ups, health education opportunities >

    …CHILD… assessed at birth for compromises to optimal health and a PLAN is made for health management of that child… we stay AHEAD OF THE PROBLEM exposing the patient to more frequent health assessments and management visits, but minimizing the total cost of care because the compromise is not ignored or allowed to worsen without intervention…

    …ELDERLY… managed throughout their entire life… we stayed AHEAD of the problem and minimized the total cost of care because any compromise to health was not ignored or allowed to worsen without intervention.

    IT COSTS LESS TO MAINTAIN HEALTH than it does to RESTORE HEALTH! And we should be seeking businesses that want to be in the business of HEALTH MANAGEMENT – cover the child thru adulthood and into old age… let’s find a way to start THAT business… it could and should be profitable, but it would also be personally fulfilling for the entrepreneurs that make it happen!

    Comment by Medical4Dental (@Medical4Dental) -

  123. te in a discussion as important as this. There are many layers to the problem so I’m going to be simplistic and probably end up with multiple posts, but bear with me… I’m definitely no expert and I have as many questions as I have insights, but here goes.

    I decided to start by discussing the processes that we already have in place. We have health insurance coverage available to us for purchase. Thankfully, Obamacare brought about the elimination of pre-existing condition coverage exclusions – and Trump has said he’s going to leave that aspect of the program alone, so – I’m going to say that our starting point is Available Health Insurance Coverage For All Of Us… I didn’t say “affordable”, I said available. And even though we have health insurance coverage available, there are still those without insurance. Insured and Un-Insured. 2 types of people. BOTH of which are harmed by the current structure of the health insurance business. Not just the Un-Insured. And the DISINFORMATION (intentionally false or misleading information that is spread in a calculated way to deceive target audiences) from the health insurers is what should first be addressed in our attempts to remedy our nation’s healthcare problem.

    Health Insurance Companies – A For-Profit Business. But NOT a business tied to managing risk, in my opinion. There really is no financial risk to the business in their offering of coverage, currently. And here’s why it’s not immediately obvious to the insureds that the insurance company has nothing to lose:

    The Insurance Company Creates Multiple Types Of Coverage Plans… Their Products – The Insurance Company Can (And Probably Does) Direct Its Sales Team On Which Plans To Sell To The Local Employers As Part Of Those Employers’ Benefit Packages – The Employer Purchases A Health Insurance Plan Based On What Options Are Put In Front Of Him/Her – AND – On COST, Rather Than Plan Content And Scope Of Coverage – The Employee Receives The “Benefit” From The Employer And Assumes Some Level Of Security Is In Place – The Employee Experiences A Health-Related Issue For Which A Claim Is Made Against The Insurance Coverage – The Insurance Company’s Receives The Claim And Renders A Decision Whether Or Not To Pay The Claim – In A Surprising Number Of Instances The Claim Is DENIED…

    The insured is shocked…angry…scared… and, ultimately stressed at the financial difficulty the unpaid claim will cause for him/her, the family…

    The insurance company is arrogant… “not a covered service”… “plan exclusion”… “see our published medical policies and guidelines” …

    The employer is unaware a problem exists, probably… that employer lays his head down every night with the good feeling that comes from “my employees have health insurance as a key component of their employee benefits!”…

    So, what went wrong here? Who controlled this entire process from the very beginning? The insurance company. Now, they are a for-profit business so you might be saying right now, “so what”… The so what is it’s our healthcare and we are at fault in not taking it more seriously. We don’t research what we are buying for health insurance coverage as much as we do the car we are thinking of getting. But then again, those car manufacturers produce and distribute a LOT of marketing material with specifications, options…all published for us to mull over and make our best choice for ourselves. … Not the health insurance company…In fact, not only do I believe that most people are not properly informed as to what their health insurance actually covers, I’m suspicious that

    1. ALL of the insurance plans/products were not MADE AVAILABLE/DISCLOSED to the employer/buyer for consideration when the decision for purchase was being made;

    2. The plans/products that were made available/disclosed were not ASSESSED for coverage, exclusions, limitations – vs – cost by a QUALIFIED INDIVIDUAL;

    And I’m fairly confident that no one ever sat down with a calculator/pencil and paper and did the “the premiums for coverage are $x”, “the cost of services anticipated for me, based on medical history, etc., are $y”… when contemplating insurance coverage.

    The insurance companies are manipulating a situation in which the individual understands that healthcare costs are too great without an insurance plan to cover those costs by keeping the details of what the individual ACTUALLY purchased a mystery.

    Where we need REFORM is in structuring HOW the insurance companies acquire business. I’m thinking FULL DISCLOSURE on premiums by plan (scope of coverage) – AND – insights into how premiums might be reduced… if x # of people who are considered healthy join the group, premiums may reduce by $y…. that kind of thing…

    1st Question: Are health insurance companies in any way regulated by federal, state, and/or local – governments?

    2nd Question: Since premiums are based on the health of the GROUP, can’t the insurance company ASSEMBLE a GROUP for coverage, rather than accept that the EMPLOYER = the GROUP?

    3rd Question/Thought: The variables to claim payments such as in-network, out-of-network services are currently more complicated than they need to be. In-network fee schedule should be FIXED. Out-of-Network fees should be the provider’s fee, but benefits calculated using the in-network fee schedule. 1 Fee Schedule, not multiple fee schedules. If Dr. Jones and Dr. Smith are both In-Network and the patient goes to see Dr. Jones, the claim should pay Dr. Jones the same amount that it would have paid if Dr. Smith had seen the patient. I don’t believe that this is the case, currently. Something about incentives??? Forget incentives to providers. It’s FEE CERTAINTY that the INSURED is looking for and deserves. Incentives changes the nature of the doctor-patient experience, in my opinion. And I’m surprised it’s even legal with all of the anti-kickback legislation. … Am I off the mark here?… Medicare publishes its fee schedule and it is 1 FEE for a given service based on the zip code of the provider of service. I think we should adopt this for commercial coverage insurance plans, as well. It probably comes back to HOW the insurance companies acquire business… if incentivizing the doctors is involved in business acquisition, what IS that really?

    Summation: Insurance Companies Are Not Operating Using An Ethical Business Model, Currently.
    Government should
    1) design a system for evaluation of the insurance coverage plans sold in the U.S., currently.
    2) assess the depth and scope of the coverage plans offered by each insurance company, assigning a grade to each;
    3) evaluate the A+, etc., plans for cost/benefit ratios, percentage of product on market, etc.
    4) determine what changes, if any, need to be made to insurance plan coverage sales per insurance company. – Set A Standard For Ethical Business Practices For The Health Insurance Industry.

    Summation: Healthcare Providers Are Not Compensated Uniformly, Currently.
    Government should:
    1) Evaluate participating provider contracts with health insurance companies for possible improprieties
    2) Mandate a compensation structure based on a single fee schedule calculation (reference: Medicare);

    Individuals Do Not Understand Health Insurance Coverage, Currently.
    Government should:
    1) Develop A National Campaign To Educate Americans On Health Insurance – Benefits, Exclusions To Coverage, Limitations Of Benefits, Etc.

    Since employers are often purchasing health insurance coverage for employees without educated awareness of the benefit being provided, eliminate employer offered insurance plans…

    Instead, have employers allocate a certain amount to subsidize the EMPLOYEE’S CHOICE for health insurance coverage. The amount of the subsidy could be dictated by the federal or state governments and based on the salary of the employee..smaller wage = larger subsidy.. that kind of thing.

    With more INDIVIDUALS purchasing health insurance, the federal government should wage a national campaign to educate people on coverage, benefits, etc. – AND – form an agency to assist INDIVIDUALS in the decision to purchase health insurance… an advocacy group… under government supervision so as not to become corrupt over time…

    Once we’ve addressed the issues with our current health insurance industry… we can use that tool to take care of people who can afford the insurance that they need…

    Now, let’s move on to the people who can’t afford the insurance that they need…

    Comment by Medical4Dental (@Medical4Dental) -

  124. High Profits shouldn’t exist for non-profits. The government wants to tax the poor and give tax breaks for the rich. The profits made by non-profits should be taxed at the highest possible rate, say 90% and Politicians should live under the same medical policy as their constituents.

    Comment by Samuel Curtis (@SamuelC16085288) -

  125. @ProtonicsTech believes EVERYONE DESERVES TO BE HEALTHY WITHOUT WORRY – Thank you Mark

    Comment by ProtonicsTech (@ProtonicsTech) -

  126. One suggestion I have been thinking about regarding pharma and drug prices. I think its a quite simple way to solve the drug pricing problem. Simply enact a law that says medications may not be sold to US customers for more then they are sold to customers in other countries. Further, limit the profit margin pharmacies may collect.

    Comment by Joey De Tomaso -

  127. Mark, I like your thoughts on fixing Obamacare, but if I was going about fixing it myself, why not look at the best health care system in the world? According to the World Health Organization ranking of health systems in 2000, Japan’s was ranked #1.

    In 2008, Japan spent about 8.5% of the nation’s gross domestic product(GDP), or US$2,873 per capita, on health, ranking 20th among Organization for Economic Co-operation and Development (OECD) countries. That amount was less than the average of 9.6% across OECD countries in 2009, and about HALF as much as that in the United States. And to top it off, people in Japan have the LONGEST life expectancy at birth of those in any country in the world.

    Whatever they’re doing is definitely working and something I believe we should try to copy as best as possible. Here’s a short description of the health care system in Japan as found on Wikipedia:

    “The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered by a universal health care insurance system that provides relative equality of access, with fees set by a government committee. All residents of Japan are required by the law to have health insurance coverage. People without insurance from employers can participate in a national health insurance programme, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians.

    Medical fees are strictly regulated by the government to keep them affordable. Depending on the family income and the age of the insured, patients are responsible for paying 10%, 20%, or 30% of medical fees, with the government paying the remaining fee. Also, monthly thresholds are set for each household, again depending on income and age, and medical fees exceeding the threshold are waived or reimbursed by the government.

    Uninsured patients are responsible for paying 100% of their medical fees, but fees are waived for low-income households receiving a government subsidy. Fees are also waived for homeless people brought to the hospital by ambulance.”

    Problem solved. Ok, what’s next?!?

    Comment by John Willsey (@johnwillsey) -

  128. Mark, I like your plan, because it seems to address crisis situations – in which poor people who don’t pay anything are covered, now, anyway. If a homeless guy gets hit by a bus, he gets treated at Parkland for free. They don’t turn him away because he has no insurance and no money. Currently, Parkland tries to recoup the expense of treating uninsured and broke people by charging as much as they can from insured patients and from county taxes. So, we’re already using your plan, just not “officially” and not for everyone. In some ways, it’s like private vs. public school: everybody pays taxes for public schools, and everyone can send their kids there, but some people pay extra to go to private schools. Another benefit of your plan is it does not limit or restrict what people can do outside of the government plan. Freedom to choose a non-government non-public plan is crucial.
    Cheers, and congrats on Dirk’s 30K!

    Comment by Jeff Swan -

  129. I think that programs like some of the Christian cost-sharing insurances (whose members experience a significant reduction in out-of-pocket expenses and know that their money is going directly toward medical bills) are models that the free market should endorse. Daily, managable bills are covered by the patient (Dr’s visits) and ER visits and beyond are fully covered by the cost-sharing group. Our problem has been exacerbated by government involvement, why look to them for more help?

    Comment by Paul Johnson -

  130. Insurance companies add zero value to health care, but remove hundreds of billions of dollars in profits. A single payer system puts those funds directly into health care. The question h=you have to ask yourself: Is insurance company greed greater than government ineptitude?

    Comment by vinnythehack -

  131. TRUE FREE MARKET IS THE ONLY WAY TO GO! Anything else is fat government forcing bad products and even worse services on UN-willing but needy consumers. Oh yeah…and maybe do away the FDA so that major scientific advances COST-LESS to discover and cost-less to deliver to patients. Way to go Cuban!

    Comment by Jordi Lozano -

  132. Mr. Cuban,
    I agree that a single payer system would be better than the corporatist garbage we have now. Here’s the thing: If we can separate routine from catastrophic care, why can’t catastrophic coverage also be provided by private insurers, with the government only helping those who truly can’t get private catastrophic coverage? To me, the problem seems to be 1) that the people making pricing decisions are not the doctors or the patients and 2) Price gouging in healthcare goes unprosecuted in the US, even though it violates the letter of the USC law.
    To fix this, we first have to abolish employer-based care and repeal the HMO Act of 1973. This would make the adminstrative waste in the system more streamlined, and allow a free market for insurance that doesn’t discriminate between those who work for “big business” and those who work for mom and pop stores. Then, we can go about separating routine care from catastrophic. Routine should be a free market with no insurance required and actual quoted prices, with doctors and patients themselves agreeing on pricing. Then, catastrophic care can either be market-based on an individual basis (not employer based), and the “uninsurable” should be taken care of with a single-payer system that doesn’t discriminate.
    I will leave you with 2 points: 1) I found to be a very helpful website in navigating the problems of healthcare, written by a doctor who committed to studying the system and 2) This problem can only really be solved if we understand that to take care of the people here, we can’t blow hundreds of billions of dollars every year playing king-maker in the Middle East and other parts of the world. The money has to come from somewhere, and it needs to be foreign policy.

    Comment by SubZero (@SubGrew) -

  133. If you’ve lived or visited overseas where universal healthcare is a thing, it makes you realize how insane and cruel our system is. Lots of countries have figured this out and not only have better outcomes and healthier citizens, it costs less, too. We don’t have to look that hard for solutions to this problem, just look at how it’s done in other countries and pick one that would work for this country. It’s a public good not to have poor desperate people crowding our emergency rooms for things that could have been easily handled by a general practitioner or treated before it became an emergency. That old adage about an ounce of prevention being worth a pound of cure? It’s true. We’re all paying too much now for bad coverage and outcomes. It’s time to stop the madness.

    Comment by Michele Wickham -

  134. Who takes less ? You left out the most major stake holder, the government, which finances long term healthcare debt.Yet, the Conservative political party doesn’t want to recognize Healthcare as a Human Right and entitlement. This ideology files in the face of free markets. The USA is stakeholder and is due the cost
    efficienies of being the largest stakeholder.

    Why don’t the Economics of large scale in standardized procedures occur before Obamacare? The same reason as with Obamacare, the centers of influence are few and are financially biased toward inefficiency, fraud, marketing, compensation, price gouging to name a few corruption of value.

    Who are those few, yes, the percent of population who manage total US assets; it is only a nominal number of persons who manage those assets, and they are personally biased. It’s not 1% of population own 40% of public Insurance, Healthcare providers and Pharmaceutical companie or That’s 10% of families owning 76% of the profits, It’s who are the investment decision makers for the 10% owners, and that number is closer to 30,000 biased persons – persons with fabulous healthcare, financial assets, property, education,homes, planes, cars, who have self interest in attaining excessively more. BTW, the equivalent number of people inone large corporation are inefficiently managing the healthcare of the USA

    I would ask you:

    Why do I need a prescription for maintenance drugs? Drug pricing, no prescriptions needed for most drugs – self prescribe.birth control. Don’t want people self prescribing antibiotics – LOWER INSURANCE, HEALTHCARE, and PHARMACEUTICAL COST. Its inhumane that a person can not self medicate if they can’t afford a doctors prescription. (think on that)

    Have you seen many stockholders willing to dump pharmaceutical industry shares?

    Why haven’t we made it easier to educate and licensed more healthcare providers. Do they need fine arts classes? Schools in Grenada?

    Since the government is a stakeholder and student loan financier why don’t the government negotiate lower tuition cost and higher student numbers at medical schools

    Let there be more competition break up companies, and create more providers

    Why are insurance, healthcare,and pharmaceutical companies not lowering cost and you will find an answer
    corrupted by biased persons.

    Comment by John OH (@Sohoist) -

  135. My plan to solve the most material healthcare issues: 1) using wellness to bend the cost of healthcare down; 2) pushing down prescription drug costs; 3) solving for adverse selection; 4) connecting the decisions with the costs of healthcare related decisions. Here, is the five step solution:

    First, a new federally administered reinsurance program for high risk healthcare exposures. Patterned after the national flood plan, this would allow private companies to distribute, price, issue policies, and pay claims for 15% of the premium. This would include reinsurance for unlimited limits, pre-existing conditions, birth defects, chronic diseases, end of life care. This shifts a large amount of premium from the private market to the government reinsurance company BUT dramatically improves the capital position of the private carriers.

    Second, expansion of the federal exchange and elimination of separate state exchanges. Each state would still be allowed to control the rules for buyers in their state and this would quickly facilitate the ability of insurance companies to compete across state lines in a meaningful way and not have to deal with so many various platforms. All carriers participating in the exchange get access to the reinsurance. Additionally, every participant in the federal exchange will receive annual well visits for free. Paid for by me and other taxpayers. Use whatever means test you need to help the poor afford coverage.

    Third, use of wellness programs to drive down costs. Health care costs will never decline as long as Americans are the fattest, and unhealthiest, in the world. So, insurance carriers will be required to: 1) provide well visits for free; 2) surcharge prices for smokers, people who do not obtain well visits, those who fail drug tests; 3) include wellness counseling for anyone who does not meet specific healthy life criteria. This is the only way to create real incentives for people to live healthier lives. We are all free to choose how we live but we must also accept the consequences and not expect the rest of us to subsidize those poor decisions.

    Fourth, only those who maintain consistent coverage are eligible for mandatory pre-existing conditions. The existing tax for non-buyers, and the proposed 30% surcharge, do not solve for adverse selection. You can choose to not buy insurance but the penalty for that is that you do not then have the right to wait until you get sick to buy it. This is extremely critical. One of the biggest failures of the ACA was its inability to get those who are healthy and can afford to buy it to do so. Connecting that buying decision to their longterm insurance protection is fair and logical. And, it is the only way to coerce the 20,000,000 potential customers to sign up and help share the costs of those who need it. You know…insurance.

    Fifth, expand the use of HSA’s and high deductibles so that those who are able can save for higher medical bills in retirement. Consider offering the same tool to the poor with federally funded payments to start them. The data is clear that people make different and more cost conscious spending decisions when they spend their own money. These tools are the only way to get close to that.

    Comment by Clark Johnson -

  136. You could accomplish the same thing by having the US Govt reinsure all “uninsurable” exposures including those that you describe. They already do that with flood insurance–federally funded for anyone in a designated flood area with private company distribution and underwriting. I doubt you would be able to pass a bill that asks us to trust the IRS to get the math right. I know you think the math is easy but businesses go broke all the time getting easy math wrong. And, I would not characterize underwriting and actuarial analysis as easy math simply because you have to price the service before you know what the costs are. Worse, your plan does not solve material issues: 1) using wellness to bend the cost of healthcare down; 2) pushing down prescription drug costs; 3) solving for adverse selection; 4) connecting buying decisions with costs.

