Public health care

[Storebought]

I've been thinking about what a public health system that didn't rely on any kind of nationalized health insurance, paid for by some new payroll tax, would look like.

Suppose, instead of some nationalized health care, we have locally-funded emergency care only, in which we treat ambulance service and the emergency wards of hospitals like a local public service, such as a police or fire department.

All of the residents living within the closest approach to an emergency wing would pay property and/or sales tax for the upkeep of the day-to-day costs of catastrophic health care; the going rates can be obtained from local insurance policies (which, necessarily, will no longer offer catastrophic coverage)

For nonresident consumers of emergency services, the patient will be charged the hospital's sales tax on his bill.

I will be the first to admit that this is, well, still half-baked. But I wanted to start a debate on this topic that didn't fall into the typical "single-payer" sloganeering that has poisoned the older threads.

[Storebought]

The problem is that different places would have different levels of funding. Long Island has some very poor school districts right next to some very rich school districts. It would make more sense to have the funding not be so local. Also, property and sales taxes are rather regressive.

It is important to note that the primary reason why emergency room visits are so expensive for patients is that they have to treat everyone, even people who can't pay. Obviously a universal health care system would make that system be less crazy.

In my own plan, I insist on sales and property taxes because even transients pay them, unlike income tax. Since accidents are statistically speaking just as likely to strike them as lifelong residents, it doesn't seem quite fair that residents pay all of the hospital operating costs for emergency care though local income tax.

Yes, hospital emergency wings are required by federal law to admit patients regardless of their ability to pay. And for truly indigent ... well, society already pays for them, badly, today. I am pretty convinced that we will never recover payment from them under any plan. They are a permanent loss.

I wanted my plan to reduce some of the overhead (and then some) that the hospital charges for the patients that can pay, whether insured or not.

[Storebought]

Not a good idea, especially if it doesnt allow for competing private sector. As any other state company, it's prone to inneficiency.

That' just it: my *plan* only applies to ambulance service and emergency wings of hospitals -- in other words, public health. In no way does it apply to clinics (which are private institutions) or to long-term care, etc.

But I'd certainly like to hear alternatives that are based around localities/communities.