Health Reform

Do we get Health Care "reform" that will:

• Tax you now, provide better health care never?
  
  
• Continue the linkage of health care and your employment, forcing millions of Americans to keep jobs they don't want and not take jobs they do?
  
  
• Force you to purchase a health policy from a private company, a sop to big business (and a likely unconstitutional mandate)?
  
  
• Fail to keep one of the Democrats' promises and indeed result in a worse outcome than if we had done nothing at all about the Health Care mess?

If you like this path, and you live in Massachusetts, vote Democrat on Tuesday.

If you reject this path - Democrat or Republican - then you must not vote Democrat on Tuesday.

Democrats want a public health care option, for good reason.  If we are going to be forced to have health insurance then we should all be in the same pool.  You, I, Congress and The President.  We should all have skin in the same game.  But The Democrats did not assemble a bill that will provide what they claim they want.  Instead they took bribes and put forward a bill that will in fact destroy both public and privately-funded health care.

Republicans believe this is a broken model.  They're right - it is.  But they have not put forward a true market model, as I called for in September, nor do they have any intent of addressing the problem either, as they are being bribed too!

The truth is that this bill before the House and Senate will destroy health care in The United States.  It will force you to spend 25% of your pretax income on "insurance" that will cover less than you get now.  Many will opt to pay the fine instead, which will in turn cause the insolvency of the system, at which point the health care providers and insurers will clamor for bailouts just as the banks did when they made unjustified and unrealistic projections based on fraud and lost their bets.

On January 19th, one state in America will choose the path for health care in this nation.  The choice is, unfortunately, not between a good system and a bad system, but rather between forcing the politicians to scrap a catastrophe, leaving what we have now in place in the meantime, or hurtling toward a full-on collapse of private insurance and the best health care in the world.

A vote for Coakley is a vote for that collapse.

Choose - and vote - wisely.

There are two interesting articles in the WSJ relating to the "Health Reform" bill, one by Karl Rove and the second coming from The Heritage Foundation, a conservative think tank.

Let's first talk about Karl Rove:

Taxes start going up now, Medicare cuts begin after next fall's election, and spending for subsidies commences in five years. The price tag is not the first decade's announced $871 billion cost: It is $2.4 trillion. That's the cost of the tax credits in insurance exchanges, and the additional Medicaid costs the reform generates, over the first 10 years it's fully up and running, according to Congressional Budget Office numbers compiled by Republicans on the Senate Finance Committee.

Take the partisanship out and what you have is the above, basically.  On this Mr. Rove is exactly correct.

The tax increases come now, Medicare cuts come after the next election but in point of fact the spending will come never.

I'll explain after I provide some of the second article:

The purpose of this compulsory contract, coupled with the arbitrary price ratios and controls, is to require many people to buy artificially high-priced policies to subsidize coverage for others as well as an industry saddled with other government costs and regulations. Congress lawfully could enact a general tax to pay for these subsidies or it could create a tax credit for those who buy health insurance, but that would require Congress to "pay for" or budget for the subsidies in a conventional manner. The sponsors of the current bills are attempting, through the personal mandate, to keep the transfers entirely off budget or--through the gimmick of unconstitutional taxes or penalties they dub "shared responsibility payments"--make these transfers appear to be revenue-enhancing.

This "personal responsibility" provision of the legislation, more accurately known as the "individual mandate" because it commands all individuals to enter into a contractual relationship with a private insurance company, takes congressional power and control to a striking new level. Its defenders have struggled to justify the mandate by analogizing it to existing federal laws and court decisions, but their efforts do not withstand serious scrutiny. An individual mandate to enter into a contract with or buy a particular product from a private party, with tax penalties to enforce it, is unprecedented-- not just in scope but in kind--and unconstitutional as a matter of first principles and under any reasonable reading of judicial precedents.

Congress has a responsibility, pursuant to the oath of all Senators and Representatives, to determine the constitutionality of its own actions independently of how the Supreme Court has previously ruled or may rule in the future. But it is very unlikely that the Court would extend current constitutional doctrines, or devise new ones, to uphold this new and unprecedented claim of federal power.

Got that second part?

Good, because here's my prediction.

Congress will somehow manage to put these two bills together and come up with something that both Houses of Congress will pass, and Obama will sign it.

The lawsuits will come immediately thereafter.

They will succeed, because there is simply no justification anywhere in The Constitution, nor can one be manufactured, to force someone under pain of federal fine and/or imprisonment to purchase something from a private party simply as a consequence of being alive.