    Comment by Clark Johnson -

  137. Politicians aren’t capable of putting together a proper system because of partisan games. For instance, did you know that ACA knew insurance companies would lose with medically needy and Congress was to fund the losses two ways. One was through government money the other was profitable insurance companies paid a portion to the government fund to help those that lost$$. Congress refused to fund and as a result premiums went through the roof and some pulled out. Humana/Aetna pulled out claiming losses, but in fact were trying to cook the books so they would be allowed to merge. NO ONE HELD THEM ACCOUNTABLE. NO ONE REVIEWED OR AUDITED THEIR NUMBERS. WHY?? GOP wanted ACA to fail because it got more GOP elected, and they knew it was a hot button. They intentionally tanked ACA for political purposes. (Along with gerrymandering and voter id/.intimidation). Otherwise, they had “nothing” to offer and had a difficult time getting elected.Notice they want to allow for insurance purchase across state lines but don’t want you to get RX from Canada or other countries where costs are less/ ASK YOURSELF WHY. It’s not about safety of the drugs. Counterfeit drugs make it to the US market and to main stream pharmacies as it is now. Canadiens aren’t dying from bad drugs and neither they in other countries.
    Why are we trying to reinvent the wheel?. Get with the other industrialized nations and find out how their system works and how it’s paid for. We’re making this way too hard. I would personally like single payer, and I would also like to be able to use physicians outside the US for major surgeries where the cost is substantially less and everybit as good if not better. Remember people, medical malpractice is the 3rd leading cause of death in the U.S.!! but we pay more than anyone else. Doesn’t that strike you as odd? Time to remove the colored lenses and see this system for what it is. Looked at your hospitals lately? Building mammoth buildings, glass, steel, 60″ flat screen tv, gourmet food. They’ve become more like resorts than hospitals. We are all paying for that. Increase the medicare tax from 1.20% to 5%, remove the wage cap on SS & Medicare payroll tax for those earning $45K and higher, and charge an appropriate monthly premium based on age and income. And no restrictions on women’s health, including abortion services. You may not personally support it, but it’s legal and as such the medical procedure should be covered. Women will die without it. PERIOD

    Comment by Christine Thomason (@Coolkitty807) -

  138. Pingback: Mavericks Owner Mark Cuban Comes Out for Single Payer | Single Payer Action

  139. One of the core roots of the problem, as with any product, is cost to produce. If your product/service is expensive to create or provide, the rest of the accounting methodology must follow or the product or service will die. The Healthcare industry (at the top of the supply change) has morphed itself into a model that thinks it has “earned” the right to charge a luxury fee for their products and services. The leadership of HC is where it starts. It’s a BUSINESS and the demand for the product happens to be high, (we all need HC) but should that give others the right to charge such enormous, luxury-syle fees, as we may see in a product such as jewelry, furniture, luxury cars, boats, sports stars and such? All nice toys, but we don’t NEED them to survive. They are only available to those who can afford them, and that’s fine, I understand and it’s how business works, but HC should NOT be seen as a luxury and only available to those who can afford it or as a lucrative career path that you make million dollar salaries.

    For 2012, Integrated Healthcare Strategies surveyed 49 private hospital systems with a median of $3.5 billion in revenues and found the median salary for chief executives was $1,072,000. The median total direct compensation for CEOs (excluding retirement and health benefits) was $1,719,000.

    By Melanie Evans | April 25, 2015
    Total compensation for some of the highest-paid CEOs in the healthcare industry increased faster than their companies’ profits last year, a Modern Healthcare analysis of the first firms to report executive pay found.

    Not a sound, sustainable business practices and my government forced me to buy it! I wish I could force my client to buy my products at whatever price I decide. Sign me up for that model!

    The facts stated above are only a minute part of the problem, but this leads to the problem as a whole. It starts at the top and all the other costs related to the CEO compensation, sets a benchmark for the remaining requirements of the business. The law of supply and demand should not be the norm in our HC system, a PRODUCT we all need to survive. Even if an individual is wealthy he/she can make a choice whether to fork out $500 to see their favorite rock star, or a $1M for a fancy sports car, based upon desire, not “need to survive”. Why should we be forced to buy anything that we cannot afford to buy. Without competition this is exactly what happened – ObamaCare required for all – even if you can’t afford it. Healthcare and Insurance are two businesses that profit (enormously) off of others’ misfortunes and Life Randomness Lottery events.

    I like your ideas Mark but we must somehow control the “wholesale cost” and change our mindset as a Nation that HC is just like most any other business, a competitive model where the best product, at the best price wins the customer. Attempting to find a solution at the political level is absolutely impossible and a complete was of time and money that will never get us to the RIGHT solution. A solution for sure, but still not based upon a sustainable business model. They are not business leaders, required to be PROFITABLE in order to stay in business. I would suggest imposing the same HC plans on the politicians, with the same high premiums, same high deductibles (Mine: Healthy, Non-smoker): $1100 p/m w/ $6400 ded. per person) that I experience. I would bet your salary Mark, that we would be hearing a totally different song of sorrow if that was the case.

    My suggestions:
    1. Remove all politicians from all efforts in crafting a solution – they are NOT business leaders with a common goal. They are Reps and Dems all with different objectives, some solely based upon a parties line, and not what makes business sense. Great system for GOVERNING a Nation but unsustainable for a business model. Our governments history (history is fact) in economical business affairs is all the proof you need. Ex. – IRS, NAFTA, etc.
    2. Control Cost – Fair and reasonable margins, must be competitive arena (ensures quality and price), remove political elements (lobbyist)
    3. Healthcare is a product and a service – Create the AHA (American Healthcare Alliance) – a consortium of successful, experienced, well respected leaders in business. Commission them to develop a private HC plan that works and is AFFORDABLE and equally available to all. All meaning you must be willing and/or able to contribute to the solution.

    Comment by DAS Ventures (@DASVenturesco) -

  140. The root problem regarding health care is simple, imho. Those providing it, no mater how they are involved (doctors, hospitals, pharmacy companies), don’t want to make or earn less. Not only do they have to cover costs, they want profit. That is simply a reality. I think that if you don’t address this fundamental
    problem, you won’t get far with any plan.

    Comment by Debra Contreras -

  141. What you propose is similar to the system we have here in New Zealand. Its not perfect, but I think it works well for most people. All injuries relating to accidents are covered by a state owned enterprise known as Accident Compensation Corporation (ACC). You pay for this accident cover directly to ACC and it is in effect another tax that is based on your income and occupation. The riskier your occupation (rugby player), the more you pay. There is a ‘no fault’ policy, so that no one is sued as a result of an accident, which is something I think America sorely needs. The personal injury claim industry in America sickens me, especially when I see them advertising at NBA games!

    For illnesses, we have two options, private health insurance or the public health system. For emergencies and things like having a baby, your care is through the public health system and is 100 percent paid for by taxes. If it isn’t an emergency or life threatening illness, then you can either go on the waiting list for the public health system, or pay to go to a private hospital. If you have private health insurance then your care will likely be covered by your policy. If not, then you could be in for a steep bill for your care.

    Most people have private health insurance, and some workplaces offer discounted premiums and better terms as an incentive to keep good employees. The premiums are affordable and anyone earning over NZ$60k a year can easily afford them.

    Comment by gabrielbradly -

  142. Mark, I would like to suggest there is more to the equation than just good or bad DNA. Our personal choices for what we put in our bodies should be a consideration. My thought is to somehow tax sugar and grains, similar to how tobacco is taxed, because they are known to case health problems. Jimmy Downe

    Sent from my iPhone


    Comment by -

  143. Having a hostile, common enemy unifies decision makers more effectively than polite arbitration among cohorts. It may take a complete collapse of the healthcare industry to motivate appropriate market participant behaviors.

    Comment by RoyceHart -

  144. I am going to take a stab at this. I am not a healthcare professional, but someone that has experience in US Government as a former intelligence officer, founder of multiple start-ups, brother of a sibling that has Multiple Sclerosis, and unfortunately, a family gene pool that is riddled with various illnesses. While each section can be expanded into volumes of books, this will be a short synopsis of what is needed. The following sections touch on healthcare, the role of the US Government, transparency of costs, high-risk pools, testing and the role military can play in helping to assist with these problems.

    The Interest of Healthcare Companies
    I have nothing against healthcare companies making a profit, but we need to be very clear that they’re a business. They are in business to make money. They are a business that deflects as many expenses as they can, as many businesses in any industry already do. The notion that healthcare companies are there to make you better, healthier by giving you extra care or give you every test needed is very far-fetched. The problem with the Affordable Care Act is that it removed the public option and required individuals to get insurance from the same companies that denied coverage to paying subscribers, underpaid for surgeries and would make you jump through hoops in order to get authorizations for treatment. Remember, these are the same companies where someone would pay for insurance for 15+ years and then be abruptly kicked off when they needed heart surgery, all previous years of payments would be refunded, and this would be because you didn’t check a box on some document fifteen years ago about having a vehicle accident in 1980. The requirement of getting insurance from the same companies that destroyed people’s lives, constantly denied treatment (especially towards end of life) and was out solely to make as much money with doing as little as possible in paying is the reason we should have had a public option.

    Before we even start, there is a need to understand that healthcare companies are not responsible and don’t have an interest in how healthy the entire population is, whether they’re insured with that company or not. By default, only the US Government is there to take care of your health interests.

    The Interest of the US Government
    Let’s put the notion away that people don’t pay taxes, as some people argue incorrectly. We all pay taxes in some form. If I am working for a company, both the company and myself are paying taxes. If I own property, especially in Texas, roughly 3% of the value is taken for taxes every year. If I buy bubble gum or gasoline then I get hit with taxes. There are indirect taxes as well, which can account to toll roads, fees for various levels of government services and dozens of other examples. There is one certainty in the US, and that is you will be hit with some form of taxes. Whether it’s going to a local municipality or federal government, the money has disappeared from your wallet; taxes are taxes are taxes, no matter where they go.

    The US takes an interest in your safety on a daily basis; you might not see this directly, but it’s there. Safety in the form of a heavily funded military that keeps the borders safe from potential enemies. Safety in the form of a growing highway system to keep you safe on the roads. Safety in the sky when you’re flying in and out of airports. Safety in the form of local and state police. The only lack of safety that is not offered is safety from disease, illness or accident.

    It’s in the interest of the US Government to ensure that the people living within it’s borders, whether they’re citizens or not, are the most healthy they can be. The reason for this is that it gets back to taxes. A healthy person is able to work, able to provide, able to buy different goods, and within all those aspects, is paying some form of taxes. A sick person is limited on income, will pay less taxes and will end up in a financial hole if treatment is needed.

    Just like the government takes an interest in collecting your taxes or keeping you safe from foreign armies invading, then it should also keep you safe from illness. It’s the upmost duty of the US Government, not because it’s just the right thing to do, but it makes economic sense to do so. A healthy person pays more taxes and a sick person pays less.

    Transparency of Cost
    The largest problem with healthcare, after access to good healthcare, is what you’re going to pay for it at the time. Healthcare is the only service/product where you don’t know the price. There is no other tangible product/service that you have NO clue what the cost will be, NO upfront information on the accuracy of potential costs, but you MUST get that service at the time of need. No one walks into a car dealership and says “I must have this car in the next two hours or I will physically die” and then will receive dozens of bills after amounting to tens of thousands of dollars. Transparency of prices is key to fixing healthcare, whether it’s the Affordable Care Act or any other replacement plan. If people don’t know the price of a procedure, treatment, doctor visit, testing in advance or life-needed procedure then there is no way the system can get fixed. Multiple studies, articles and in-depth conversations have outlined this specific point, but no one has resolved the issue.

    The solution is simple, and in-fact, extremely simply. If the issue is no one knows what they will be paying for services, then offer the prices. There is not one emergency room or hospital I am aware that doesn’t request reimbursement or assistance from Local, State and Federal Governments. If an uninsured individual walks into the emergency room, the services are rendered and the hospital attempts to collect assistance from government for the service rendered. Here is the condensed process:

    1- US Government creates a centralized website that will list every hospital, doctor and clinic.
    2- As a condition for taking any type of local, state or federal funding healthcare providers will be required to upload all prices within their institution every year. This means that everything from a blood test to heart surgery is priced accordingly. There will be three classes for prices: no insurance, preferred insurance company plans and non-preferred insurance company plans.

    The healthcare providers will have to abide by those prices and not bill one penny more. For instance, if a heart surgery is needed different codes will be provided in advance that are fully inclusive of the total costs. The heart operation will list codes that are commonly used in healthcare, but will be standardized amongst the entire United States. Previously, codes might be different depending on institution, even though the procedure would be the same. Within one operation you might get five codes including: 78635, 73641, 09937, 82633 and 09173. Each code will represent a cost that is commonly billed now, but comes at different times after a surgery. One is packaging the total costs for the surgeon, facility fees, anesthesiologist and additional fees in one package.

    Ideally, the system will be simplified to the level of shopping for a new cellular plan. You can compare different hospitals offering the same service and in the same area for accurate pricing. One will enter their insurance plan and will automatically see prices in a city, state or even out of state. There could be a difference in pricing of 50% off a certain procedure or test, but if you previously couldn’t find out the pricing, now you have a centralized system to do so. The emergence of different medical choices can allow consumers to go to a neighboring city or even a different state if the costs of the facility are significantly less than what is offered in their area.

    The goal is transparency. The goal is simplification. The goal is having the consumer choose and understand the pricing. The goal is for healthcare providers to issue proper pricing in advance. The goal is an open marketplace to know the prices, whether you have insurance or not. The goal is to make hospitals compete in lowering the prices with each other to attract consumers. The goal is competition, but that every consumer has a starting point to put all healthcare providers on the same level.

    High-Risk Pools
    Prior to the Affordable Care Act, my sister with Multiple Sclerosis was uninsurable. No company would touch her, and the ones that did, wanted over 10k a month for the premium. Let me repeat that, $10,000 a month for insurance and that doesn’t include additional medical costs. The Affordable Care Act, with all its faults, had a few benefits inclusive of covering pre-existing conditions.

    I am assuming that many companies left the ACA because people that were actually in need of medical services started cashing in. I am aware of numerous individuals that held off surgeries in the years prior to ACA due to cost and no insurance getting the procedures they needed done after the start of ACA. Insurance companies have lost money due to this and this is inherently unfair for healthcare providers.

    The solution to this issue can be achieved through a “High-Risk Pool” that is insured and backed by the US Government. The insurance would be similar to Medicare and Medicaid plans. The insurance would have just as much access as other for-profit insurance companies, so that a patient doesn’t have to drive hundreds of miles to be seen by a doctor. Certain ailments like MS, diabetes, heart disease would put you into this pool of insurance. The services for this insurance would not exceed a very bare amount of $50-100 a month, and would the majority of the subsidized cost will come from the government. Assistance for the unemployed and under-employed needing financial assistance will be available, so that we are addressing all levels of society.

    If one is able to remove the high-risk pools, then inevitably, it will be cheaper for insurance companies to insure their current pool of more healthy individuals.

    Testing, Testing, Testing
    Had a blood test recently? Had an MRI scan or x-ray? Surprised by the costs and you had insurance? Surprised that a simple blood test cost you over $500? Surprised that an MRI ran you a few thousands of dollars? Surprised that developed countries can do this for a fraction of the price, sometimes for a few dollars?

    People put off care because of testing. People will put off going to the doctor, even when they are ill, because of costs. People will avoid life-needed diagnosis because they don’t have the funds to pay for it.

    The price of testing is absurd and has become a second cash cow for medical institutions. While the “transparency of costs” section addresses this to an extent, it needs to be addressed further. There is no reasoning of why the same MRI machine made by Siemens or General Electric will be priced 1x for images at a rural hospital and 20x inside a metropolitan area. There is no reasoning of why the same imaging machine made by the same company is priced .2x in Thailand, but is charged 1x in the United States.

    The fluctuation of costs for the same machinery imaging is absurd, depending on what location the imaging is done. This is a role where government can step in with caps of prices for imaging and testing. A cholesterol test should cost, for instance $50 across the board, and not fluctuate from $50-$500 even with insurance. An x-ray should be mimicked in the same manner and so on with different types of testing.

    We discussed earlier that there is a need to make the process of buying and shopping for insurance much more simplified to mimic shopping for a cellular plan. An additional add-on or package, could be unlimited testing for a family for “X dollars” a year. The service might be an additional $20 a month, but will give you the opportunity to get testing and imaging done with no additional costs. By using the combination of capping the cost and pre-paying for a pool of care, costs can be reduced. This is a simple business proposition, would I rather sell 5 tests at $1000 each or 5000 tests at $5? Costs will be reduced because there is a greater pool of buyers bringing down the prices with more purchases.

    More testing will lead to quicker care. You will be able to find the cancer quicker and get it treated. You will find the issue of that pain before it becomes irreversible and untreatable. You will add years to your life from simple testing, if caught in time.

    Military and Veteran Affairs Hospitals
    There are additional ideas that can be expanded included providing access to military and VA hospitals for the general public. From my experiences of working with US Military in an intelligence capacity, there is a divide from the military and general public. While there is a great deal of funding that still goes to the military, the general public doesn’t see the benefit directly. Of course, there is a direct benefit of safety of the country from military service, but this goes over the head of the general population.

    There are military doctors everywhere; in many bases, camps, training regions and in all VA hospitals. Access to these institutions for the uninsured can help relieve some of the need for the uninsured to go to emergency rooms that drive up overall cost. Doctors in the military will be able to get additional training and the infrastructure is already available to handle additional patients. While VA hospitals are improving in access to care, there is an ability to treat additional patients.

    There will be pushback of people stating that since some didn’t serve they shouldn’t have access to care in those military medical institutions. The absolute truth is that the majority of the US Federal budget goes to defense, but the benefit is unseen by most. If utilization of some of those aspects and resources that are unused can be put for a domestic benefit, then it would be beneficial for all. Remember, that taxes are paid to fund defense. Hospitals are built in other countries using defense dollars. Why not use some of the under-utilized to improve the situation of those in need in our own neighborhoods.

    Hopefully, the above is a short guideline of things to address now. One can expand on each section and fill volumes with other ideas. What we need are stronger leaders that actually have an interest in the overall population, and not just the ones that fund them. I would welcome your comments.

    Sam Haytham
    Austin, Texas

    Comment by Sam Haytham (@sam62389518) -

  145. The biggest problem I see with a plan like this (well besides getting it passed by Congress) is that there would be a continuous fight over what constitutes a chronic illness or serious injury. The upside of such a problem is that insurance companies (and to some extent hospitals) would devote most their energy into trying to figure out how to get the government to pay for more of a patient’s care, rather than trying to deny those patients that care at all.

    Comment by Todd Morris -

  146. Seems similar in most ways to the assigned risk market in private passenger automobile insurance….allow the federal government to be the reinsurance market in this case…. allow the free market to find the market prices for consumer and legislatively determined levels of coverage at the state level… of course allow companies in this market to sell their product over state lines for scalability and price discovery purposes. Many more variables would be involved but here’s your base to begin !

    Comment by Robert Anderson -

  147. Public education is a good comparable for the single payer system. The problem with public education is that there are factors such as regional cost of living that impact real cost. I think a real limit that we don’t see ourselves (Americans) as a single group and the problem is either attempted to be solved for group A or group B. What our current political system lacks is joint problem solving. Identify the root cause and work the problem while tracking and monitoring progress. I’m not sure there is a non-zero sum solution here but one thing that there are mounds of data supporting is the positive impact to healthcare on human development.

    Providing free access to healthcare options for those under 18 seems like a reasonable first step. Under 18 year olds are cheaper to insure. We will need to solve this through experimentation, Obamacare isn’t a complete solution but it was a good effort and probably not all bad. Good ideas here, now the real question is how do we get experiments in action and be data driven for outcomes.

    Comment by Tony Pease -

  148. I think your solution, clearly debatable, actually touches on a greater point. We need smart people looking for solutions when it comes to big problems. Let’s cut through all the BS and back and forth trying to gain ground for this constituent base or that and simply fix problems. You have outlined a very viable plan in several paragraphs, with a clear and concise direction. Something, no matter if it is healthcare or not, that the leaders in Washington struggle with. Well done!

    Comment by Phillip Manning -

  149. “Who takes less?” is a great question.

    There are two answers.

    1) Government. Consolidate programs into a true national health service. Medicare + Medicaid + VA + local health departments +…. It all adds up to an unreasonable administrative burden, costing far more than it needs to and leading to inconsistent levels of care and conflicting priorities of both funding and provision of goods and services.

    2) Patients. Citizens need to realize a base system of healthcare is exactly as it sounds – a base system. Access to the latest imagining technologies and autoimmunological therapeutics are not in the cards for a base system of care. Neither is access to providers of the patients’ choosing.

