Establish a Single-Payer Health Plan
This is part of an Economic Security Plan that I proposed during my 1996 campaign for U.S. Senate.

Access to services, choice of provider, individuals' responsibility for caring for themselves, and an equitable distribution of health-care costs based on the ability to pay are the primary concerns of any universal health-care program. The three-part program in the Economic Security Plan meet those concerns.

It recognizes that a healthy population benefits the entire country, and thus funds the government's portion of health care from both the personal and corporate income taxes. It provides for catastrophic and long-term medical coverage, but it also places some of the burden for the cost of intermediate care on the consumer.

The basis of the plan is a focus on preventive medicine, along with patient involvement in the process, including responsibility for keeping costs to a reasonable level. Under this plan, health-care is a matter between the patient and the provider.

1. The individual annual allotment.

At the low end, a basic level of health care would be available to everyone, with the choice of providers solely in the hands of the patient.

The plan, funded through general revenues of the federal budget, would have a basic minimum annual health care allotment, somewhere in the neighborhood of what health maintenance organizations now pay doctors to take care of one patient. One recent estimate placed this at around $2,100 per year. However this number (and the numbers for percentage of income which follow) could float from year to year as the country gets a better handle on the costs or savings of operating under this plan.

This basic coverage would be provided via a coded health ID card similar to a bank debit card, which can be used to pay any health care provider licensed to accept health card payments.

Dental, eyecare, mental health services, and alternative medicine providers would be included. The choice of which types of services, as well as which providers, would be left to the discretion of the patient, based on the patient's perceived need for those services.

This plan would result in the doctor or provider deciding in consultation with the patient, rather than a remote billing clerk with no medical training except a chart of approved practices, which tests or services to perform under the circumstances.

The structure of this plan would address one major problem with open-ended health care plans -- the tendency to view insurance payments as free money, with a ''heck, no skin off my nose, the insurance will cover it'' attitude. Fraud and over-billing runs rampant under such an open-ended system.

The allotment plan would encourage the patient to check the bills for accuracy, and to shop around for the best prices for routine services, in an effort to stretch the allotment as far as possible.

If an individual is healthy, and does not use the full allotment in a given year, unused portions would be rolled over and added to the next year's allotment, thereby extending the time before that second stage, self-payment, kicked in.

2. Self-pay

The inducement for the individual to check bills and price-shop while using the annual health care allotment card is to forestall as long as possible the next stage of this plan, which is the out-of-pocket patient-paid portion.

Once the annual allotment is used up, individuals would be responsible for the entire next level of their medical bills, based on a percentage of their annual income.

(Since this concept is new and untested, the percentage should not be cast in stone. I recommend a starting figure of 10 percent, until we see how effective the cost-containment works.)

The individual would have several options to cover the self-pay portion of this plan. The simplest would be to pay cash, to draw from personal checking or savings accounts or other assets, until the income share has been reached.

Another option might be for an individual private insurance policy to cover this type of situation.

A third option might be through a payroll deduction. By adding a line on the W-4 form, an individual could divert a portion of his pay, up to the annual self-pay share, which would be added to the medical ID allotment card.

As a last resort, the patient could contract with the government to pay the patient's portion after the medical bill is incurred, with a payroll deduction or other plan set up to repay the government loan.

Regardless of how it got paid, once the individual handled the self-pay portion, the third part of the Economic Security Plan, the catastrophic coverage, would kick in.

3. Catastrophic care and long term medical care

Catastrophic coverage, including the medical portion of long-term health care, would be paid by the federal government, from a dedicated Catastrophic Trust Fund funded through a surcharge on all income (personal and corporate). The medical portions of Medicare and Medicaid would fold into this program and disappear as a separate entity.

4. Health-care Conclusions

This proposed national health care system, with allotments, self-pay portions, and catastrophic coverage, would make some level of basic health care available to everyone, encourage prevention programs such as immunizations, and early intervention, while limiting the financial risk to both the individual and health care provider.

Cost-shifting and cut-rate payments to providers by insurance companies would become a thing of the past.

This plan would eliminate the need for regulations about insurance portability, pre-existing conditions, deductibility of health care premiums and costs, coverage for family members or significant others, and a myriad of other details which now take up the time, energy, and attention of a lot of people.

It would also return personal responsibility to the health care scene, rewarding preventive medical care and good health, as well as vigilance toward the details in billings.