This is so blatantly unconstitutional that nobody in The House or Senate can seriously expect it to stand.  Therefore, we must conclude that it is not intended to stand - both House and Senate fully expect that mandate to be struck.

When, not if, it is you will discover the what I have said all along is the truth purpose of this so-called "reform" - a single-payer system.

Here's how it will happen.

1. Congress will pass and Obama will sign something containing this "individual mandate."
   
   
2. This will generate immediate lawsuits which will begin their way through the system, headed for the United States Supreme Court.  That process will take several years.  Note that the so-called "benefits" of this reform will also take several years to show up.  This is not an accident.
   
   
3. Meanwhile, the taxes begin immediately.  This is exactly what happened in the 1930s by the way - taxes were raised right into the maw of an economic recession, and helped turn it into a Depression.  Such it will be this time as well.
   
   
4. Young, healthy people will pay the "fines" under protest and refuse to buy coverage (it's cheaper than complying with a $15,000/year mandate to pay the $750/year fine!) and join said lawsuits in Step #2.  This will in turn begin to force private companies out of the system (remember, there are also price controls in there!) as adverse selection will not be eliminated as promised.
   
   
5. At some point the courts will strike the individual mandate.  Free to not pay the fine or buy insurance and prevented from raising rates adverse selection will collapse the remaining private health insurers.

At this point you have:

1. Permanently higher taxes (since it is constitutional to tax!)
   
   
2. NO private health insurers left in the market.
   
   
3. The "standards and practices" remaining and impossible to remove (note the super-majority requirements in the bill - intentionally put there to prevent the removal of those standards and practices!)

What comes next?  Unable to impose mandatory individual payments to private companies The Government will then have "no choice" but to put in place a Canadian-style system.

For good or bad, you will get both rationing and a tax-funded medical system in The United States.  Private override insurance may remain available and you may be able to continue to buy health care for cash, but neither is assured - neither can be done (for the most part) in Canada, as just one example.

I do not believe this outcome will be an accident - indeed, I believe it is the intention of the Obama Administration and The Democrats all along.

Those who are ascribing some sort of partisan "liberalism" motive - that is, a desire to take over 20% of the economy - are wrong.  The real desire is to collapse health care spending to around 9-10% of GDP.

Since neither party is willing to have an honest debate and discussion with Americans relating to the amount of care we can afford to provide people, including but not limited to care as we age, for those who are unable to pay for it on their own, and since both parties have been co-opted by the medical device and pharmaceutical industry who have clamored for "more and more" of GDP (while delivering relatively small incremental "benefits" in the form of extending life, albeit at a questionable level of quality), this is what we're going to get.

Mark this Ticker and come back to it in three or five years - I'd make a fairly large wager that this is exactly what we will not only get but what is the true intent behind this "bill."

Do we live in a Constitutional Republic any longer?

The 16th Amendment made lawful the income tax - that is, a direct tax on Americans.

But nowhere in The Constitution is the power found to force people, under penalty of law (including fines and imprisonment), to pay private parties for services they do not desire to purchase.

Yet that is in the bill passed last night.

Yes, we have Congressfolk - both men and women, and all Democrats (save one Republican) who voted for this.

This sure appears to be blatantly unconstitutional - and, I would argue, those who voted for the bill know it.

If you watched CSPAN yesterday you heard the speeches.  All those who rose in favor of the bill talked not about The Constitution and how this bill was a solution to the problems facing America's Health Care System - a system that consumes some 17% of our GDP - but rather it appealed to how individuals with specific circumstances would be helped.

But a desire to help someone is not the test for legislation.  All legislation by definition is designed to help someone.  The test is whether whatever is being proposed comports with the black-letter requirements of The Constitution, and the even-blacker-letter requirements of the laws of mathematics. 

This bill meets neither essential test of all legislation; it instead proposes to destroy our Constitutional system of government.

Yet despite member after member rising last evening in opposition and stating that these mandates were unconstitutional not one rebuttal of that point was made by those in support.

The "Holy Grail" for the so-called "private" insurance businesses is forcing everyone onto one of their plans.  This is due to the problem of "adverse selection" - that is, you would not buy insurance until you got sick if it is quite (or very) expensive.  The more expensive the insurance gets the worse this problem becomes and the "insurance" ceases to be insurance at all.  Remember, "insurance" is a thing you buy to protect against an unlikely outcome - if you're already ill or believe you will become ill the outcome isn't unlikely - it is either probable or known.

Yet the desires and demands of private business do not give license to use The Constitution as toilet paper.