    Once we acknowledge the truths that consolidated spending is the most efficient path and patients are not consumers when funded by public monies, then we can begin to enact a not a single-payer system, but a singular system of payment with a foundational definition of fundamental care which will provide a cost effective level of sufficient healthcare for the residents of our country.

    Comment by Jason Wreath -

  150. The equation is simple. Money in (premiums of consumers) vs. money out (healthcare costs). Both need to be addressed. Are we sure all people taking advantage of “the best healthcare in the world” are paying into it? I am not. The law of large numbers at its best. Could this be a second step in the approach on immigration our current POTUS is taking?

    Additionally, a free market for care could help control the cost. But as a healthy, fit person who happened to get T1D, with a spouse who has multiple sclerosis it is upsetting, appalling I should say, to expect me to pay more for insurance…

    Great topic…

    Comment by Edward B Stevens (@EdwardBStevens) -

  151. It seems to me that the Insurance companies are the only ones getting richer. Healthcare providers that want to be in an Insurance carriers ‘Network’ have to contract and agree to take a flat rate payment whether it is for a patient that comes twice a year or one that comes 4 times a month. The medical education systems leaves most recent graduates in a tower of debt for the education that they receive. How do they (doctors) ever get ahead of that curve? Malpractice continues to grow and cost associated with running a medical practice aren’t going down.

    A chronically ill patient with Medicare ends up with thousands of dollars in leftover charges after paying for their ‘gap plan’ coverage at the age of 65 plus or if disabled. I am middle class, I work hard, as does my husband. We carry a good PPO (pay 1200 per month family plan) and pay a penalty for having same ever since the ACA passed. I don’t have the answer, but as a middle class taxpayer, I would rather pay a flat 1% and be done with it.

    Comment by Anne Ledger -

  152. The issue you’ve raised is that healthcare is not just a risk (i.e. something you insure), it is a necessity like food and shelter. Single payer simplifies everything, and as someone who has dealt with the insurance “marketplace” for individuals, simpler is much better (don’t get me started on taxes!). One of the problems is the slippery slope issue: good health requires good nutrition, rest and shelter. Where do we draw the line between the collective interest and individual responsibility?

    Comment by mark2taylor -

  153. You have to start with a Fundamental decision on whether you want a ‘reasonably extensive’ healthcare program regardless of cost structure, or a ‘reasonably affordable’ financial framework within which to create your healthcare program. The two are mutually exclusive so any discussion that doesn’t choose between these two is doomed to failure as the proponents from either view will never sit for “success” of the other side’s paradigm.

    The U.S. percent of GDP spent on Healthcare is tops globally, roughly 50% above ‘social’ medicine countries like France, Germany and Canada. It’s simple math, what percent of medical care is uncovered or not administered, against the percent you hope to cover or initiate as new care, as a percent of your already massive spend.

    As Mr. Miyagi once wisely said, “Walk left side, safe. Walk right side, safe. Walk middle, sooner or later get squish just like grape.”

    Comment by GP 1108 (@BSFEM1108) -

  154. No disagreements Mark. Neither ACA nor AHCA are “health care reform” as they are branded. They address accessibility to health insurance. And, health insurance is expensive because health CARE is expensive. A significant first step would be for everyone involved in the system to be transparent in their pricing. At least at that point, the real drivers of excess, inefficiency, and waste would become more obvious. You can’t fix a problem you can’t see.

    Comment by Kevin Trokey (@kevintrokey) -

  155. Structurally separating the reimbursement for chronic illnesses and catastrophes (“genetic or randomness-of-life lottery”) vs. other medical issues drives an artificial wedge in the delivery of healthcare.

    This change compels patients to self-prioritize their medical problems when talking to the doctor. They will pass everything through a mental filter of “Is this covered or not? Can I pay for this?” This is a dangerous question to introduce into the process because it reduces the primary care providers’ ability to provide holistic and preventative care. Healthcare providers should be evaluating and prioritizing medical issues, not patients.

    To say it briefly: This plan has the potential to limits our ability to improve outcomes (or maybe even decreases outcomes!) by systemically limiting our ability to provide holistic and preventative care.

    The biggest and most efficient gains in outcomes lie in our management of chronic diseases. A very significant part of this is identifying and managing issues early. We risk limiting our ability to dramatically improve outcomes with a policy like this.

    Comment by Wayne Kim -

  156. I agree with your plan, but not your basic assumptions. As far as the randomness of life events, yes, we are all in the same boat. But random events, either genetic or accidental, are not what drives healthcare costs. It’s lifestyle choices. There is some very compelling data to suggest that 50-80% of all healthcare is a direct result of people eating crap processed food and getting zero exercise. I’m 62 and never go to the doctor because I eat a nutritious diet free of crap, exercise every day and rarely indulge in alcohol or sweets. I watch what the people around me eat (my kids, grandkids, employees, customers), and most of it is complete crap. They are constantly sick and going to the doctor for the “cure”. So part of this “simplification” you’re suggesting has to include the type of pressure that one faces with car insurance. If you have a bunch of wrecks, you’re going to pay more. I’m a social liberal, but unless there is some motivation provided by personal monetary accountability, people will simply continue their bad habits and expect society to bail them out via drugs, surgery, PT, whatever. I’m all for bailing out people who encounter medical emergencies or have genetic illnesses that they truly have zero control over. But the rest of the country is long overdue for a wake-up call. Otherwise, healthcare is going to eat our national economy alive.

    Comment by barbhoney -

  157. Poking holes…
    More government intervention rarely works better for anything
    Takes away your rights to get a second opinion or see a more reputable doctor
    Reduces the motivation for doctors to be better or up on the very best technology
    Opens the door to so very much more corruption both from public officials and the wealthy. (would put us more in line with the Soviet Union and Communist Party from the 70’s).
    I’m sure there are so many more flaws to this system, but those were the first few thoughts.

    Comment by blessem -

  158. Several thoughts:

    – Difficult to separate life threatening events and conditions from chronic ailments that carry high cost. As an alternative a cap on annual insurance payouts could be instituted above which all payments to healthcare providers would be covered by a medicaid/medicare type entity funded through taxes (your proposal). These caps could be set for both individuals and families and would mean that insurance companies would have a cap on risk. This would also help with simplifying and reducing the cost of insurance coverage. Downside would be added tax for high risk coverage.

    – Simple regulation is needed to enable free market competition: price/cost transparency for health services and procedures, cross state plans.

    – Alignment of incentives currently does not exist and this is an impediment to market dynamics and cost containment: patients want quality service at low price, healthcare providers want to provide minimum service for maximum money and health insurers want to collect as much money as possible while paying out minimum. Alignment would require for insurance companies and healthcare providers to share revenue and costs associated with care, which would incentivize them to optimize service and reduce costs. Not sure how that could be accomplished.

    Comment by Ranko Bursac (@ranko_bursac) -

  159. The biggest insurmountable issue is that healthcare fails the capitalism test. If I go to buy a car, and the salesperson says the car I want is $100,000, I can refuse. And if enough customers refuse, the company has two choices — reduce the price, or go out of business. I can also counteroffer, I can negotiate, we can come to an agreement.

    Now instead of a car, it’s a cancer treatment, and it costs $100,000. What are my options. Negotiate? Say no, come back to me when you have a better offer? Sorry, the wife and I have talked it over and we’re just going let her die? When it’s now health, the answer is always “yes”. Whatever you want to charge, that’s what it costs. A million dollars for a life birth in a hospital? Not anything I have control over. The only “choice” is the one forced upon me if I don’t have insurance, where I have to say no because I have no options. There’s no free market choice, because I never have any negotiating power.

    The “failure” of Obamacare is that it only went halfway. We need the healthy people to enroll so that the cost burden is shared, but we don’t have any control over exactly what that collective burden is, and neither does the government. If a pill is a billion dollars, then we all cover a billion dollar pill. No one at any point is enforced to say no, that’s ridiculous.

    Everyone points to other countries with socialized or universal healthcare and points out how they can do medicine cheaper, but no one seems to get it’s cheaper because that’s the law. The governments have say-so, they regulate costs, which we all treat as anti-American. But if you want to bring prices under control, in the absence of economic forces, then that’s what you do.

    I’ve lived in both the US and Canada and had health insurance in each. Most people think Canada has “national health insurance”, but that’s not true. Canada simply has a law that each province must have health insurance, and gives them each three rules:

    1. The government acts as the insurance company
    2. Any medical practitioner in the province must take that insurance payment if you want to practice medicine there.
    3. It must cover the costs 100% (no billing the patient additional)

    (To fellow Canadians who will point out there’s minutiae and variances and this is a bit of a simplification, yes, but it serves for discussion purposes.)

    These rules effectively put the government in charge of what healthcare costs. And if you don’t pay your premium (in BC it was $65.00/month for a single person), it just gets taken out of your tax refund because it’s all the government anyway. But you can’t actually NOT sign up for healthcare.

    Americans would think this is frightening, that the government could decide what claims to pay and what not to pay. But how is that any different than any insurance company in the US that denies your claim because “they” don’t think it’s necessary or they don’t want to cover it. At least the government in principle is supposed to ensure fairness. The private insurance here just wants their stock price to go up.

    Comment by Kris White -

  160. Short and sweet? I agree 100%. And, please negotiate with the pharma companies for those life saving drugs. There’s just no excuse for $1million prices per year. Thank you for throwing this in. I look forward to see where you go over the next few years.

    Comment by Phil Mickelson (@PhilMDev) -

  161. Mark the answer is simple. You can’t use a system and not replenish the fund. The Govt. should buy life insurance on every covered person (tack a premium fee in the health insurance or on taxes). Once they die the monies replenish what they spent or may not have spent on healthcare. Very similar deal as COLI or BOLI but I named this one HOLI. I’ve been harping on this for years.

    Comment by Briton Lacy -

  162. A flat 1% tax on all purchases with funds going to health care would go far.

    Comment by comedustwithus (@comedustwithus) -

  163. Healthcare as an investment??? Question: can we create a healthcare system in which the benefits of the system will cover the costs?

    Comment by Dempsey Real Estate (@petedempsey64) -

  164. The way that payers(Insurance Companies) handle fee-for-service and capitation with rates they can change historically without tracking aging or any oversight is has to be a illegal practice that they have learned to manipulate. This is the problem they can flex or deflate rates on their business logic which does the consumer(you) or sponsors(State Money) not good. I do IT work for all facets the payer, provider or case manager services. It’s greatly flawed and when inquiring about the business logic they could not offer me info about how they calculate it. If you can not provide information to the guy setting up the system, something is afoul. TO CHANGE THE PRICE YOU HAVE TO HAVE OVERSIGHT OF THE MCO/PAYER PRICING OF RATE. PLAIN AND SIMPLE

    Comment by Milo Thompson -

  165. The way that payers handle fee-for-service and capitation with rates they can change historically without tracking aging or any oversight is do right illegal practice they have learned to manipulate. This is the problem they can flex or deflate rates on their business logic which does the consumer or sponsors not good. I do IT work for all facets the payer, provider or case manager services. It’s greatly flawed and when inquiring about the business logic they could not offer me info about how they calculate it. If you can not provide information to the guy setting up the system, something is afoul.

    Comment by Milo Thompson -

  166. Mark, I’d like to address your first point. The providers do not get affected in the way you may think. We actually have to see 3x more patients to keep the same income. We are not seeing 20-30% pay raises every year with the rise of premiums!!! It’s people like you, the executives at these “Non-profit” insurance companies that are making millions in bonuses!!! Also the pharmaceutical companies and their fees are outrageous! Again to pay the bonuses to the executives many of which don’t even have a degree in the sciences but know a great profit margin when they see one! I’d love to hear your response to that!!! P.S. I use to play a lot of hockey down there in Mt. Lebanon. Bought all my equipment from Rupp’s right across from St. Bernard’s church.

    Comment by Rik Sable -

  167. It’s a great plan. The two problems are:

    1. Someone will have to decide what’s covered and what’s not. And no matter what, there will we be people angry about what’s left out.

    But this is a small problem in comparison to the other one ….

    2. Doctors and hospitals will make WAY LESS MONEY under this plan. YOU — meaning business, meaning employer-based insurance — currently pay doctors and hospitals way MORE for the same thing. If they start getting Medicare or Medicaid rates instead of what you are paying them now, medical providers will see massive, massive income decreases.

    Comment by The Cranky Traveler (@cranky_traveler) -

  168. You’re right when you frame the discussion in terms of the Genetic Lottery and Wrong Place, Wrong Time Lottery. That should speak to everyone, across the board, and it’s crushing to not have the financial means to pay for care for ourselves and 10x worse for our loved ones.

    You’re proposing a valid idea, poking people to ask better questions. Unfortunately I think most politicians are too corrupt to take your idea seriously, but I wish they would. Back to your idea, I would add only that there are incentives of some sort for those who actively do what they can to prevent a deterioration of their condition, or make lifestyle changes to reduce whatever problems our taxes would end up paying for. It reduces the idea that people with chronic conditions are satisfied to live with pain and let others foot the bill. I don’t think that’s the case at all.

    I’m an American Citizen living in Italy, and the health care system here works. We still pay a small deductible for certain services, but overall the system runs well, and people don’t complain about paying taxes for this kind of service. The value is there. I think if we really felt like we were getting value from our healthcare providers (and not nickel and dime’d for every little aspirin, etc.) Americans would embrace the idea of tax money getting spent on practical services that we use everyday.

    Consider a run for office in 2020!! I think you’d bring enormous benefit to the country, and I think you’d be a powerhouse getting real work done!

    Comment by kimberly1234 -

  169. Pingback: Mark Cuban offers Obamacare fixes - Royal Heads

  170. I think fixing health care insurance is a simple matter: Get employers out of the mess. Make them give employees the money they are paying insurance companies on their behalf. Then, open the state health care insurance market monopolies to allow people to buy insurance from any place and company they want. I think, with cash in hand, people would shop for what suited them best, and the prices would plummet. I imagine a world where we see just as many health insurance ads on TV as DISCOUNT AUTO INSURANCE ads (which is A LOT). If we can just make health care insurance work like auto insurance, I think the prices would work themselves out. Regulation and company involvement are in the way of that.

    Comment by dkdunkirk -

  171. As a group, we are not strong enough to resist the slide down the slippery slope to redefining all ailment as covered.

    All individuals within economies, be it bacteria or human, respond to free “no transactional cost to me” resources in a wasteful fashion, like we do when we use processed water to water our lawns, wash cars, and flush waste to be sanitized.

    Comment by Bob Rahm -

  172. Mark, your idea is solid in many ways, but as others have said, Medicare for all is the way to go. Medicare is not perfect, but it is a known, proven system that most people are happy with. It has demonstrably lower admin costs, it saves doctors, especially private practice ones, money because the paperwork is much easier to process, and it controls costs by setting consistant reimbursment rates. The other reason Medicare for all would lower costs is everyone would be covered, so hospitals would not have to charge more to recoup the costs of trating uninsured people. Tort reform, banning direct advertising of drugs to consumers, and reducing the cost of doctor training are also great ideas.

    Comment by gondilon -

  173. Short and sweet summary of the issue! This sounds a lot like the system we have in The Netherlands, where we moved from a fully public system towards a partially privatizes system over the past decade. Every change comes with challenges, but I think the benefits to society and basic social humanity will prevail.

    Comment by Lukas Voesenek -

  174. I believe wholeheartedly that healthcare is a right that should be afforded to all. While there are a lot of people who think that they should not have to pay for someone else’s medical treatment of ‘lifestyle’ related illnesses, what they fail to understand is that a lot of those poor decisions are rooted in a lack of education. I have noticed that as more time passes there are more and more people who do not possess even basic everyday living skills. They cannot maintain a bank account or manage their debt. They don’t know how to cook healthy meals, or what a healthy diet even looks like. Maybe their parents didn’t know enough themselves to be able to teach those skills. Since those are no longer taught in schools, where are they supposed to learn how to properly take care of themselves? You will find that there is a direct correlation between poor lifestyle choices and poverty. To penalize someone for making those poor choices is equivalent to penalizing them for being poor and uninformed. I would suggest that, before we penalize people for having an unhealthy lifestyle, we include diet and cooking classes in our healthcare policies. Most insurance will cover smoking cessation, as well as programs to treat alcoholism. It would certainly be financially less expensive overall than the physical and monetary cost to treating all of the conditions that will likely result from a poor diet. Additionally, I think that someone with a higher income should pay more in taxes, which would pay for healthcare. I’d gladly pay more in exchange for a higher income. As time goes on, and inflation grows, it is getting harder and harder for lower earners to make it on their own. This means that they must work longer hours, or second jobs, leaving even less time to devote to a healthy lifestyle. It’s not as simple as ‘choosing’ to make poor decisions. As for taking government out of healthcare, that’s just not possible. You can’t have a system that is dependent upon individuals looking out for their neighbors, especially when those individuals set themselves above their neighbors. If contributing is an option, there will always be a large number of people who won’t contribute because ‘it’s not their problem’.

    Comment by Michelle Teer (@Mchel41) -

  175. Pingback: Mark Cuban fires his opening salvo at attempting to fix Obamacare - Global Times | World News, Politics, Economics, Entertainment,Sport,Business & FinanceGlobal Times | World News, Politics, Economics, Entertainment,Sport,Business & Finance

  176. So the basic principle would be implementing a variation of a single payer system where everyone has access to some basic level of care (your suggestion is for life-threatening injuries and chronic diseases). I would assume it would be funded similar to Medicaid (both federal level and states by general revenues, payroll tax, and a small amount by premiums of beneficiaries, though it sounds like your suggestion might not include more taxes in place of premiums of the beneficiaries). The biggest thing I like about it is that it seems to be a way to implement a variant of a single-payer system in the U.S. without entirely giving up patient freedom to choose plans through private markets. It’s an attempt to incorporate the strengths of both a single-payer and a market-based system, which generally speaking is what the U.S. has been trying to do anyway.

    A few issues come to mind that I think could use some more thought:

    1) Determining what’s covered by the single-payer program
    The categories you mention are chronic diseases (both physical and mental) and life-threatening injuries. I think determining what sorts of injuries are covered could be especially difficult, though chronic illness is clearer. It might be necessary to abandon the life-threatening injuries aspect but you could substitute a different sort of coverage (maybe a catastrophic plan) for injuries that at least seriously reduces out of pocket costs. I think the basic idea is good–essentially that there are some kinds of care everyone should have access to–but applying it in practice could be too difficult. Is there a list of conditions that are covered in the program? If so who makes that list? If not, then who determines what’s covered on a case-by-case basis? I think those questions are worth considering.

    An alternative option worth considering might be a variant of the single-payer program you described: a sort of single-payer catastrophic plan designed for those with chronic illness. It could work similar to any other health care plan: cover all costs after a “deductible” is met and what that point is could be based on income.

    2) What happens to private insurance markets?
    The single-payer program you suggest seems to be essentially a way to prevent anyone from running into catastrophic medical costs due to a diagnosis that’s no fault of their own, which is a great goal in my view, especially since chronic illness is responsible for the majority of medical costs–but not all. Under CubanCARE, individuals would still face routine medical costs (stuff for routine illness, checkups, preventative screenings, etc.) and they would still be able to buy supplemental private insurance. Many risk-averse people, especially those with families and kids where even routine stuff can add up fast, would presumably still be in the market for private insurance. Insurance companies’ incentive would be to enroll as many people as possible, and therefore, to offer the best plans possible and wouldn’t have to cover costs of the chronic illness covered under the single-payer program cutting a lot of their costs. One big question I would have is whether people would actually decide to enroll in private plans or if the existence of the single-payer program would deter them. People without private insurance might not seek preventative care, for instance, which could be a negative consequence. Another big question would be: What would happen with employer-sponsored insurance (currently where the majority of Americans get their coverage)?. The thought with Obamacare was that employers would stop offering this coverage and send people into state Obamacare marketplaces. In reality this didn’t take place on the scale that was expected, which is actually one of the biggest problems with the state individual marketplaces (i.e. not enough people in the pools).

