The debate goes forth on the so alled healthcare reform, but are the politician talking about healthcare. Health is usually thought of  as the state of well being. This state of well being is is specific to each individual and their perceptions of their general health.  Thus, a person is the custodian of their health. They are allowed to make decision that will affect their health both in the short term and long term. This ability to make a decision that affects one's body  has been upheld by the Supreme Court in Roe versus Wade where it was found that a woman has a right to her own body. Regardless of how one feels about that court opinion, it is relevant in the healthcare debate. Because of the right to one's own body,  it has caused a proliferation of other issues such as living will, right to refuse care, hospice among them. This right to one's own body allows the individual to engage in high health risk behavior. The behaviors range from using tobacco, overeating, poor eating habits, extreme sports, sky diving and others. Because those individuals receive the benefit or exhileration from that particular activity, the person should  burden the cost of a poor outcome. The taxpayer should not have to bear the brunt of  the smoker's lung cancer or emphysema. Why should society pay for the long term care of paraplegic of a motorcycle accident? 

If it is healthcare that is to reformed than aim at curtailing behaviors that jeoporizes well being, but government really wants insurance reform. Insurance reform is easily done as long as there is no self interest. Self interest will get in the way every time. If a politician can grant insurance to everyone , wouldn't he do so in order to get elected. Medicare and Medicaid receipients have never been willing to give up any benefits. When GM and Chrysler were having their financial difficulties and asked the unions to give up some of their health insurance benefits, their answer helped seal the fate of those companies.

To reform health insurance it should be done uniformly. First eliminate the requirement for large companies to provide health benefits. These corporation buy plans at discount while the general public gets to pay a higher cost. The employees  are lucky if they get to pick between a few different plans. Most employer plans require a significant premium and/or a high deductible. If everyone had to shop for plans as an individual they would be likely to buy a plan that met their needs. With a large number of people by individual plans than group plans the cost to that individual would be less. People are capable of shopping for auto insurance, home insurance, and life insurance why should health insurance be any different.

Once a person buys their preferred insurance, the next step is to eliminate the third party paying system. This is when the insurance company pays the doctor or hospital directly. The patient should pay the healthcare provider directly. Then the patient can submit the invoice to the insurer. This allows the doctor to charge what he thinks is a fair price. The patient can decide if the got a fair value. If not they can find another provider thereby allowing market to determine pay for performance rather than the insurance industry or the government. As a provider lose clients, his practice will change the way it delivers medical care. When the patient submits the invoice to the insurer and recieves reimbursement that is less than the original cost, the individual may decide to either change insurance or perhaps change their social behavior to less the likelihood of developing health problems.

Despite those changes, there will be individuals who are chronically ill and require medications to treat their ailments. Medications can take a substantial bite into one's budget. The doctor in order to increase compliance will prescibe a once a day medication. However if that medicen cost  five dollars a pill will the patient be more compliant. The person may be more likely to take a pill three times a day if it costs a nickel. But those discussions are rarely brought up in the doctor's office. Since most drugs for chronic illness are not abuseable, allow them to be sold over the counter. The doctor can make suggestion regarding which medication to take for hypertension or diabetes. The patient can then go to the pharmacy and compare costs and side effects with the pharmacist and buy the medication that they feel comfortable with using. Why should a patient go see the doctor for a prescription if the disease process is stable? The sales of a majority of prescriptions over the counter will change the dynamics of overhead and ancillary costs associated with selling medication through prescription.

To say that the uninsure do not get healthcare is a fallacy. There are many free clinics availble with dedicated physicians. Some of the uninsured think that the clinic is beneath them. But even so, the insured have never been turned away from hospitals. This is one of the reasons that hospitals are awash in red ink. The problem is readily solved. Transition the Veterans Administration hospital system into the a general government healthcare system which will accept the unisured, medicaid, and medicare patients. The counter argument would be there are to few of those facilities which are greatly dispersed. The patient can be stabilized at local hospital and then transported. If people find this unpalatable, perhaps it will cause them to find insurance, since it will now be at an affordable rate.

No matter how simple this sounds, self interest will get in the way, the VA will not want to share their healthsystem, medicare and medicaid patients will not want to give up the convience of going to a local facility nor will a politicain take the risk of losing his job for such policies.