But the extra-constitutional game didn't stop there.  Oh no.  This 1990 page monstrosity goes much further.  It mandates that employers not only cover everyone they hire and pay at least a specific percentage of their premiums (or face a fine) it also mandates that said employer cover all members of that employee's family. While it is unlawful to discriminate against people based on their family status, what do you think is going to happen to salaries across the board to cover the risk of someone showing up for a job interview and having eight kids? 

Does Octomom become permanently unemployable - or does every employer in the nation reduce your salary offer now and forever to guard against the possibility of another Octomom showing up for a job interview?

You know the answer here - nobody is going to take the risk of a multi-million dollar discrimination lawsuit.  Your salary offer will be reduced, and if you are currently employed, you can forget about raises for a long time.

There are Constitutional solutions to this mess.  I have posted about them before. My chronicle of those posts in The Ticker is found here; it encompasses a reasonably small set.

Left un-addressed (intentionally, by the device and drug lobbies) are the reasons we spend so much on health care in this country.  Put simply, America pays for the development of every advanced treatment in the world and has for the last 30 years, yet every other nation's citizens get to enjoy those advancements for free.

That's right.  The Pharmaceutical and Device industry has managed to get legislation enacted prohibiting the re-importation of devices or drugs sold overseas.  These overseas markets demand price controls on the drugs and devices sold there, and get it.  We, on the other hand, have a "price at what the market will bear" system. 

The result is that the heart stent that is used in Canada costs a tiny fraction of what the same stent costs in The United States even though they are made by the same company.

Normally such distortions are instantly corrected by cross-border arbitrage.  That is, if I sell a widget in Canada for (US) $1.00, and for $10.00 here in the United States, someone will order 10,000 of them in Canada and ship them across the border back to the US, driving the price in the United State back down close to the Canadian price. 

In general, once I own a thing I have the right to dispose of it as I see fit.  Nobody would accept the idea that by purchasing a car I can not then sell it at some later point for whatever price I desire.  Nor would they accept this in the price of houses, lawn mowers, life jackets, boats, toothpaste, books or Christmas decorations.

Yet today it is not lawful for me to buy 100,000 doses of Viagra in Canada (where they sell for a fraction of the US price) and then ship them back to the United States.  This "unlawfulness" has been artificially created by the drug and device manufacturers, who claim concern for "purity" and "counterfeits" - a red herring and in fact a false claim.  There has never been a right to import or sell a counterfeit product; what these manufacturers have managed to prevent is the importation of lawfully-produced and properly labeled drugs and devices made in their own factories!

The fact of the matter is that if the world is to benefit from the innovation of US companies they should pay the same price as everyone else does - including the United States.  The solution to this sort of improper and outrageous forced subsidy by the American Consumer and Taxpayer is to remove the laws that bar importation of lawfully-produced and properly-labeled drugs and devices - that is, to enforce the general principle of common law that once I buy a thing to whom I resell it and under what terms is a right that I acquired in exclusivity through my original purchase. 

But fixing this distortion - one that costs Americans hundreds of billions of dollars annually - means removing a "special law" that is used by drug and device companies to screw Americans out of that money, and serves to force medical spending to the moon - all for the profit of a few oligarchs in the medical industry.

Also left unaddressed in The House Bill (again, intentionally) are two other factors that serve to together comprise more than half of our spending on medical care.  These are:

• The fact that 90% of your health care spending happens in the last year of your life.  We must have a societal conversation on this issue, and determine what society's responsibility is for that last year.  I argue that the answer to that question is in fact zero - we all begin to die the moment we are born, and yet none of us know exactly when the clock will expire in advance. As a consequence a perfect separation at that "last year" is not possible, but there are some realities we can - and must - face.  First among them is that when you are in declining health, irrespective of your age, you do not have the right to impose your desire for additional hours, days or months of life on the back of others.  You have the absolute right to expend any or all of your own resources in pursuit of that goal, but you have no right to reach into my or anyone else's pocket to do so.  There are literally thousands of instances every day across this nation where persons who are in their waning hours or days - persons where the outcome is, within medical certainty - known - are hooked to machines and monitors in hospital beds that cost tens of thousands of dollars a day, simply because they do not have to pay for that last hour out of their own resources.  This must end.  We are a compassionate nation, but this is not compassion - it is barbarism.  When my time comes I should be offered as much pain medication as I desire to take, including a sufficient amount to render me unconscious either in effect or fact - but I should have no right to expend any amount of society's funds beyond that pallative medication and care.  While this would not save 90% of the nation's health care expense, it would save 30% or more, and we can do it right now, without any impact whatsoever on treatment and care that has a reasonable chance of resulting in a cure of the patient's condition.
  