    3) Cost control
    Controlling costs is obviously an issue with any plan, both costs to individuals and overall total health care costs for the country. This isn’t so much a critique as a question mark, as I have no idea how this plan would affect costs.

    4) Access
    Assuming this single-payer program was part of the medicaid program (or even just something similar to it), you’d face the question of what the program pays providers and whether they’d accept patients who are a part of the program. Since different payers negotiate different rates with providers and Medicaid is the lowest (presumably this program would similarly be low) doctors wouldn’t exactly go looking for these patients. One option would be simply forcing providers to take these patients. Otherwise, there would have to be another way to make sure they had access to care.

    5) Resistance to rapid/drastic change
    I’m a college student and took a course with one of Obama’s health care advisers while Dems were drafting the ACA. Even with his admitted bias, he said in his opinion it was really only a B+ bill as written (and was further hurt by states not expanding Medicaid, which really stuck a wrench in the program’s design). My single biggest takeaway from the class was that any kind of health care reform is incredibly difficult and the more it changes the current system, the more difficult it is. It’s hard to generate the popular support necessary to get a comprehensive health care reform bill through Congress (there had been about 80 years of attempts, on and off, before the ACA) and so I think it’s important to portray any changes as not being too drastic. This might have to do more with optics than substance but it’s one of the biggest reasons a true single-payer system doesn’t look realistic in the U.S. It’s important not to overlook how tough it is to get Americans to agree on what our health care system needs.

    Comment by Nick Evans (@EvansNW94) -

  177. Don’t want to shoot holes. Just want to improve.

    -ben “Numerati”

    Sent from my iPhone


    Comment by bmoertle -

  178. Could we crowdfund a non-profit insurance company? Once we take profits out of the equation, we can focus on actually saving lives and improving health care for everyone.

    Comment by Richard S (@thrownaway12345) -

  179. Mark,

    Who takes less? The insurance companies. All of them.

    Disrupt the insurance companies.

    Why? There’s no reason for insurance admin costs to exist anymore. Therefore replace all the insurace companies with a “big data” software/internet robot. And wherever humans are still needed, move those decisions where they belong – between doctor and patient.

    The only reason nothing has moved in this direction already is because heavy regulations prevents easy entry into the healthcare insurance space.

    There would no longer be a need for competition. So drive down costs even further by removing profit potential by making it a government agency. Furthermore, big data “collective insights” for better care that’s not available today.

    Overall healthcare savings could be staggering.

    “A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending.”

    Comment by Stacy C. Murray -

  180. Mark, thank you for your thoughts. I liked your idea a lot. You are simply suggesting we remove the black swans (left fat tails) of people’s health and share its burden. If implemented correctly, I believe not only will this make managing the leftover risk more manageable for insurance companies and hence cheaper, but also could make the burden of the rare events cheaper through the efficiency of a single payer.

    Comment by Hesam Aslan (@HesamAslan) -

  181. Is supply and demand really that hard of a concept for people to grasp? If you move to a single payer system, it will create unlimited demand for limited medical services – you cannot enslave medical providers to do service for free.

    Individuals need to take responsibility for themselves and family. Take the government out of healthcare completely. Take employers out of healthcare completely. Stop distorting the market so much that no one actually knows what the prices are. Let people shop for the best deal.

    It is sickening to watch idiot politicians think they can do a better job of managing my healthcare than me – but please, allow me to treat that sickness on my own.

    Comment by Mike Erickson -

  182. i think you have some good ideas here. You didn’t mention how important it is for young children should regularly see a doctor. I assume the single moms even married moms do not make sure that their kids see a doctor on a regular basis.

    Comment by sanford943 -

  183. As a Canadian I’m proud you ventured to say the words Mr. Cuban. Single Payer. Just today I visited the hospital with my wife and baby and we paid…well, nothing. We never do. There is no cashier in our hospitals, well, except for the lunch room. That’s only for visitors because patients get 3 healthy meals a day, free. Just like the medical.

    Your a pretty smart guy Mr. Cuban. It is easy to look all around the world and find the most health care provided for the least cost. The ‘free market’ (which isn’t free) simply doesn’t provide affordable primary health care very efficiently. There are too many fingers in the pie trying to get their profits.This is shown by world wide health care stats that I won’t bore you with. Anyone serious about this issue already knows which countries are doing it very well.

    I’m happy to see you being bold and trying to get past the rhetoric in this health care debate. I hate reading stories of Americans driven into bankruptcy over and over due to medical costs. I hate seeing Go Fund Me campaigns for Americans caught with no coverage and life or death situations. I believe you know your proposal is only a first step. It’s as far as the American corporate interests might allow you to go, but it really is only a first step in building a quality health care system. Kudos to you for taking it.

    Comment by James Leadley -

  184. Mark, youve got to take your incredibly powerful position of influence and use it to bring this kind of analysis into the public sphere. It makes sense.

    Sadly, there’s no shortage of rich and powerful interests lobbying for god awful policies that destroy the enviorment and incarcerate human bodies or send them off to war.

    When are GOOD, HARDWORKING people gonna have champions like you that pack a punch?

    I dont understand how if Dondald Trump can be president, a celebrity with ZERO experience in public service and a track record of shady financial mismanagment and fraud, why cant some one as BRILLIANT and wealthy as you do more to AT THE VERY LEAST, inject the national converstaion with sound logic and practicality?

    Put some SKIN IN THE GAME. The game being your country. We need you Mark!

    Comment by Diego Quinones (@DiegoGQ339) -

  185. Mark, you do a nice job of putting your finger on the important points and sifting past much of the nonsense. I have been in healthcare my entire career.

    The main problem I see is how to unravel the mess of protectionist laws, rules, regulations that have been etched in granite and driven our annual cost per person to $8,800 which is $3,300 higher than the next biggest spending country, Norway at $5,500. Everyone has their hand out; providers and their guilds, drug companies, equipment manufacturers, health and liability insurers, lawyers, software developers, government contractors….and more. Healthcare has become our countries largest make work industry where the only material incentive to innovate is given to the drug companies, every other profession gets paid to maintain the status quo.

    My solution? Develop seed environments where professionals can experiment with real change with limited to no real regulation. Imagine an environment where a lawyer, insurer, guild or bureaucrat could not throw a wrench into innovation. An environment where patients recognize and accept the risks of such an experiment. We need to turn test segments of our healthcare system into the Wild West for a time to create genuine opportunities to reinvent process, payment mechanisms, outcomes – really everything.

    Comment by Chris Bunnell -

  186. Insurance premiums are out of control because of Cancer and Heart Disease not people getting hit by a bus. Catastrophic accidents often lead to death and no cost for insurers. Your plan needs major tweeks!

    Insurance companies are expensive middleware that must be eliminated. One such model is Kaiser where the providers are the insurance company. I don’t think any plan that focuses on insurance companies can work.

    Comment by mrrich1 -

  187. I get your “who’s going to take less argument” , but we’re not there yet… The healthcare system has so many built in inefficiencies that your argument is premature…The biggest cost saving / piece of the pie to be had now is efficiency. We first need an efficient system before we can even start looking at how the pie is divided.
    Example. Let’s say a company is selling product x at an exorbitant price but are still losing money. Your argument is that the only way they can make money is that if the workers take less (labor cost), their suppliers take less ( material cost), or their customers keep less of their money (pay more for product x). That’s simply not true, particularly if that company is poorly run, wasting money, not using state of the art technology or best practices in making and distributing product x. Never has this been more true than in our healthcare delivery system. I’ll be happy to elaborate…

    Comment by djamel (@zrealzoolander) -

  188. Mark why does your system require a middle man, the insurance companies? I don’t think it does. How do you suggest paying for illness brought on by life style? Smoke, drink, use drugs, eat till you’re obese…then let the rest of society pay to try to save you when you’re dying. Not fair or right. A part of health insurance needs to be the same as car or life insurance. Higher risk lifestyle, pay more

    Comment by Dana Northrop -

  189. #cuban4president

    Comment by Krista Parkinson -

  190. Insurance companies don’t want to sell across state lines. The ACA already permits this in several states, and no carrier has taken them up on it — mostly because it would be so cost prohibitive to set up full provider networks and hospital contracts in every single state. Pretty much every health policy think tank has been pointing this out for years, but Republicans never paid attention to their warnings.

    Also, the main reason U.S. health care costs are so high is because doctors control the market, keeping the number of doctors artificially low, so they can charge more money.

    Comment by SuburbanGuerrilla (@SusieMadrak) -

  191. Sounds similar to what most other developed nation do, who realized that healthcare isn’t a market that competes on price and service, so therefore isn’t suitable for free market treatment. Aren’t you basically suggesting Medicare for everyone? Since private health insurance has overhead of 20% (10% profits & 10% operating), and Medicare has 3% overhead, we save quite a bit. Other developed nation governments also have price controls, so that there isn’t 8x mark-up for things that don’t even have a patent. For the higher income people, they can buy supplemental private insurance as they do in Germany, Switzerland (or in US on Medicare).

    The problem isn’t finding a better healthcare solution. All other developed nations do, and they have empirically better health. The problem is that there is no way for it to get through Congress because it is destructive to Congressional donors. If you want Congress to represent their constituents, then you must limit campaign contributors to only registered voters who could vote for that office (no money from PAC’s, non-profits, businesses, or people residing outside of the district). Unfortunately, due to Citizens United this would require a constitutional amendment – which Congress would block. Democracy has failed because we sold it to the highest bidder.

    Comment by Approximate Apoplexy (@kent_willard) -

  192. Mark, Great article! All I can say is this, My thought on this is just wish the healthcare system would be more understanding with those who just can’t simply afford health insurance, why have a multi million dollar business when there is no systematic system, Americans from all walks of life should be able to determine there finances, walk through it with there health provider and if they can’t simply afford it at such a high cost then there should be a break down on the financial part of it. Healthcare for how many years still in a bind and still today in this day in age American’s are fighting not only for themselves but also for there family, kids as well, if there is a family of five, why not charge $3-10dollars per child not this 480 dollar premium, guestimating. I might be a bit off on my math but I hope you understand and all can get what I’m saying throwing number’s out there and the cost to make a pill or surgery and all these other expenses not only from hospitals but also walk in costs is just bluntly sad to see someone work all there life and end up with nothing in there pocket, health care in America is dead care, who’s up for coffee? I’m all about good and seeing good and would love to see for once in America actually make a difference rather than seeing people in stress losing everything, we are in a time where we actually need some serious good business people take stand and really lay it on the table when it comes to making that difference to and for the good. Low class, middle class and the rich, doesn’t matter, what matters is the healthcare system can be fixed, not fixed on look how they become richer, we are in the game dipping in the same pool. I wouldn’t call this a political matter, I’d call it MedOne the term for that would be for all and equal. The system would automatically would see your finances and whatever the family size is or even single or married it would simply charge you the fairest rate, rich or low class, middle class, if the math is right it would surly make one hell of difference for every American who would have comfortable Health insurance, Mike Daniels.


    Comment by writermikedaniels -

  193. Pingback: Mark Cuban fires his opening salvo at attempting to fix Obamacare | Politically Brewed

  194. Mark

    You explained it very simply and clearly. Insurance operates off of a couple of fundamental principles. The Law of Large Numbers (we need to insure many to spread the risk) and Adverse Selection (people want insurance only when they’re sick). Unfortunately, with health insurance it’s difficult to satisfy both without mandates or government intervention (both of with which I philosophically disagree)

    It does drive me crazy when people just rail against the insurance companies for wanting to make a profit. I think part of the problem is that we all think we should get good health care for a $10 copay. It can’t work like that.

    Insurance is a “if your barn burns down I’ll help you build it back, and if my barn burns down you help me build it back” system. But a “you help me but I don’t want to pay” system doesn’t work. It ONLY works if everyone participates. Otherwise insurance companies can’t provide coverage without underwriting and the ability to decline to insure certain risks.

    Your thoughts that everyone gets catastrophic single payor is interesting. I’m inclined to set my “big government is bad” philosophy aside for it.

    Here’s to thinking about bit more on it.

    Clark Randall GO DIRK!

    Comment by Clark Randall -

  195. This is the right idea. In addition to other changes focused on controlling costs, for example I assume that the government negotiates in advance what it will pay for the services in the “Medicaid Plan”. What do the supplemental “Market Plans” pay for? Obviously, they would cover elective, non-life-saving care. Perhaps, comfort upgrades like more hospital nights, etc. It seems the non-government insurance market would be much smaller. Question: When my daughter has a cough that won’t go away after 2 weeks. It’s probably just a cold but I want to be sure…would a doctor visit for that be covered by the Medicaid plan? How about if I fall hard while skiing and hurt my wrist, might be sprained, might be broken. If I go to the doctor, is that covered by the Medicaid plan? These are the kinds of things that we want people to go to the doctor for. It seems like a government basic plan should cover them. But, if they are covered, the private market would be a small, high-end niche. That would make sense for me, but I question whether congress would realistically give such a big industry such an extreme haircut.

    Comment by Joe Felice (@ThatJoeFelice) -

  196. I’m reading comments about costs specifically about MRI from facility to facility. What a private clinic or hospital might charge is not necessarily what they collect. Insurance providers determine what will be paid out for an MRI knee. Take hospital A who charges $6000, the negotiated payout with one provider might be $4000 at another it might be $3500. Yet the cash price might be $2500. Now same exam, go to the private clinic down the street who charges $1800 but his negotiated payout is $1200 and cash price is $650.
    Crazy right, but that is only one insurance provider. This is all dictated by the insurance company. Then of course there is complete denial but that’s a different topic. Insurance companies control the entire industry and of course the politicians. Often what happens is patients who have great healthcare coverage end up paying cash because it is still cheaper out of pocket.

    Comment by thearnoldhedge -

  197. You’re advocating for universal catastrophic health coverage, which has been proposed many times throughout our nation’s history. While not exactly the same, this is fairly similar to what happens currently. If you are uninsured, here legally, and become disabled, you will qualify for a government-provided insurance program unless you have extensive financial reserves. It just takes time to qualify as “chronic”. There are a number of problems with this:
    1. What constitutes chronic illness? I think you mean disabling or catastrophic illness. I am near sighted. My contact lenses help me lead a normal life. My myopia is a chronic condition, but certainly not one that would necessitate government assistance.
    2. Who pays for maternity services?
    3. “Life threatening injury” needs to be reworded to include other life-threatening conditions, such as stroke and heart attack. I would also include acute illnesses or injuries likely to result in severe disability if untreated.
    4. I fear that by minimizing the risk to the insurance companies of taking care of expensive conditions, it will result in disincentives to provide quality preventive care. I.E. if you are not going to have to pay for someone’s colon resection and chemotherapy if they have advanced colon cancer, what is your incentive to cover their colonoscopy?

    The best ways to reduce cost of care in this country:
    1. Stop confusing hospitals with hotels. We need to stop with the attempts to earn 5 stars on surveys and focus on true quality of care indicators.
    2. Tort reform. There is a poor correlation between malpractice claims and actually malpractice.
    3. Reduce number of health care administrators, the numbers of which have grown exponentially.
    4. Public health measures, including the very necessary end of corn subsidies.
    5. Stop mandates that are forcing small hospital systems and private doctor’s offices out of business. EMRs, for example, are too expensive for many of these organizations to survive. Competition helps keeps costs down. We’re left with a lot of bloated organizations charging exorbitant facility fees for services that could have been performed in private offices.

    Comment by Lauren Shapiro -

  198. Hello Mark, so glad to see these discussions.
    I am not savvy enough to offer suggestions, I can only relate my experience. My insurance costs were sky high with huge deductibles before I went on Medicare. I never went to the doctor, going 17 years without preventative care of any kind because it was simply too expensive. Now that I have Medicare I can and do get routine preventative care and have worked to improve my overall health.
    My point is this- when I couldn’t afford to get any medical care because I was paying $14,000 a year for crappy insurance, I didn’t care about my health. I just felt like, ” why even try?” But now that I know I have affordable insurance with reasonable copays I work much harder at maintaining good health. I have to think many other people who have poor or no insurance feel as helpless as I did.

    Comment by Sue Clark -

  199. Pingback: Mark Cuban fires his opening salvo at attempting to fix Obamacare | News World

  200. Another common thread in the comments that needs to be debunked is the idea that we need more markets in healthcare. For a variety of reasons that the Nobel Laureate Kenneth Arrow clearly laid out over 50 years ago ( healthcare isn’t like bread or televisions or couches– people can’t make intelligent decisions because there are huge information asymmetries between the sellers (doctors, pharma, etc.) and buyers (patients). It’s really clear when you think about it– you don’t go to the doctor and get a menu of options that you’re allowed to choose from, your doctor tells you what’s wrong with you and prescribes the treatment. And you don’t really know if the treatment was the correct one. Hell, you don’t really know if you relapsed because a doctor screwed up, or because your condition simply overcame the correct treatment. On top of that, the only real way to pay for healthcare is through insurance– costs are rare but unpredictable, by and large. Your monthly medical bill could be $0, or it could be $30K if you get hit by a truck and need reconstructive surgery, or you’re diagnosed with cancer and you need treatment. The only real effective way to pay for that is through an insurance model.

    On top of that, we tend to think of healthcare as a right rather than a privilege– ambulances don’t check for an insurance card before they take you to the hospital, and we’d think our society was pretty monstrous if it did. So we need to figure out a way to deliver something universally that isn’t necessarily profitable. Because insurance is the only way to do that, there are really only two options to pay for it– government can pay everything (and make its own decisions on what treatments to cover), or insurance companies can do that, but through a tightly regulated market. Without strict regulations, insurers won’t insure people that are big health risks, and they’ll be fully rational in doing so– you can’t force a flood insurer to cover your swampfront property in New Orleans at anything resembling a reasonable rate. So you need healthier people in the market, which itself requires a mandate. Which leaves you with… essentially Obamacare. Obamacare hasn’t been without its issues, but the biggest one is that the enforcement penalty hasn’t been sufficiently punitive to get people to sign up (Switzerland, which conservatives love to hold up as a holy grail, has a mandate so punitive that non-payment of premiums can carry a prison term).

    Despite the problems, Obamacare has driven the uninsured rate to its lowest level since we’ve started keeping tabs, created minimum standards for care (no more “I can’t believe it’s not insurance” policies), eliminated lifetime caps on what gets covered, etc. These are real, extremely significant changes. That’s something we need to build on, not throw out the window.

    Comment by Alex Imas -

  201. Mark,

    I’ve thought the same. Once any consumer exceeds $50,000 or $100,000 in health care expenses due to an acute or chronic condition, the federal government becomes financially responsible via tax revenue. Consumers buy coverage for $50,000 or $100,000, which is more affordable for all, or self insure.

    To go really big:
    1) The different silos (Medicare, Medicaid, Veterans, Employer, Obamacare) are collapsed into one system. Today, a consumer can be in one system one day and literally another the next day, which means a different set of rules, choices, doctors, prices, etc. The new approach is not single payer, nor government healthcare, but consumer driven. Everyone would participate in your approach.
    2) New financing mechanisms are developed as health insurance carriers become obsolete. Today, carriers funnel money among parties, but don’t do it well. By removing them from the equation, the consumer is better able to establish a long-term relationship with a local health system. Financial administration is done by organizations capable of innovating for this relationship.

    Leaders need to be looking out 10 years because it could take that long to make happen.

    BTW, I shared “Mastering Health Insurance” with your team. Its time has come.

