With Obamacare about to be replaced, I play around with one idea of what to replace it with. Let's put the doctors back in charge. Let's hinge our whole system on the family doctor.
Keep the system tied to the community, as much as possible -- community-oriented medicine.
When you buy insurance, you buy it through your doctor, from a list of providers he has. Yes, your employer can still contribute, but the choice of providers comes through your doctor, not through the employer.
And, rather than going across state lines more, I wonder about localizing insurance, maybe even having the doctor, or set of doctors, provide their own insurance pools and plans. The advantage of community-based insurance and community-based care is that you become aware of the medical expenses and have an interest in holding them down. But, being concerned about neighbors, you also are concerned about them getting the best medical attention possible. So, you have the whole community working both to keep prices down, and to provide the best care possible.
When it comes time for a specialist, or a surgeon, you select who you want, but the appointment is made through the community doctor, thus placing him in position to advise. And, you could have lists with recommendations from others in the community. (Maybe, I might first want to think more on that idea.)
FDA approvals, for medicines? Run the system through the family doctors. Let the doctors provide patients for the tests. And, let a panel of doctors be the FDA, as far as being the authority that grants or denies the approvals.
Pass laws against any kickbacks. It becomes illegal for a drug company to pay a doctor in any way for considering or voting to approve any new drug. The companies can provide free medicine, but that is a consideration that goes directly to the patient, not to the family doctor.
And, when there are referrals the doctor makes to specialists, the specialists are outlawed from paying the family doctor in any manner.
If you keep the whole system local, you might create a greater sense team, and a greater sense of finding the best medical care for everyone in your community. And, if you put the doctor at the helm, you have the right point person, since he or she is the best expert in the community. So, there is my model. I see it has parts that would need to be fleshed out, but overall, I believe it just might be a wonderful system.