    Colleen Murphy

    Comment by ClareFolio (@ClareFolio) -

  202. Within this discussion should be medical cost transparency. While there may be valid reasons why the same procedure is more or less expensive in one town versus another town in the same vicinity – medical providers (hospitals, doctors, technicians, labs etc.) should be forced to publish their pricing. Notwithstanding an unusual circumstance (i.e. performing a test and finding something, therefore triggering additional procedures) – an apples to apples procedure should either be the same everywhere (although ‘free marketers’ may disagree) – or at least be clearly published so consumers (i.e. “People”) can shop around. While one doctor may charge more than another due to education/experience – that is legitimate… Not sure why one MRI in town A should be more expensive than the exact same MRI in town B? But regulate that transparency and let the consumer choose – that IS the free market (although I like the single payor – or similar concept – that Mark puts forth).

    Comment by Mason Cooper -

  203. Pingback: Some Thoughts on Fixing Obamacare – Shoot Holes in this Please – Telephone Engineers Warrington

  204. Mark Cuban, The single payer system is based on the assumption that “We all share the same risks, we all can share the costs of our greatest risks.” as you well summarize it. In theory that is not true. Some individuals may choose to take additional risk, say smoke more. Now they are not doing it at their individual expense but at the collective expense. One other angle of reasoning (my$0.02) that could be thought through is that medical providers today have an incentive to over-treat their patients (say an MRI scan for a simple sports injury) as they are doing it at the expense of the insurance provider and subsequently the patient’s expense. This is driving up the cost of insurance overall. This problem can be solved by unifying insurance and healthcare provider. Under-treatment is malpractice while over-treatment is not.

    Comment by Aadharsh Kannan -

  205. Mark, I agree it’s simple math, someone must take less! There are no volunteers… but the middleman is the insurance company whose profits are the envy of many. The patients are aware of every dime they spend on healthcare and do the best they can to get the best care at the most affordable price. Government although wasteful are somewhat accountable to their constituents. Who are insurance companies accountable to stockholders? No… they just care about profit. When insurance companies don’t make their margins easy solution raise premiums or cut and run. Insurance companies have not looked at the expense side of their business in decades! The first place to find savings is: 1. Government needs to set minimum coverage insurance providers must sell. 2. Government needs to set maximum premium that insurance providers can charge for this coverage. This will force insurance providers to compete and market differently to go after any extra healthcare coverage. At the same time insurance providers will be forced to find ways to cut costs. Insurance companies have been dictating the direction of the healthcare industry for too long. Having lived in Canada for most of my life and working in the healthcare industry in the US today, I have a unique perspective and see the benefits and pitfalls of both systems. It is fixable! I would love to help.

    Comment by thearnoldhedge -

  206. Some thoughts:
    – Insurance companies today are incentivized to make healthcare more expensive (in aggregate) whether they are assuming the risk on their books or just administrators (as they are in many employer paid plans). It’s fundamentally a cost-plus business. Innovation that reduces the cost for a given outcome is against their economic interest. I would argue this is a big part of why the costs are so high today and increasing faster than inflation. Some variation of single payer is the only way to break this paradox. Outcome to cost ratios are better in all developed countries that use single payer
    – Big cost reductions will come from changes to how care is administered, not from changing who pays and/or who takes the risk. There are many opportunities to do this – from managing people with chronic conditions differently to increasing investments in prevention and early detection. Check out I met their founder when they were just getting started – blew me away. Significantly better outcomes at MUCH lower cost – especially for obesity-related chronic conditions
    – Standardize protocols for treating common conditions. I’m not suggesting that doctors shouldn’t have authority, only that there is so much variance today in protocols that there is lots of room for improvement
    – Re-test drug (and devices/procedures) effectiveness once they’re in the marketplace. Today, only significant adverse reactions are really tested after drugs are released to the market (i.e. lawsuits or prevention of lawsuits). Some protocols/drugs are simply more effective than others, but that information isn’t well documented or shared among providers
    – Get rid of consumer-focused drug (and device) marketing. It creates huge additional costs in the system and likely adversely affects outcomes – doctors, who often have as many as 2500 patients in their panel – tend to be easily swayed by a patient coming in and asking for a specific drug by name
    – I really like the MFN concept for drugs and other commercial products
    – With a single payer style system, I think the price variance craziness for specific procedures and tests will take care of itself. Some profit will come out of the system and some jobs, but that’s inevitable in the path of decreasing costs
    – Find mechanisms to continue to incentivize automation and efficiency in care (even in a single-payer system) so that entrepreneurs can continue innovate with good returns. There is a technology revolution on the horizon where many fewer people will be required for care. Perhaps another conversation
    – Lastly, campaign finance reform would make these types of changes possible. As long as campaign contributions from the various interests continue to be a prerequisite for winning a seat at the table, we’ll continue to have these bizarre solutions like the ACA and the even more bizarre and troubling AHCA. The only way today to please everyone is to actually please only the ones who have the money (insurance companies, pharma, other HC providers) and spend some of that money to convince the people who actually pay (i.e. rest of us) that this is the best we can do

    Comment by Geoff Nesnow (@DonotInnovate) -

  207. Until you reign in the cost of the actual care you are wasting your time. Health insurance is merely financial service that facilitates payments on your behalf using grouped money to do so. Look around your doctors office, you will see a lot more staff then ever before. Staff cost money that money comes from the charges to the patient. That means billing clerks, insurance coders, and on and on all driving up the cost. Ever see a price chart in a doctors office? Nope you have no idea how much a office visit cost. Health care really isn’t a free market system because general practice physicians do have to compete. Who prices shops their general doctors or even if you need a specialist ? Until you change the whole mentality of people and medicine you’ll see the same issue regardless of what manner of payment or who makes it and cost going up.

    Comment by LM (@factualone) -

  208. Until there is a real patriot defining and implementing healthcare laws, the healthcare industry has the consumers of healthcare firmly by the balls. Through their lawyers and lobbyists, they are able to legislate profits and minimize their risk.

    David Marshall Naples, Florida.

    PS to run by business in Naples, Florida I pay a total of $89 a year to the city and county as taxes to hang my investment advisory business. When I lived in The City of Pittsburgh, I paid a 3% wage tax-no upper limit, and a 3%+ tax-no upper limit to the State of PA. I was able to improve my situation because I had choice. The same needs to be done in healthcare. I want to self insurance to $50,000, but the laws written by the healthcare industry do not allow me to do this. They capped each family member at $7,000. I would rather take the $50k risk, and pay low monthlies.

    Mark, once pre existing condition clauses are thrown out, and the idea that no family should go broke because of healthcare bills, then it is all about choice which will create competition and lower prices.

    Aside from pre existing and no family going broke clauses, keep the government as far away as possible. They screw everything up big time.

    Best regards,

    David Marshall 412-877-7700


    Comment by david marshall -

  209. I’m trying to think of all the various conditions not covered by your three-topic suggestion. One I would suggest is that preventative care would also need to be covered, lest the chronic conditions will be more apt to develop. Another thought, do we risk setting up class warfare when you start adding to the list items like “elective” surgery? The haves vs the have nots will likely see marked differences in what procedures will be available – and we’ll be relegated to the federal or state governments determining what should and should not be covered. Granted, that is not all that different from what we see today in the private insurance market, and there is a decent argument that could be made that by aggregating the population, the data on these conditions, and ability to predict trends and outcomes better might help drive better decisions as to what would and would not be covered. There are so many examples we could pull from – does a person with osteoarthritis of the hip have to use private insurance to have a total hip replacement unless they meet very strict criteria as to when the federal government would pay for the procedure. I can imagine several different types of physicians and providers opting to not participate in the federal program, and only offer private pay and private insurers – not necessarily a bad thing but a possible fallout. I think the best possible aspect of the private pay system is that noone is left behind when it comes to receiving healthcare, and that the possibility of additional care delivery models will likely spring up as a result. I applaud your discussion and effort to generate discussion. I firmly believe, as it seems do you, that healthcare in this country should be a right, not a privilege. I trust that we will see this fixed in our lifetime. Best regards,

    Aaron Browne, PA-C

    Comment by Aaron Browne -

  210. If there is a single payer system with 100% coverage for emergencies, hospitals will start to charge ridiculous prices on such care since the government will pay for it. This is already a problem with medicare and medicaid. Doctor’s have the ability to bill differently based on the patient and they choose the most expensive billing when the patient will have low or no deductible, since the patients will not choose a different doctor because of costs if the costs are paid by someone else. If we went to a system like this, there would have to be a max profit margin doctors offices could make or a max price they could charge for a certain type of care.

    Comment by Michael Schatzel (@MichaelSchatzel) -

  211. Sorry but as long as you believe INSURANCE companies are “stakeholders” the whole thing falls apart. The top 30 healthcare CEO’s earn more annually than 1000 (one thousand) primary care physicians combined. I can assure you they are not the ones getting the “steak.”

    Insurance companies ADD NO VALUE to the delivery of healthcare.

    Comment by George K. Fahnbulleh -

  212. 1. When I was in the USAF, we could offer up our leave time to individuals that had none left because of medical situations exceeded their benefits. Why not offer tax incentives for individuals that can help pay for another individual’s or family’s medical bills that exceed their ability to pay. Gets community involved AND keeps govt out of determining what is right and wrong.

    2. Portable health insurance: Let ME buy my health insurance and NOT have golden handcuffs with the job I’m in, but let my employer subsidize my health insurances costs if they so choose.

    3. Incentivize Drs to not just FIX my health, but to keep me healthy. “Pay to Stay” healthy, but if I get sick, my “warranty” kicks in and I pay nothing until I get healthy again.

    Comment by kevincu -

  213. Mark, I love that this has your attention. I reviewed the proposals from @thepragmaticpol his ideas are a little more intricate than yours but very interesting…Check them out. The real challenge here is to get the damn pols from both sides to sit at the table and create a solution versus trying to score points with their respective base voters.

    Comment by Billy Jalbert (@Mauibilly) -

  214. Mark is on the right track, but it’s not enough. It could be a place to start small and test the tolerance that Americans could have for a single payer/universal system. Keep in mind, the VA is technically socialized medicine and Medicare is a single-payer model, so we already have “pilot” models in place – and people like them!!

    Look at every other industrialized nation! They either have universal healthcare, a single payer system, nationalized healthcare, or a hybrid of the three. The US is failing in every key health measure compared to our industrialized peers. We should be following the data that is available to us that is screaming “adopt one of those three models.” In the free market, when you try year after year to compete but you rank at the BOTTOM of your industry, what do you do? You either join them (usually via merger or take over), go out of business (in the case of the US health system, people die), or you change your strategy and learn from best practices of the top organizations and hope that your organization will come around. In the case of healthcare reform, the top organizations are our allied nations who all agree that healthcare is a right.

    In addition to moving to one of these three models, the US needs an overhaul in our nutritional education. Heart disease is the #1 cause of death in the US. The majority of causes of heart disease is environmental, specifically diet. Our education/health systems should be promoting more whole plant-based foods and less animal protein. If anyone even wants to argue this read The China Study by Dr. Campbell of Cornell. If we are serious about cutting costs we must change diet behavior in the US.

    Lastly, the lack of a universal system results in gaps in patient data/information. There are an estimated 100,00 to 400,000 deaths each year in the US due to medical errors!! The fact that we can’t even narrow down this statistic to less than a 300,000 margin is an embarrassment. Oh and by the way our government won’t dare add medical errors to the list of leading causes of death because even at the lower end it would put it in the top 5!!!

    I look forward to America coming together and agreeing that healthcare is a right and not something you have to earn through having means to pay. If we could agree with that imagine how much we could accomplish in regards to other matters (national security, debt, the economy, etc.)

    Comment by Christopher Sinclair -

  215. a simple way to understand and obtain health coverage. sounds excellent! similar to your ideas for small business reform. looks like you are building your platform. you know you want it 😉 #2020

    Comment by dennis despo (@dennisdespo) -

  216. You did lay it on the line. Under Obamacare, many people resent paying higher premiums for other people’s anti-selection. A simpler way to handle this would be to set up public reinsurance for excess claims due to pre-existing conditions (although there would be a fight on what qualifies). I actually tweeted that idea to “real Donald Trump”. It does appear that Trump wants to cover the “wrong place wrong time” issue (Connor Goldern in Central Park) at 100%. How we deal with risk-sharing (and with risks that other people create ) is a central moral problem in a liberal democracy.

    Comment by jboushka -

  217. Initial thoughts. It’s fair to say that if you’re a millennial and you think you are going to receive SSI without reform, you’re not being realistic. Why not treat it like we do unemployment insurance? Companies pay for catastrophic insurance and in return employees aren’t guaranteed maintenance health insurance so to speak. Or, perhaps offer a lower wage with maintenance insurance and a higher wage without it. My point is I’d rather partially privatize your good idea.

    Comment by mrlsrq -

  218. Mr. Cuban,

    Free market is not likely to work for healthcare in the same way that free market national defense or free market education or transportation systems lead to aberrations. There needs to be another stakeholder that is the state. It is in the State’s balance sheet that the benefits of healthcare for all are revealed. The overall benefits of a successful healthcare policy on happiness, productivity and competitivity do not come to light unless something above the consumer, HC provider and Insurance companies, an arbiter of some sort have a say. Thank you Mark, I am a fan.

    Reza Taghavi
    Saint Paul, MN

    Comment by Sina Taghavi -

  219. This is attractive on paper, but the details are really hard. To begin with, what qualifies as catastrophic care? Is it a chronic condition like diabetes or HIV that’s managed through expensive medicine? Is it a potentially fatal illness where treatment is impossible out of pocket for all but the wealthy, like cancer? Presumably, it also includes things like broken legs and torn ligaments, which require expensive surgery.

    Now, the issue is what DOESN’T get covered. For young people, it’s probably trips to the dentist; even for young professionals with really good healthcare, the annual checkup isn’t exactly a priority. I’m in my late 20s with an advanced degree, a six figure salary and very good health insurance, but I haven’t been to a primary care doctor in more than half a decade, just because I’ve told myself I didn’t have the time. So we can assume young people, overwhelmingly, aren’t going to be getting anything supplemental if their catastrophic risks are covered by the government, unless the employer-sponsored healthcare system stays in effect.

    That has the side effect of removing the most profitable consumers from insurers’ risk pools. Without young, healthy people in their risk pool, insurers lose their most profitable cohort. That, in turn, leaves people with a reason to use insurance products. That’ll be older people who are more conscious of the health risks they face, people who already struggle with chronic conditions, etc. And insurers have to price those populations profitably. The result is that the costs of care for all but catastrophic conditions is going to skyrocket. Given the adverse selection problem that’s likely to occur with remaining care, I’m skeptical that insurers are going to fill in the gaps when those that purchase such care will likely be the most expensive patients with high risks, so premiums and deductibles will have to skyrocket accordingly.

    With very few people able to afford that coverage, you end up with a healthcare system even more tilted toward fixing emergencies as they come up rather than managing our health, which not only makes our health worse, but also costs more, because “heroic” care like surgery costs a whole lot more than regular checkups to make sure that our health is proceeding on a decent track. It’s like the difference between doing tune ups on your car and changing the oil regularly vs. waiting for your car to crash and then doing repairs– the former is significantly cheaper than the latter.

    Atul Gawande has a terrific piece about it in a recent New Yorker that I encourage you to read.

    So, while it’s certainly great to offer catastrophic insurance to people so we don’t go into medical bankruptcy, it’s equally crucial to not just subsidize but encourage incremental care, and universal catastrophic insurance, through various avenues, does the opposite.

    My view is we need to incentivize people to get incremental care– to go to their checkups, visit the dentist, manage their health indicators, etc. The most effective way to do that might be a direct cash transfer– we pay people to go to their annual checkup, or we subsidize their gym membership (the latter is less effective than the former, I’m afraid…). The payments could actually cut costs because we’ll manage people’s health rather than reacting to emergencies.

    That’s my off the cuff thought…

    Comment by Alex Imas -

  220. I am glad that Mark Cuban is leading a non-politician’s discussion of healthcare. He is building his platform for political office in the same exuberant, yet pragmatic way that he made the Dallas Mavericks a championship team–first by rallying the community around his efforts. Judging from the way he has both taken on and cooperated with the NBA, I personally think he would make an excellent leader.

    Healthcare is a complex issue with many contentious players and a lot of money in the pot. This makes any solution or “deal” difficult to obtain. As soon as two players at the table are content, a third one is likely to turn over the table and walk away. Doctors, hospitals and health plans all demand to be paid at the rate of inflation…that means premiums will go up for consumers–employers and independent purchasers of insurance. The notion that the free market will solve this is so risible that it does not merit a rebuttal. If “the invisible hand” of market forces could regulate health care, why did health insurance start and evolve?

    Mark’s core idea is solid and will eventually prevail–all people need to be covered. Since catastrophic healthcare is both most expensive and statistically occurs less frequently, it could easily be put on a one-payer line. The Federal Government already makes special funds available to the public in case of natural disaster via FEMA. Why not extend this principle to catastrophic health events?

    Regarding the garden variety healthcare issues most of us face, such as flu, respiratory infections, rashes, etc. the “doctor on call” programs certain health plans now feature (including OSCAR in NY) work really well. If you have a bad sinus headache, do you really need to make an appointment to see an MD? You’re better off talking to a doctor on the phone, relating your symptoms and getting the treatment you need. I’ve found that a doctor’s office does not enhance the value of health care. It’s usually a waste of time and health dollars.

    These are my suggestions based on MC’s suggestions. I hope they are useful.

    Comment by Eric Sonnenschein -

  221. I freely admit I am no expert; I am only a 67 year old guy that has been self-employed for the past 25 years and has independently bought insurance for my family for 22/23 of those years. Over that time, I would guess that I paid close to $250,000 in insurance premiums, deductibles and uncovered costs for a family of 4, none of which ever had a serious ailment or spent a night in a hospital.

    If we all could put aside the ideological arguments for the free enterprise system or socialism and simply look around the world at systems that work, in terms of health care outcomes and costs, and model the basis of a system off of them. In 2013, first available data I found, the U. S. spent 17.1% of GDP on healthcare, the other 12 or 13 advanced western democracies spent between 9% and 12%, roughly. Also, most of those countries have better health outcomes. We simply don’t get nearly the bang for the buck that they do.

    The notion of the free market system is not truly applicable to health care. The laws of supply and demand do not apply in the traditional sense. At the risk of being a master of the obvious, who supplies health care and who consumes/demands it? Obviously, doctors, hospitals, pharma companies, labs, etc. are the suppliers and while people are the consumers they don’t generally directly pay the suppliers; the government or private insurance companies do and they are the only entities that can exert price pressure on suppliers. Except in rare instances, the public can’t shop in the traditional sense for health care. One can shop for insurance, but in most cases not actual health services. Given this framework, the free market notion of allowing insurance companies to issue insurance across state lines will drive health care costs down is simply not realistic. It might exert a little pressure on insurance companies’ profit margins but that’s it. Assume you live in a town that has 3 or 4 hospitals and say 10 insurance companies that each cover a comparable number of people. One of the insurance companies decides at some point that it is going to take an activist role and drive down health care costs so they decrease the amount that they will reimburse hospitals and doctors for certain services. What do you think is going to happen? In all likelihood the hospitals and doctors will simply refuse to take patients that are covered by that insurance company. Don’t believe it, just call a few doctors offices or hospitals and ask for a list of insurance companies they accept and those they do not.

    We need to take a hard look around the world at systems that work for less money. If it’s a single payer system fine, have the standards of the system set at the federal level and have the insurance companies administer it based on competitive bids. The framework of that system could be developed through a process that is driven by the input, cooperation and compromise of the stake holders. If it means less money being paid to some of the providers, maybe something can be done as an offset, e,g. free tuition to med school, etc,.

    Comment by Michael Matusewicz -

  222. Mark as I read this it is very close to MEDICARE. To me, it would be what Democrats say when they talk about Medicare for All option in ACA. Whether Senior Citizens realize it or not, they pay for Medicare. It is deducted from their social security checks. In 2017, the amount is $134 per month but it is means tested. So if a senior couple makes more than ablout 160K, they pay $268 per month. Now, if they make more than somewhere around $250K, the monthly premium woud jump again probably about $400 a month. This is known as IRMA adjustments. Now – Medicare only covers 80 percent of your costs. You can buy Medicare supplemental insurance from PRIVATE insurers. Mine comes from United Healthcare. Their are at least 6 options of coverage you want. I chose the Level F to take me to 100%. That costs about $195 per month for a Florida resident for that 20% gap. Some senior cover the gap at 85%, 90% of the gap for a lower monthly premium. I bring up the premiums because the $134 base rate for Seniors for the 80% coverage may be an entitlement and under market. Seniors are NOT complaining about Medicare and most have this public/private combination. Insurers are not pulling out of supplemental market and it is very competitive so we know they are making money.

    Yes this could be done across the board. At one point, I was opposed to it. I spend the last `15 years of my career with Medco Health (nationwide drug coverage) and EmblemHealth (regional Health plan). With ACA, companies had to spend 80% of premiums collected on health care which seems reasonable. As we watch companies like Aetna, United Health etc pull out of ACA, I look to their companwide medical loss ratio, Yes, they may be losing money on the ACA plan but their medical Loss ratio’s are 81-83%. Now even if they pull out of ACA – they still have to maintain a medical loss ratio of no lower than 80%. So why are they doing this for an extra 2% ? In my view, if you want to walk from the market then it’s fine for the GOVT to compete with you. Generally, I like private enterprise versus GOVT but if they walk away so be it.

    Comment by Mr. A (@Sa0100pp) -

  223. The chronic issues are the difficult ones, because not all chronic issues are the same. Some are genetic, some by chance, but some are also caused by the way people care for (or don’t care for) themselves. The figures provided in an above comment are interesting in that chronic health problems represent the majority of the health costs. I can see people getting very worked up about pitching their hard-earned money towards a system in which chronic health issues caused by those who don’t take care of themselves are covered. That is exactly what happens in a private insurance company (although people do choose to pay into the insurance instead of doing so from a mandate), but when government gets involved the political arguments make things messy. The idea for life threatening illnesses to be covered is great and I love the fact that you take into account mental health (I live in Sacramento and work downtown and we are definitely in need of greater support for mental health programs). I think that the chronic illness category is where it will get into a definition war, for which I can’t offer a good solution. Instead, perhaps coverage is based on benchmarks. For example, if you have diabetes and need insulin, you will be able to get the insulin based on lifestyle choices, for example steps per day, which we are able to now track due to the increasing presence of wearable technology. (Trust me I know there are flaws with this idea, like just giving your track star kid your fitbit during practice, but incorporating these types of technology into care could be a positive step).
    I like the idea of a single payer system for those basics, and then greater coverage would be available on a personal choice basis through private companies. I feel there has to be some sort of price regulator though. An outstanding example of the need for one is Shkreli raising the price of medication to astronomical figures. That is free enterprise, but it can have disastrous effects on those who rely on medication. It is difficult from a moral perspective to apply the laws of the free market to a person’s health, as the free market can be ruthless. Leaving healthcare to the free market also can result in further socioeconomic divide as those who have can get by, and those who have not are more greatly affected by the high costs of health care. I don’t know what the regulators should be, as regulations are also fodder for political arguments. Perhaps instead of focusing on insurance coverage, the government should instead invest in issuing generic versions of the most commonly used and prescribed drugs as a means of providing a control price from which private companies could not deviate too far for fear of being replaced by the generic government brand. Instead of a public option for insurance, it would be a public option for the medicine, which constitutes a large portion of medical costs.
    Great work putting this to public forum for people to hash out in a respectful way. When people attempt to come up with their own solutions they often move away from the divisive ideologies that are inherent in a two party system and start to see the difficulties there are in coming up with a solution that satisfactorily covers a diverse and massive population with a wide variety of needs.

    Comment by Brett Fraser (@BrettFraser) -

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  225. The cheapest full(ish) coverage system in the world is the NHS in the UK which has no market element at all but that is funded mostly from income tax. But as a start Mr Cuban this looks like a very good way to go and super simple.

    Comment by Zachary Newman (@zac6x9) -

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  227. Mark, before you talk about solutions, it’s really important to get buy-in on your implied philosophy, which (I think) is: “No matter what, we as a community should enable everyone to have access to acute and expensive chronic care – period.” Stating this as a foundation for your solution is important. There are going to be people who just philosophically disagree with the premise that everyone deserves access to expensive care. But I think a majority will agree with it, and then the discussion can be about exploring the best ways to pay for EVERYONE receiving access to that care.

    Also, think about whether this should be done at the federal level. I would say it’s worth considering throwing the healthcare problem back to the states and providing states the flexibility to try different things from single payer for everything to a freewheeling consumer-driven system, taking employers out of the healthcare business. I still believe we have a lot to learn if we encourage states to try experiment.

    Comment by LionAndSuits (@LionAndSuits) -

  228. Hi Mark,
    There is one think constant in this world and that is greed. While I agree with you in the sense that there are no guarantees that opening a bidding war for customers will work by nature it does work. However, the bigger problem I see is that medical professionals have been spoiled for years. Moreover, what I am referring to is that they for the most part do not compete. They have a group of people who are in desperate need at the time and the last thing people think about is the cost.
    For instance, I went on line the other day to check on the price of a hip replacement since I am familiar with this service as I have be cut on 4 times and am looking forward to servicing the joint eventually since it has been more than ten years since a replacement joint. As I looked at the listed prices it was apparent that there is no real rule for pricing and it varied from $3000 to $177000. However, if I go to Europe I can get a total package price including lodging and post therapy.
    American Doctors and other medical professions have by some fluke created a bubble except where Medicaid and Medicare are involved. Conversely, if I were to damage my car and go to and auto-body shop I could very easily get an estimate and shop for many more. This would also be followed by an insurance adjuster’s quote by which the body shop would have to abide. Some might consider this price fixing and it is in a sense. However, its like the Wild West when we come to medical bills and insurance.
    I really don’t know if Congress is up to this challenge since it is so complex.
    There are numerous problems to overcome but here are a few thing that might help.
    1. Insurance bundling. If we allow clients and Insurance companies to bundle together more than one type of insurance it spreads the risk. And if we can determine the risk versus cost we can determine pricing and profit.
    2. Self-insured. As a former business owner I bought workman’s comp. for my employees and it was priced by so many cents on the dollar. However, in Washington State if there was an excess of funds collected you could receive a rebate. By pooling together resources in large groups this is also possible.
    3. Cost of Collection. Obviously as we are not practitioners we don’t know the percentage of loss each year. However, I suspect it is quite high and probably 30-50% of income. Moreover, perhaps this is why medical cost are so high. If we can reduce this or eliminate it than maybe a cost reduction could be achieved. Moreover, if prompt payment was received it might reduce it further. In a perfect scenario payment would be receive within 24 hrs. Maybe we can make if we make our medical card to work as a Debit card and the billing is paid according to pre-approved pricing.
    4. Liability insurance for Doctors. This also increases cost because it is passed on to the patient.
    While there is no easy fix or solution you are right everyone deserves the security of insurance protection.
    Jim Davis

    Comment by James M. Davis -

  229. An important change in describing the concept is to move away from single-payer and refer to it as universal rating, or single pool, which more accurately reflects what is going on here. ‘Paying’ is an administrative function (i.e. rather meaningless to us) whereas how risk is rated, and shared, is everything. The value-add of insurance companies over the decades has been to determine how much higher to charge people who are sick, and then how to build networks that exclude them. We should be smart enough to recognize that a million disparate risk pools adds no value to health care, nor to the economy, and that as a society a system of universal rating brings enormous gains, just as you are hypothesizing. There are political issues that comes with the employment disruption caused as we sunset health insurance industry, but that is the medicine we need to take (pun intended.) Gradually, the economy replaces the obsolete function of health insurance with something that is more value-added.

    Comment by Doug McGuire -

  230. How about Obama making your home affordable. My home was a non performer morgan stanley and saxon stole from Me and God my 2 young kids. A woman I loved that left me and her 4 kids . no interest not underwater.
    60 k down lived there ten years did not miss a payment. cashed in two 401ks to fight the machine and they even robbed my home while I was on vacation. Saxon approached me said miss two payments they will save me $70 a month so OK WHY NOT. When the neighbor with the nicest house on the block and the most wonderful happy kids is watching his life broken and raped and pillaged on his own land. Think dont Judge Wrongful foreclosure is an epidemic worse than aids cancer or dementia all deemed not worthy of services or Obama care. Banks calculate the same in $$$$$$$$ My mortgage was set to adjust had no value. Banks prey on underwater homes and others like myself. 60k down 2007 another 60k added for curb appeal by 2010 and an addition to help My friend and her girls who were homeless from an abusive spouse. 15k Saxon not my mortgage company but it was sold to them, They bought Jet skis or had a party and i have an email saying they F___kED up morgan stanley shut em down over 12k of my money never got applied or was accounted for by them. Informed of this as they wells fargo fannie mae and unknowns, sold my mortgage 3 time in less than three years and changed my deed and as they were trying to fix their mistake adding 30 k or erroneous made up fees to try and sweep their mess under the paper trail that is nothing short of the work of Satan,, Their mess not mine as a mortgage company foreclosed that was not even servicing my mortgage..
    Obama never cared and seems the only one that does is Me. They may know me but they have no idea who I am. I was set free Mark 16;15 Acts 20;24 Made homeless and ridiculed. The #1 Entrepreneur in iowa as a high school freshman and #2 in nation as a sophmore. Professional motocross racer business owner GM in the corporate world and a life coach and trainer for more than one Global conglomerate. I have a story and I have a Plan to help the youth and families and veterans and all souls lost or otherwise. With the power of dreams and Honda in one hours time i teach people to fly and get through the shit in theirs and others lives and to tell the truth and take care of their things. 584 bc Persians taught their children from 2 to 22 to ride a horse shoot a bow and tell the absolute truth. Wake up America..
    pay attention and pray for your neighbors and families and friends.. Im ok broke but back racing running my race with endurance. Set free to go do good deeds and be childlike and help others that cant help themselves. Collidal silver buy a $30 bottle Go play in the dirt get away from their chemtrails and tell Obama care you found a Cure all. Pa retired at 49 no longer a slave but a voice calling out in the desert. John 1;1-50 take note of 50 we all have a choice make your own heaven or let hell be your reality. Obama cares not they decide who lives and who dies. Thank you Mark God bless you he led me here right now. Two lefts do not make a right but three do.

    Comment by sheppardofthefield -

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  232. One of the problems that is tantamount to anything working would be transparent pricing. We practice the used car lot method these days.

    Before getting a price, they wanna know your income, how you are paying, when you are paying, what your deductible is, are they accepting your companies insurance and a whole host of other BS.

    Most people would be pleasantly surprised if they knew the true cost of what they were buying up front. Most services that most people need are very affordable if you just pay at the point of purchase. Same thing with RX’s. The list price they tell you is not the real price if you have the right BIN# and are paying cash. I find most prescriptions that I fill, I can get for less than the $20-35.00 copay most people pay for most drugs at the pharmacy.

    The health care system is a fraud and until that problem is addressed, there is no fix in sight. They will just keep changing which red cup they are hiding the ball under. Its a now win game with tweaks.

    Cancer treatment is the biggest scam. 95% of the initial research is paid for with grants from the Government (TAXES – the government doesnt make its own money), what isnt paid for by govt grants is paid for by family foundations, charitable foundations and rich dudes like Mark.

    Then they come up with a treatment. If you need the treatment however, its gonna cost you 100-300K per year to get it and they blame the cost of research and we buy it. IT’S A SCAM. They can afford to pay their ceo’s 10,20, 50mm and more.

    If you live in an area that is close to any pharma company, drive by one day. Drive thru the parking lot.

    You wont find a car older than 2-3 years old – none of the cars are american made – and the majority will be brand new mercedes, BMW’s and Lexus’s. And Im not talking about the executive lot. That is reserved for the limo’s.

    The US isnt even in the top 10 worldwide as far as Health Care systems.

    Mylan is being hailed as a hero for coming out with a generic epi-pen for half its $600.00 cost or $300.00. There is about $1.00 worth of active ingredient in an injection and the CEO (A Senator’s daughter) gets paid 40mm a year.

    Next time you have to fill a script, go to a site like, see what the real cost is and then see the variance in prices just in a 10 mile radius.

    Call your pharmacy and ask for a price on something and see if you can even get an answer other than a list price. Call your Doctor’s office and ask how much a check up would be if you were paying at the point of purchase and not using insurance – you will be shocked at the answers.

    I had to go for blood tests recently. They started by quoting me list price which was $750.00, $100.00 copay and Insurance covers the rest. I’ll cut to the chase. I negotiated and said I wasnt going to use Insurance. I had to have my Dr verify I wasnt using insurance and that the list price was unaffordable and I had to negotiate with the labs office but at the end of the day, I was able to pay $163.00 which is just about $10.00 more than I paid before Obamacare, when I went to out an out of network lab and didnt use insurance.

    The Dr (who pre Obamacare) billed my Insurance $200.00 for a visit and got $20.00 from me and $65.00 from insurance company 90-180 days later, charges me $75.00 with no Insurance and payment at point of purchase.

    $163.00 and $75.00 is affordable for even a high school kid with a part time job.

    The health care industry in the US has been very good at keeping us all in the dark on what things really cost, and what they really make. Shine some light there Mark and I think you could find some much better solutions.

    Costs me more in maintenance on my car per year than it does in healthcare real costs and my insurance for that is 2K per year with a $1000.00 deductible. Why cant healthcare follow a similar model? Same with my Homeowners Insurance. I dont make a claim when my house needs to be painted, but I am gonna call if the roof blows off. That only costs about 2K a year as well and I have the same 1K deductible there as I do on my car.

    One last point. WHile everyone is worrying about who is going to pay for their flu bills everyone overlooks that health insurance doesnt cover long term care if you get older. Once they bleed you dry and you loose everything you ever worked for your whole life, they give you medicare and stick you in an institution. There has been little to know discussion about that. Most people would like to age in their home and that is very expensive and not covered at all by basic healthcare insurance. You have to buy something called Long Term Care Insurance for that and that is thousands per month on top of health care premiums.

    Comment by DW Events (@DW_EVENTS) -

  233. My husband and I had this discussion and he said the same thing. But single payer was a dirty word in my mind until we continued talking and ended up essentially agreeing with you. Once I embraced that, I think there’s one more step. In much the same way as simplifying the tax code eliminates or significantly reduces the IRS, simplifying paying for healthcare should eliminate insurance companies. They’re too big, it will never happen, but they’re the big, huge, obesely fat middle man. Could it be done without the government filling the void of greed? Probably not, but fun to think about.

    Comment by Marlene Moss -

  234. I think one of the additional stakeholders should be anyone who pays income tax since the current program and likely the new program will be subsidized by governmental money. Those people do fit into one of the other roles as well but have a greater stake since they have 2 roles in this mix.

    Currently many health insurance companies and agents are receiving less profits now. In my state BlueCross alone has lost millions since the launch of the individual mandate. As a result in my state and other states health insurance companies have been forced to cut commissions all the way to ZERO in an attempt to cut the flow of cash in the form of losses. I know you are a pretty charitable guy and I would like to think I am too, but I don’t work for free. I will for charitable organizations but not for work.

    Glass houses brother. It is not fair to classify all insurance companies and health care providers into a bucket of unwillingness to do what they can to cut costs. I don’t know if any have made an “announcement” of this sort, but I am pretty sure we will see a similar number in any profession. I agree with what I believe your sentiment is that companies should be more willing to compromise to make this work.

    One of the things that must have some weight in this equations is that we do make choices in our lives that do have great bearing on our likeliness to become ill or have injury. These are extreme examples but they are to just make the point. A person who eats nothing but organic food and exercises moderately will statically have much better health and much lower medical expenses that a person who eats junk food only and never exerts themselves at all. A person working as a crab fisherman on the Bering Sea is much more likely to have injury than an office worker. Obviously we can’t rate each of these specially to their health makeup and class of work but there should be some degree of deviation with those who choose more dangerous professions and having poor health habits paying more than the office work and very healthy. It should have some degree of averaging though otherwise the unhealthy and those with dangerous occupations could not afford health coverage and would fall upon the support of the government, which then falls upon the tax payers.

    The “catastrophe” events are not the issue. Our epidemic of obesity, love affair with junk and fast food, overuse of medication, drug additions, overuse of alcohol, distracted driving, and run away medical costs are the problems.

    One option that I believe could help would be if insurance companies were allowed to offer more limited coverage policies again. Insurance companies use to be allowed to offer polices that would cover a little more than just the items you listed in your governmental plan: Coverage for being admitted to the hospital and tests and medications while admitted in the hospital.

    To a prospect, once I explained the difference, coverage, and premium savings many of my customers would choose this options. The commonalities in this class of people were that they were younger than 50 and healthy. This could provide additional premium dollars into the insurance pools while not significantly increasing medical costs.

    I don’t know that I want to trust our government with another program or not. However, your proof of concept could be tested in the relationship between Medicare and supplement policies sold now by private insurance companies. This is a similar relationship to what you describe in your plan. You could poll consumers, health insurance companies, and health care providers to see how this is working.

    Beaux Pilgrim
    Reed Insurance
    Vidalia, LA

    Comment by Beaux Pilgrim -

  235. I am a fan of Trump for the markets but this is the first post I have read that actually made me take a second and think. I agreed with the majority of what you said only because I couldn’t come up a rebuttal that made enough sense to refute your facts. I am thankful that I read your post.

    Sent from my iPhone


    Comment by -

  236. The problem I have is that the government has failed to show me any reason to trust them to manage our money, let alone our health. We pay and pay and then we are told how we are being given something for nothing … and how we are getting entitlements. Enough of that though. Simply put, your idea is interesting but the government needs to be out of the solution. And charity is a choice. It is nice to think that everyone who is really sick should get millions and millions of dollars of care … but that is charity … Americans are extremely charitable … we just need a place to donate money that supports these extremely sick folks!

    Comment by Frank Gilbert (@PFGilbert) -

  237. Some minimum level of coverage for catastrophic injury and chronic physical/mental illness is certainly needed, but I can’t agree that implementation would be either universal or immediate. Some entity, public or private, would have to rate and qualify patients for care.

    If it’s the government, then all you have to do is look at the VA’s handling of disability claims to know that it simply wouldn’t be able to handle such significant volume. Military members and veterans make up less than 1% of the US population, and I think it’s fair to assume that they have a documented medical history that is better than that of the average American. Nevertheless, the VA has taken upwards of 2-3 years just to qualify veterans for medical care, if not longer.

    If it’s private entities, then there’s an aversion to avoiding cost and responsibility. Deserving patients will undoubtedly slip through the cracks. Along with that, what is the severity of an injury/ailment needed to qualify for care? How will pre-existing conditions be evaluated?

    That being said, I think we should start by asking “who can fix the problem?” rather than “how can we fix the problem?”. Until that’s addressed, we have disinterested parties in charge and will continue treading water. I happen to think that if any sector should take on the challenge of fixing our extremely broken system, it’s public and private universities. They receive public funds, government subsidies in the form of student loans, and massive endowments. They’re entrenched in medical education and research, and SHOULD have an interest in serving every level of society without making profit a priority.

    As an entrepreneur with no coverage, I struggle with the fear of injury or illness every day. For now, I’ll just have to suck it up and hope I can stay healthy.

    Comment by CITYZEN Spa & Sento (@CITYZENSENTO) -

  238. Pingback: Mark Cuban fires his opening salvo at attempting to fix Obamacare - UK News

  239. Before we look for solutions, it’s probably better to start at the problem. Do healthcare providers actually know how much is really costs to treat a disease or perform an operation? Everyone will know the basic direct costs, but what about the enormous overhead that needs to be included. And it should cover individual procedures not aggregate medical groupings. The data exists, it just needs to be used properly. Don’t get me wrong, I’m not looking to drive costs down to the cheapest provider – I’m not calling 1-800-DoctorB (The B stands for bargain) for my heart surgery. But knowing the fundamental costs can lead to a transparent discussion on insurance coverage and premiums.

    Comment by Lea Patterson (@PilbaraGroupLea) -

  240. This is a good idea, but doesn’t benefit the insurance companies. Insurance being a game of risk, companies are willing to take risks and institute policies that will minimize their costs. This proposal, if I understand it well, is calling for transfer of premium not expended by insurance companies to IRS. And if the company covers certain cost for care, it gets reimbursed by IRS. Brilliant. It keeps more money in government coffers, but drains accounts of companies in insurance market.

    The proposal creates window for State insurance where companies can offer coverage for primary care services not covered by the general insurance for chronic illnesses. The question is not only if insurance companies will accept this proposal, but how does it affect premium for primary care which is more recurring than chronic illnesses?

    Obamacare has more advantages for both insurance companies and customers than the proposed plan as well as the GOP plan. Fix the individual mandate, work on leveraging premium, ensure companies cover employees through market place, and promote competition by permitting cross-state coverage.

    Thank you for opening this discussion, Mark.

    Comment by varleesannor -

  241. As a digital strategist for a health insurance company, I can echo that patients with chronic conditions, especially those with multiple chronic conditions, are the super utilizers of health insurance. Here are some stats:
    – 5% of the population accounts for 49% of expenses.
    – Patients with multiple chronic conditions cost up to 7x as much as patients with only 1 chronic condition.
    – The 5 most expensive chronic health conditions are heart disease, cancer, trauma, mental disorders, and pulmonary disorders.
    – The top 5% spends about $11,500 on average for health care. The lower 50% spends about $660.
    – The lower 50% of spenders account for 3% of the total national health care dollar.

    Here are stats that makes it challenging to manage the costs for those with chronic conditions. Of those individuals who rank in the top 1% of spenders, only 25% maintain that ranking to the next year. Of those in the top 5%, only 34% remained in the top 5% over the next year. Of the top 10%, 42% maintained their rankings.

    So the turnover among the costliest of spenders is high, unfortunately due to mortality. As we become better at protecting this class, then those costs will remain in that pool. In addition, those stats show that new members are added every year. This is not a static problem with easy maintenance. It is a behavioral problem with multiple inputs and causes.

    As others have pointed out, it is preventive actions that help keep down chronic costs. Flare-ups associated with chronic conditions must be avoided, and those with multiple chronic conditions must be watched more closely. Machine learning is making great strides in this area, but it is still in the data gathering stage as opposed to the exponential growth phase. And we haven’t quite conquered the best methods for new habit formations.

    Mark, you might be interested in the groups exploring Health 3.0. It’s my dream to work at a company making strides in this area.

    Comment by Jeff Carroll (@jefftcarroll) -

  242. Pingback: Mark Cuban fires his opening salvo at attempting to fix Obamacare | MEDIAVOR

  243. Well thought out.

    My biggest concern is that past domestic and foreign examples of government management of healthcare will show lacking care compared to private enterprise. It’s the profit motive that drives r&d, care availability and care standards… not law.

    We are at a new cross roads in western civilization with a new set of problems. The bigger question… that is really hard to answer… is.. “Since healthcare is plentiful does that make it a guaranteed right”? We know that people live in all sort of houses… I suspect mine is different in quality and shape than yours… and unfortunately some of the worst of the worst in housing is ran by or subsidized by who… government!

    So to further your lottery logic and if we did what you suggest… we just changed lottery games. The new rule is if you are born in America (or immigrate… another topic), that means you hit the “I live in the right place at the right time” lottery. Okay for Mark and Steve but what about a little girl I know in Uganda who won’t make it to 20 if she doesn’t get an operation on her leg… and soon.

    In my humble opinion… the biggest culprit in the equation is insurance to begin with. When you insulate the consumer for the cost of goods and services and create a pool to cover costs for all as they come up… then pricing for said good and services inevitably gets out of whack to the value the bring to the market.

    I know… I know… we shouldn’t talk about markets, competition, free enterprise and supply and demande when we are talking about health or life and death… but should we. If we don’t address it WILL BE the downfall of quality care availability for anyone (except those who can afford to go around the system and a very, very high level).

    The second issue staring us in the face is that essentially, in the past, anyone could walk into any emergency room and get care for a life threatening injury without insurance. There are localized tax system, payment plans and debt write-offs already in place that cover that. When the government decided to try take over such a large part of the economy and sell the people down the river who were already making an effort to cover their own healthcare insurance so the “millions” of uninsured could have theirs too… we all got screwed.

    Unfortunately it is very, very hard to get toothpaste back in the tube. But we should try.

    Comment by Steve Pruitt -

  244. Intresting post thats relevant:

    Comment by Oblaatt (@oblaatt) -

  245. Here is a radical idea…
    -Move to a Socialized Health Care
    -Clean up our food and drugs (wholesale revamping of the FDA & USDA). Remove all special interest influence. This will help keep health care cost down.
    -Do away with health insurance companies except for vanity items.
    -This would be funded by heaver taxes on Tobacco, a Sugar tax, alcohol tax, and tax on other unhealthy items.
    -Higher tax on people who insist on living an unhealthy life style.
    -Use Social Security to fill in the gap and lock it down from any other purpose other than health care and it’s original purpose.
    -Insist that Doctors work on curing patients rather than maintaining their illnesses. (European medicine is light years ahead of us in this department).

    Comment by ibcarson -

  246. The more you take Government out of it and leave it to the free market the better it is….does not really hold up for one simple word….greed (some call it profit). The Stakeholders and others have had it their way for a long time and it has never been right. Whether they cut people off for chronic conditions or preexisting ones etc to save their bottom line, the fact remains they will all go for the all mighty dollar just as fact is the young ones are feel invincible ruins the law of averages. So there must be a balance. You are probably headed in the right direction more so than anyone else.

    You also have greater issues at hand. What folks in one area perceive or value is largely different from other areas. When it comes to a single payer system, you can ask folks in some provinces in Canada and they will tell you it sucks others say it is amazing. Depends where they live, what access they have to hospitals, doctors etc. Same would apply here, a person in rural Montana might not be as happy with their options as someone in NYC. Again, it just means you have to find a balance. Bravo on you for generating discussion.

    Comment by AZHockeyNut (@AZHockeyNut) -

  247. One point I think you are missing is the inefficiency and increased costs caused by the regulations and the massive staffs the hospitals and insurance companies have had to add to handle Obamacare implementation? I would like to see the overhead number added in the last 10 – 15 years to treat a patient. The biggest question I have: Insurance companies pulling out of exchanges because they cannot make any money, Dr.’s hate the new world because they do not have time to see and treat patients, and the patient believes they are spending way to much money. So since no one happy, are we actually in equilibrium?

    Comment by Cliff Mccrary (@cliffmccrary) -

  248. It’s a complex problem, so it won’t have a simple solution. If you accept the premise that health care is a basic human right and societal (and therefore government) obligation, then at least there is the basis to move forward.

    Obama crafted the ACA in such a way as to cover a lot of bases. The bases he did not, and could not cover had to do with the insurance companies, which are regulated on a state level, not a federal one.

    Rising health care costs- let’s look into this deeper. Three main areas- insurance, providers and pharma.

    There are certainly examples of pharma costs being much higher than they should be and we’re seeing more and more of them publicized. I’ll leave it at that, instead of writing a thesis on the subject.

    What about the insurance companies, who seem to be profiting? Pull out of a state when their earnings sag, but may improve over time when more individuals have access to early intervention and treatment? How about the health care providers themselves? They have stated rates charged for services, but negotiate rates with each insurance company, another rate for Medicare, yet the private pay individual without insurance cannot negotiate.

    Does the whole for-profit health care insurance approach make sense, and should states permit them to back out of being a provider of ACA coverage, while still offering group and individual coverage in that state? If you put essentially universal coverage into play, does it still make sense for insurance companies to rely on old actuarial tables that do not charge a premium difference between a family of 3 and a family of 6?

    I believe this is a very complex problem. My opinion is that the ACA was a good start and needs fine tuning, with the tuning not being in the areas covered under ACA, but the tangential ones that have led to higher and higher health care costs.

    Comment by I want my $252 (@I_want_my_252) -

  249. Healthcare is not a free market, by definition. There is essentially no elasticity of demand, if you need a healthcare service in order to survive you will pay the highest amount that you are able. In many cases there are no substitutes or alternatives, the consumer is not able to compare products and services or shop around. Consumers are rarely in a position to make an informed decision and rely on the medical providers advice. it is nearly impossible to understand the cost of service before the services are rendered. Also, the barriers to entry are quite high, not low. You’ve highlighted the problem well, the profit incentive of the insurers and healthcare providers is to charge the highest amount that the market will sustain, which is high given the lack of elasticity in demand, and the provide the least amount of service. However, the consumers, many voters, and our consciences tell us that the objective is to maximize the services provided. We have to ask our selves, do we value our healthcare enough to temper the profit incentive in healthcare. What risk does this pose to retaining talented doctors and our innovation?

    At the very least we should decouple health insurance from employment. If it were my choice, I would never purchase the healthcare plan that my employer chooses. However, its not cost effective to purchase one on my own without being part of a larger risk pool.

    Comment by Zomb Infosec (@Zomb_Infosec) -

  250. This makes perfect sense because we ALREADY provide 100% coverage for emergency care. Hospitals and doctors do not let someone die on their doorstep: they stabilize and treat them regardless of ability to pay. Even if someone has no healthcare, no savings, and no income: the gunshot/brain bleed/appendicitis/etc. will be treated and the patient will be stabilized.

    The doctors, nurses, and vendors need to be paid somehow for their services, however, so hospital billing becomes extremely complicated and complex. People with insurance, or who have large savings, pay more than what their actual personal care cost to coverage other uncollectible bills so the hospital can stay in business.

    Unless doctors & hospitals will be allowed/forced to let people die on their ER doorstep, we already have universal catastrophic coverage.

    Your proposal would just clean up the financing mechanisms so there is less wastage in billing, negotiations, risk, and uncertainty.

    People could still purchase buy-up plans to cover nice-to-have options, schedules, tools, etc.

    Comment by jjsimoniv -

  251. Why not offer all Citizens what Congress and the Hill Staff have then everyone is treated equally. Then costs would be taken care off, as Congress sees the REAL costs.

    Comment by Geoff Daly -

  252. Mark, I like your ideas. I’ve always felt the over-complicated infrastructure of the insurance companies is the bottleneck. The money saved by streamlining could maintain reasonable profitability and make them heroes as the agents of change. How many people stay in jobs they hate just for the health benefits? Think of the innovation such transparency and simplicity could foster. Every citizen should have access to wellness programs from birth, which might help mitigate the onset of preventable diseases that are costly to manage. Another idea is begin a medical savings plan with payroll contributions that will eventually phase out Medicaid / Medicare and fund medical care for all. It will take time and people will hate it, but we need to start somewhere to make the changes, stop the bickering and focus on what really matters…

    Comment by Patricia M Keiran -

  253. I wish I had time to thoroughly meet Marks challenge of finding holes but here’s a few observations.

    Stakeholders should include lawyers and politicians. Many reports I’ve read show that doctors and hospitals are doing more tests , blood works and x-rays so as to prevent ending in an expensive mal-practice suit because of something overlooked. A patients care cost are related to the physicians expenses so maybe tort reform for more states. I don’t know if tort reform has helped keep costs down, i am making observations.

    I exericse , don’t drink, don’t smoke, have no history of heart problems in the family. I have no problems with saying not to challenges of staying healthy.I do not fly private planes or skydive for fun. I, as a male will never need pre-emptive care designated for females and I’m past the prime of wanting to bear children. I may get hit with a bullet or a satellite falling out of the sky but I should be able to purchase health insurance as i do home insurance. If I live in a flood plane, I should expect to pay more or be denied flood insurance. If I’m obese and consume 2 big gulps per weekend of carbonated sodas. I never exercise and smoke as many packs of cigarettes a day as I can, then i should pay higher for premiums or even be denied for some types of insurance. The insurance companies may not volunteer to take less profits but they should be allowed to customize a plan that I could use afford.

    Pharm companies and medical supply companies, to name two in the industry, are big contributors to politicians. Trump or no Trump, you should admire the fact that in the primary he took no funds from big companies that could influence his future aspirations. Heck no one thought he could win anyway. If politicians were forbidden to take political contributions from companies of influence, drugs, oil, guns, then maybe they would vote more on principle and not whats good for their pocket.

    I have to say that I enjoy this blog from Mark more than trying to force one opinion down my throat.

    congrats on DIRK 30K and thanks for keeping him in Dallas

    Comment by stevenjmckimmey -

  254. This is actually something that can work. I’m not any body important so take this however you may like. But this plan is doable and it can actually be full health care for all and cover even the minor needs, like colds, flu, ear infections, whatever we need when we have to make an office visit with a doctor. I have thought and thought and thought about it over and over again, done some research and it seems rather easy and it really can work. Adjustments of course, but that’s how anything worth while starts out. I love that your willing to bring it up. You are right though, its not so popular with some but “those” some will end up needing something at some point so why not face the facts that none of us are exempt no matter how healthy we live our lives….I would love to find out more about this.

    Comment by Lindsey Ann -

  255. Preventative care is the key and your plan doesn’t cover that – – so by not getting preventative care, people end up with chronic conditions which could have been prevented. There is a wealth of information from other industrial countries about what works and what doesn’t work. Why not use their ‘research’ and design a program that covers everyone, cradle to grave, as part of services like clean water and clean air.

    Comment by Figment (@Figment_Imagine) -

  256. Most overweight and obese people (over 60% of the country) are sugar-addicted, so I agree with a sugar tax as a way to pay for a single payer basic medical plan for everyone. Let the insurance companies offer cadillac plans and find their niches, but up until now they’ve been parasites on our medical system. Also, most family/internist MDs don’t know much about nutrition that determines most chronic diseases…so they’re basically worthless other than handing out pain pills and statin drugs, etc. that only put a band-aid on the problem. There are some “out of the box” MDs (like Mark Hyman, MD at the Cleveland Clinic) that teach people how to change their eating habits to feel a lot better and not burden the health care system. The REAL answers are out there (and working)…the only problem is getting the lobbyists who buy off the politicians out of the way.

    Comment by TJ Oliver (@TimOliver13) -

  257. With this statement “This will be single payer (yes i know its a dirty phrase in this country) for chronic physical or mental illness and for any life threatening injury.” who decides what a chronic physical or mental illness or life threatening injury is? Is the insurance company, the doctor or the gov’t?

    Comment by Pat Mickelson (@arizmick) -

  258. As a Canadian, If a politician were to even suggest turning our care system to the American model their career would be instantly over…single payer benefits the most and cost significantly less.

    Comment by Oblaatt (@oblaatt) -

  259. I say what we need to do is make sure that the CEOs of these healthcare and insurances orgs get the maximum bonuses known to man. These are the people who’ll donate to the GOP cause in the mid-terms and in the next general election. Also, more important than helping the citizens of the US; more important than “America First”, we need to ensure it tarnishes Obama’s legacy. Improved health? Protection for medicaid? Lower costs for the elderly? None of it matters to them. You scratch my back, I’ll scratch yours.

    Comment by stevencsite -

  260. I agree; however you’re now advocating for single payer nationalized healthcare. It’s a phenomenal product with terrible brand equity. Do you know anyone with strength in marketing brands? 🙂

    To add to the opportunity around your proposal, what I think is under explored are the opportunities that this creates for innovation. In some regards, nationalized health service makes health service a commodity item. Which is a good thing – it’s something that is commoditized to an extent that it’s affordable (NOT just accessible) to all.

    Similarly, the argument to olpening up state lines to competition only drives innovation in the product. Each provider tries to provide a “slightly better product” at a price that the market will bear. The simplistic argument is that opening up competition will drive price down. But either it doesn’t really (price fixing) or it does, and then you’ve made it a commoditized product anyway (just like if you nationalized it in the first place).

    Either way you cut it, now that you can’t differentiate your product, you have to differentiate on the service associated with the product. And once the service is commoditized, you have to differentiate on the experience you offer. This idea of the experience economy (Joseph Pine) isn’t new, and it’s the engine of disruption. It’s the difference between watching a Maverick’s game or a game of pick-up.

    So let’s drive commoditization of the affordability of healthcare, as a forcing function for providers and insurance companies to think about how they can differentiate the services they’re delivering. That’s when American Healthcare moves from medieval to modern. That’s where the innovations in digital health occur, and where insurance companies and service providers start acquiring startups and upstarts. That’s where we begin to fuel innovations in predictive and preventative healthcare.

    Commoditize healthcare so it’s a citizen right there for us all when we need it, and move the flow of dollars into innovation the service and experience economies around health. Good luck driving the dialogue!

    Steven – Sport. Practice. Perfected.

    Comment by Steven Webster -

  261. m, thanks for trying to fix these things the gentiles have created.. how silly of them to try to rule this earth. – p p.s. what’s your thing against the d? stop bring so blatantly jealous. u know they can use more helpers, not talkers

    Comment by lbomaster -

  262. I’m a benefits consultant and what you propose makes much more sense than the Republican proposal. The ACA is unsustainable so something MUST change. I believe we continue to pile dysfunction on top of dysfunction. We also need to address internal reforms in terms of prices, discounts, and how internal billing and accounting functions.

    Comment by Timothy Shrout -

  263. Finally someone has unemotionally justified single payer! THANKS MARK! The is really only ONE insurance pool – all residents of the USA – anything smaller is creating an artificial set of winners and losers. Anyone who thinks they are low-risk are one heartbeat away from moving into a high risk pool. Having single payer eliminates the massive duplication of systems and staff used by each insurance company to do the same thing – process claims.

    Comment by steve w (@thebigwoj) -

  264. Can you be specific about what would be under the insurance company’s purview? Would that include all preventative care (cancer screenings, checkups, etc)? If so, that’s a problem. People won’t spend the money on an insurance policy solely for preventative care (“I’m 20 and invincible!”) and so it will drive costs up for the government because they’ll take in sicker people and more expensive people to treat. I’m 100% behind single payer, but I don’t think you can split it up. Also, where does dental and vision fall into your framework? Again, if that’s under the Insurance Company, the poor will choose to spend that money on food and rent instead.

    Comment by Jessica Dreher -

  265. Wouldn’t it be even simpler if our government simply allowed insurance companies to sell plans that offer catastrophic coverage only? These plans would be extremely inexpensive and affordable for just about any American who prioritized correctly.

    This option, combined with a freer market where I could buy insurance from an insurer in any state would create the competition that would force insurance companies to tighten their margins.

    Would it solve the entire problem? Not even close. But I do believe that the above would be a more effective version of what you outlined above.

    Beyond that, it is absolutely imperative that we drive down the cost of healthcare. One thing that would help right off the bat would be easing the regulations on the medicines and prescription drugs that we pay way more for than most countries.

    In short, we need the government to get out of the way and stop protecting the profits of insurance and drug companies. Once this logical step is taken, we can work out the rest.

    Comment by Raymond Esses -

  266. Moving to single payer for catastrophic coverage would be more efficient, and Medicaid provides the cheapest catastrophic coverage, so you’re of to a good start there. Then, there should be Health savings Accounts, which would be partially subsidized for the poor. That would make for a better, cheaper system than we have currently.

    Or, we can try to duplicate the Singapore system, which would be more free market oriented.

    I would personally prefer that all drugs be legalized, with each currently requiring prescriptions no longer requiring them. Make all drugs OTC, and watch prices fall. Notice that OTC drug prices fall over time.

    There’s no reason to have two people counting pills and filling bottles at pharmacies. The drugs could come prepackaged, as aspirin does.

    For those who want to help control addicts’ access to certain drugs, there could be limits placed on purchase after official diagnosis of addiction by a physician, with system-wide electronic records tracking purchases. I personally prefer no such program, despite having just lost my mother to a prescription drug overdose in January. It was lack of insurance coverage of Suboxone, an expensive maintenance drug for opiate addiction rust killed her.

    Comment by Mike Sandifer -

  267. Having ‘enjoyed’ the NHS in the UK, I can say the proposal sounds mighty similar – but it has failed the consumer in the UK in many way. The NHS started with that mandate, but has been expanded and expanded – a danger of being government run of course.

    While true critical emergency care is good, it has been eliminated from many towns due to cost – so care is there, but too far away to be effective. As for chronic and genetic – the NHS fails to meet it’s own standards for timely response to cancer (at least in many categories) let alone less serious genetic issues.

    This does not mean it’s the wrong idea, it means – like everything else – the devil is in the detail, and more importantly the execution.

    As a consumer in the US (a major city), I find access to the right expertise plentiful BUT the cost structure developed because of the burden of the insurance companies in the process is ridiculous. Face prices which are 20X or more the ‘contracted rate’ and direct pay customers paying less than that sometimes when declared as uninsured shows the problems. Insurance companies tendency to bounce legitimate claims and a billing system which is totally opaque to the end customer is a huge problem.

    Billing should be standardized AND made entirely transparent to the consumer – so they can say “I did not receive that service”. ALL plans should have sufficient deductible to get the consumer’s attention – possibly proportional to earnings in some fashion – so the consumer HAS to pay attention in the selection, service quality and billing of their service provider would be a good start.

    I am told business insurance premiums for providers are still very high. Limiting damage awards would help reduce that cost, which in turn could bring some specialist services prices back to earth.

    As noted elsewhere in this thread obesity related illness, as well as smoking historically, accounts for major costs to the system. The system should be allowed to penalize patients who routinely exacerbate their condition, or who flagrantly ignore service providers recommendations.

    Bottom line, I believe the friction and profit between service providers and insurers is where the opportunity lies to fix an otherwise strong care system.

    Comment by Wag Jaw -

  268. Part of the concept is everybody participates and the law of averages applies (younger/healthier offset older/high risk). The problem as you pointed out is that the young are invincible and aren’t participating so the curve has been wrecked.

    1. Entice the young to participate with a low cost major medical plan that can be offered by any insurance company anywhere (cross state lines cut the regulatory crap) driving competition between the insurance companies to attract the coveted low risk market segment. Drive participation to improve the averages.

    2. Multi-Generational coverage. Reduce the dependency on Medicaid/care by allowing families that obtain health coverage through their employers s to add their aging parents as dependents (at a reasonable additional cost). More options to cover higher risk segments by leveraging multiple generations to offset the risk. I married couple in their 40’s with 3 young children add grandma and grandpa as dependents and evaluate the risk/cost benefit of the entire family.

    3. Reward innovation in healthcare and reduce regulations. Two stitches shouldn’t cost $1000 or more, review regulation to create an opportunity diversify access to care…. Think a franchise of stitch by the inch $200 per stitch… Certified and trained to know what they can stitch up and what requires more advanced care beyond their capability and allowed operational parameters. I believe there are many services that could be provided along these lines reducing costs and improving efficiency at critical at trauma and emergency centers.

    Just a few off the cuff ideas.

    Comment by Joe Chambers (@joechamb) -

  269. I like this idea. On thought, though. It seems like the taxpayer might save money in the long run if we also pay for preventative care, so that problems like diabetes are stopped before they start, and certain types of cancer are caught early, and so on. To avoid paying for these things at the start seems like a false economy in the end. Maybe I’m wrong?

    Comment by fpsulli3 -

  270. My biggest concern for this is that anything managed nationally gets mismanaged and spirals out of control. With that in mind, total costs by taxpayers will likely go up as opposed to go down based on private marketplaces. If that is taken care of somehow, then this plan is solid.

    Comment by Joe Putnam (@JosephPutnam) -

  271. I like your idea. It’s better than the current Obamacare and definitely better than the alternative just put out by the Republicans. You are right that it’s just fact that a lot of people will face serious health issues at some point in their lives so everyone needs to be covered and your suggestion does that in a way that’s fair as everyone pays. I do still think that in the long run the U.S. is going to have to do what most other developed countries do and have universal coverage paid for by a tax on everyone…..something like Medicare for everyone. That other dreaded single payer.

    Comment by quirt (@quirt27) -

  272. This is a good start to the discussion. I am conservative, and will research more about how your potential plan would operate.

    Comment by Greg Scoggins (@coachsuperg) -

  273. Sounds great in broad strokes Mark, but like anything, I’m sure some paperwork would be needed. Is there any possibility that what you propose could really be implemented? If anyone ever had the business acumen to make it happen, it certainly would be you.

    Comment by Scott Lyons -

  274. I wrote about two different ways we might reform the US healthcare system, and to some degree, our points converge. Perhaps my perspective will help with your thoughts on this:

    Comment by Pragmatic Pol (@ThePragmaticPol) -

  275. in my view, government has a responsibility to provide the basics for its citizens to have a foundation. It’s crazy that we don’t do this in one of the most important areas of life: health!

    As far as costs, ground floor single-payer would put way more money into the pockets of the middle-class. Insurance companies make a fortune off of severe illness, catastrophic injury, etc. That’s no big secret. If government covered these costs via a small payroll tax, insurance costs will plummet due to the lack of necessity. The result is at worst a break-even cost, with everyone being insured.

    I hope you run in 2020, Mark.

    Comment by smstedman3 -

  276. Catastrophic care can be very expensive and your idea would allow for less expensive insurance for all lesser ailments. You will have to split a hair as to when it kicks in and when it ends. Each of which will be determined by who? But, why do we always go all the way around the problems without tackling them. In my very limited knowledge of health care costs there seems to be (2) major contributors to the rising costs – pharmaceutical companies and pharmacy benefits managers. By allowing the government to negotiate drug prices it reduces the cost of one and eliminates the need for the other. Once this is done single payer is probably a zero sum game for the provider, hospital, and patient.

    Comment by Derek Falls -

  277. I am generally in agreement with you. Basic health and preventative care for everyone. The ability to add extra coverage and benefits via private coverage. I would also include, perhaps, leveraging all of the many interns in the medical field to perhaps supply some of the preventative care, which would save money, give them skills and improve the overall health of the population, thereby reducing costs. Then there are also known agents that are damaging to health – i.e. excess sugar in our food stream and smoking products whose effects we all pay for. Some control there would reduce the need for many types of care.

    Finally, on a related issue…. the whole idea of being able to charge ‘what the market will bear’ on major social concerns bugs me. The fact that individuals or corporate entities can buy life saving medicines and gouge the consumer, insurance companies and Uncle Sam by increasing the price by 3000% is essentially legalized loan sharking. There should be a group of products, including medicines, which are regarded as elements so essential to the people’s well being, that there can be some sort of cap on the pricing, perhaps with reasonable exceptions within a fixed range (for modifications, or higher risk or development and testing). The government in it’s turn would need to streamline the approval and testing and oversight of those products. Perhaps consumers would also have to accept some limitation on the maximum amount of damages that could be awarded, on an approved product in these categories assuming no neglect or deception was involved in bringing the product to market.

    Comment by The Mismatched Man (@burtabreu) -

  278. Three words can describe the solution—–Medicare for everyone. Not medicare Advantag e plans either because they bring the insurance companies back into the game too extensively. Currently , Medicare with a plan F supplement is as good of coverage as the average person will ever meed and it’s all set up in advance. I’ve been in the health insurance field for 27 years and this is the only real solution.

    Comment by Larry Mickelson -

  279. Mark, the IRS cannot get our taxes right in the hundreds of thousands of pages of tax code they are responsible for enforcing. You want to throw mandatory healthcare on their plate. You of all people, as an entrepreneur should realize that there is not a single government agency that is run efficiently. This suggestion just increases the likelihood of mismanagement, lack of oversight and fiscal disaster. I believe that whatever solution we arrive at needs to have the least involvement of the federal government.

    Comment by Bob Stamper (@robertrstamper3) -

  280. Some potential pitfalls I see is what you are suggesting is Obamacare but just for chronic conditions and therefore you will have many of the same problems you have now. Insurance costs will increase, insurance companies won’t want to participate and will pull out just like they are with Obamacare. And now politicians and insurance companies are going to argue with what a chronic condition is.

    Though to be honest, I don’t have a better solution.

    Comment by Matt Butler -

  281. I’m not a fan of insurance, having grown up without it, but do think this is the most logical step for our country to take. At this point, national healthcare is a thing, and I doubt we’ll ever be able to repeal it. Even if that weren’t the case, every American will require medical care for something catastrophic at some point or another, and the system is going to bear that burden in one way or another. So why not centralize it and offer catastrophic coverage nationally? I’m down with that. What I’m not down with and what we can’t afford is to offer medical coverage for everything imaniable. National insurance shouldn’t be an ATM where you get to pay for cough medicine, crutches, etc. etc. Instead, it should be coverage for catastrophic events. If you need go to the doctor for a check-up, that’s on you, and that’s something you can buy private coverage for if you really, really want to. As someone who grew up without health insurance, I can assure you that you can survive without it and in a lot of ways it’s much more efficient and effective. You have to consider a medical expense before choosing it, and you aren’t as wasteful when it comes to medical care. No, you won’t be able to go to the doctor for “free” every time you have a sniffle, but under Mr. Cuban’s plan, you will be covered if you have a heart attack or need your leg reconstructed after falling off a motorcycle, i.e. what inurance is meant to be used for. Since the question will likley come up about how we’re going to pay for this, let’s answer that right now. The easiest way to pay for this is to cut unnecessary spending across the board. If the Federal government cut waste in other areas, we could cut taxes to the point where we pay less in taxes while still covering people for catastrophic events. If we can push this through along with tax reductions in other areas, I for one can get behind this model for national healthcare.

    Comment by Joe Putnam (@JosephPutnam) -

  282. Sounds good on the surface, but as always, the devil is in the details.
    1. Under this model, would services like OP psychology be covered?
    2. How would physical therapy prescribed by a doctor be covered?
    3. How would chiropractic treatment be covered?
    There’s a lot to like about your proposal, Mark. But the entities that make gobs of money under the current system will shut this down because they line the wallets of our elected legislators. Until Congress passes comprehensive campaign reform legislation (including overturning Citizens v. United), no legislation this logical and fair will pass the crooked Congress.

    Comment by Robert Lehrer (@RobertLehrer) -

  283. Mark- pre-ACA I had the silver package of Blue Cross/Blue Shield that my company offers. I had reasonable expenses (dr appts $50 co-pay, prescription drug, etc). Premuims on this job was 3.3 % of my salary (I’ve worked 3 jobs since 2005) on that job. Now I’m required to pay 9.9 %, have a $6k deductible or I pay a penalty. Which is catastrophic insurance I used to have in college. I’m paying the penalty and using the difference as an unofficial MSA.

    Comment by Pierce Hanson (@racingdeltaarea) -

  284. Your plan makes perfect logical sense, Mark. I wish more wealthy people saw things your way.

    As with most things in life, formulating a valid plan and the execution of said plan are two highly different things. I’m not sure our current politicians can get along well enough to put the system you described into place. I sure hope it happens sooner rather than later though.

    Comment by FinanceSuperhero -

  285. Mark,
    As a small business owner, and head of household, my biggest grievance with Obamacare was the absurd policies. There are 3 tiers, low, middle and high. I always went with the most expensive policies thinking I would receive the best coverage. This turned out to be false. It was already annoying that I was forced to use the market place because I was a single employee. Even so, my premium was $1200/n and I literally had no coverage. Everything visit needed a referral, and most doctors had a problem accepting that specific united healthcare plan. One doctor told me it was because the high tier plans and the low tier plans had the worst coverage. He advised I go with a mid tier plan. So I looked at those. Those plans have a much lower monthly premium, but the deductible is insane. 6k-12k deductible PER family member? I’ll never come close to reaching that rate, which means I am essentially paying for everything out of pocket – so why pay the monthly premium at all.

    When I started hiring employees I was able to get normal medical plans again. My premiums haven’t changed, but now everything is maically covered.

    I don’t really understand why there would be a difference. Paying $1200/m with United healthcare through the market place is somehow different than paying $1200/m through united healthcare outside of the mrketplace – and it shouldn’t be.

    The program would be a success in my mind if all policy policies were created equal (respective to their premium price). In other words, you should get what you pay for.

    Comment by Vinny Troia -

  286. Your plan is a great start, but obviously insurance companies are going to fight hard. I work for a specialized laboratory which is considered an out-of-network provider for virtually every insurance company. A couple of monster labs (LabCorp and Qwest) have worked contracts out to be the only in-network providers, shutting out all other competition. Since we have no contract, the insurance companies are killing us with denials an reduced payments. We have little to no recourse, other than to ask our patients to appeal on their own. The insurance companies don’t care. These in-network contracts are killing smaller providers, and killing competition.

    If we can’t get a single-payer system for the main care, then we should at least get rid of networking providers, so that all insured have access to whatever care they require, wherever they are. This would help those traveling, and those in more isolated parts of our country. And smaller providers would have a chance to provide help where it is needed, as well as competition in the marketplace. Many of us are dedicated, caring providers that are being systematically eliminated from providing our services.

    The insurance companies are the real pigs of our current system. The initial ACA didn’t do enough to control them.

    Comment by Susan Caya Thompson -

  287. Honestly, I agree, no one is willing to take less. How would a “new program” impact the compensation of physicians? Would we as a country be able to handle it or meet the demand?

    Comment by Varun Bajaj (@DholBoy) -

  288. I absolutely agree that single payer is the way to go. An additional way for insurance companies to profit more from a single payer option is to have insurance company CEO’s get paid less.

    Comment by chilltowntv -

  289. This is basically the European system, with the subtraction of preventative care. They pay a much higher tax rate but don’t have to ever worry about getting ill, or losing their job because of illness. As a result, they go to doctors more often and avoid having the “oh shit” moments that we often have when we avoid care because of restrictive costs.

    I like where you are going with the let’s say “oh shit” tax to cover emergencies but, and here is the rub. INSURANCE IS A SCAM. It is the very reason costs are high. If there wasn’t insurance, just basic medical costs without inflation, prices would be reasonable for care.
    Asprin doesn’t cost 28.00 per pill. The same way a hammer doesn’t cost the Pentagon 5000.00 but that’s what’s charged. Why is that acceptable? Why and how have we allowed this to happen. We have to return prices to a rational reasonable place. Sure brain surgery should cost about the price of a car but not a Lambo.

    You nailed it when you asked who wants to take less, no one does, however when it comes to people’s lives capitalism needs to take a back seat to humanitarianism. Med school should be free. PERIOD. That would be the start of the healthcare revolution. Doctors should be treated like politicians who get free everything. If Doctors and hospitals got a flat 75% tax break and had no loans and didn’t have pay 100 ‘ s of thousands in malpractice. .brother the USA would be the healthiest country on earth.

    Comment by driftworks -

  290. It has appeal. Your suggestion would shift the battle to how do we define which ailments are significantly dire to warrant be covered by the government. Once those criteria are established, who (or what agency) makes the determination on a case-by-case basis which ailments presented meet the criteria for government coverage and which don’t. Inevitably, there will be citizens without private coverage who’s ailment will fall just short of one that is covered by the government. Those cases will get huge coverage in the media, placing strong political pressure on government actors to expand coverage over time. Also, what is ailment X isn’t sufficiently dire to be covered by the government in, say, 2017. So the citizen who suffers from ailment X doesn’t get treated (because he has no private insurance) and the ailment gets worse over time and eventually becomes sufficiently dire that government coverage is warranted – but now it’s going to cost the government way more money to treat the ailment than it would have had the government stepped in a covered it back in 2017, etc. Just some thoughts. Thanks for posting.

    Comment by Brian Baugh -

  291. Unfortunately the doctors that want to make more money won’t say the medical issue is a “chronic physical or mental illness”. They would get paid more from the insurance company than the government.

    Comment by John Mattingly (@mattyjam559) -

  292. Your logic does have one important flaw in it, which is there are actually classes of people who have lower risks… the Christian “Health Sharing” companies are proof of that. I don’t drink, smoke, etc. and am not overweight… my “premium” is only $640 a month for a family of 7, with $500 deductibles. Pre-existing conditions, however, are not covered. This is not a Christian thing, it’s a “healthy lifestyle” thing. A commenter above suggested lower premiums for the more healthy–that’s effectively what the health share companies are already offering.

    Comment by Rich Harshaw -

  293. I’m so with you and the rest of the industrialized world. I want us to be healthy. I want everyone to be healthy. Done.

    Comment by Paul MacFarlane -

  294. I’d like to see healthcare work in a similar fashion to social security where there’s a safety net but it’s not expected to be the sole source of income or in this case, healthcare. Not a perfect solution obviously because of unforeseen diseases and exorbitant costs. In general I think we as citizens need to consume healthcare more responsibly. Instead of going to the ER with an ear ache, make an appointment with PCP, etc.

    Comment by David Kaplan (@Kappy94) -

  295. Taxes are inherently regressive. 5% increase for the wealthy “hurts” less than a 5% increase in taxes to someone making 20K per year.

    Also, the odds of your two risks (injury or illness) are not equal for all. Lifestyle choices, neighborhoods, etc. all change those odds.

    Comment by M. Anderson -

  296. The biggest hurdle to reform is pre-existing conditions (and chronic ones as you have stated); you are right, at the end of the day, it is going to HAVE to be the government to handle those… the only alternative is that those folks are chronically uninsurable. My confidence level that such a program would be manged properly is close to zero, but I think your idea is solid–and i’m about as conservative as they come.

    Comment by Rich Harshaw -

  297. as always , good advice, from the sharp eyed-big-hearted Maverick!!

    Comment by Ambra Moore -

  298. I like the idea. Two thoughts… in terms of the health care providers, the US spends much more per capita than our peer group countries. I think that’s because we are now so inefficient so streamlining medical treatment could reduce costs…… You would have to make preexisting conditions subject to the single payer system.

    Comment by bob baer (@bobbaer) -

  299. Pingback: Trumpcare

  300. The largest cost to our healthcare system is on diseases related to obesity. An obvious solution is a tax on high sugar products to pay for the single payer system you suggest.

    Comment by Joe Hopkins -

  301. I appreciate the out of the box thinking and straightforward approach this presents. I’m on board.

    Comment by Joey Meyer -

  302. Vested interests aside, what’s to stop the USA taking up the Australian model.

    1% levy on everyone, up to 2-3% for high income earners (Levy Surcharge) which funds public hospitals (which fall under state or Fed purview).

    Some idiosyncrasies with how the private and public systems (and incentivisation) interact in Australia (and perverse tax incentives/subsidies to take up private insurance) but the basic idea of Australian Medicare is rock solid.

    Disc: I am an Oz citizen.

    Comment by Tim Marsh -

  303. This will be an exciting discussion, thanks for your passion….Take care Cuban!

    Comment by masudosman -

  304. I hate to say this, but I agree with what you have said. The only way costs will come down is to make it a true free market place.

    Comment by Square Sharp (@kirksports) -

  305. If nothing else, your idea is simpler.

    Comment by Jerry Stevens -

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