  
• Tort reform.  Simply put, we call it "practicing" medicine.  There's a reason for that.  The law must change, even though this will outrage attorneys and their lobbying interests.  A right of suit and recovery must remain for those cases in which gross negligence is shown; we have all heard of cases where the wrong arm or leg is amputated, the perfectly-good eye operated on rendering the patient totally blind, and other similar outrages.  No society can or should accept outrageously negligent activity as "the cost of doing business", including ours.  But most so-called "malpractice" isn't of that form.  It is instead a lawsuit due to a bad outcome - an outcome that was known to be in the realm of possibility by the patient prior to the procedure, or due to an unforeseen risk.  Medicine is not a science; it is an art.  As an art we must accept that there is always the choice to do nothing and accept whatever outcome God (or Darwin if you prefer) ordains; it is by man's intervention that one attempts to change that natural course of events.  Such an attempt will not always be successful.  Defensive medicine to avoid the possibility of lawsuit costs hundreds of billions of dollars, all occasioned not by medical necessity but rather by documenting evasion of all reasonably-foreseeable risks - a ridiculously expensive practice for which we all pay.  This must end.

If we cannot have a reasonable set of reforms as I have outlined in my "Wake up Washington" Ticker in September then we should instead pass a single-payer system such as exists in Canada, but (unlike Canada) let those who choose pay in cash for "excess services."  No, it's not perfect, and yes, it is rationing.  But so is what The House passed - they're just hiding it in their 1900+ page mess so you can't easily find it.  A Canadian-style system, funded by general revenues, is Constitutional, unlike the outrage passed last night.

Either of those outcomes would produce marked improvements in the system we have now along with driving down costs dramatically - perhaps as much as 50% - from what is spent today.

The House Bill not only fails to address the problem but is an outrageously-broad and, I would argue, an unconstitutional reach into Americans most private parts.  The Administration's own spokespeople admit this bill will cost us some 5.5 million jobs - on top of the 8 million we've already lost in the present economic malaise since the peak of employment in the summer of 2007.  My "back of the envelope" computations are similar - I come up with 5 million jobs lost with a 20% variance and 95% confidence level - that is, somewhere between 4 and 6 million should be the total.  Darn close, given that I'm not privvy to the Administration's facts and figures and am forced to work off published information.

When Pelosi and her gang of thugs took their place behind you they didn't even bother to snap on a glove first.

Ok, so President Obama once again wants to act like he's still running for office instead of inhabiting the Oval Office.

I get it.

My objection is simple: Neither the Republicans or Democrats have put forward a plan that actually addresses the structural problems we have with medical coverage in America.

I am going to reprint and expand on my actual fix for Health Care, for the following reasons:

It will work and control costs by dramatically increasing competition.  Today, employed persons typically have one choice for insurance coverage.  This plan will bring them dozens to hundreds of choices at competitive prices.  You wouldn't accept a system where there were a dozen stores but only one where you could shop because of the company you worked for, but if the grocery business had such restrictions a gallon of milk would cost $20, because the store you could buy from would know that you couldn't go next door.

It will end cost-shifting and cost-hiding, which is bankrupting millions of Americans and is the core problem underlying the imbalances in the system today.

Finally, it will not increase the budget deficit one nickel.

Here it is; you can read the original as well if you want:

Let's reprint the key points, simplify and expand on them:

If you sell "insurance" to anyone in a given state, you must accept all persons in that state on the same terms and at the same price.  If an insurer has a "we accept anyone at the same price" policy for a business, you must be able to buy into their plan for the same amount of money that the employer is charged on a per-person basis.  That is, all plans must be "open enrollment" for everyone within the state - period.  This immediately gets rid of the "tie" between employment and health "insurance", and it also removes one of the biggest issues that small business and self-employed people face - the inability to buy insurance at any reasonable price if there has ever been anything wrong with them medically.  The solution to the "adverse selection" problem is identical to that which exists in corporations - you typically can only elect out or in of a policy or plan on an annual basis - that is, you're obligated to participate for a full calendar year.  Enforcing the same terms (you can only opt in during one month, and are obligated for the entire year) solves the problem of someone deciding to buy only when they get ill, as you would have to wait for the enrollment window to open.  For acute conditions where adverse selection becomes most important this restriction resolves the problem.  This also resolves the pre-existing condition problem that the self-employed have today.

All health providers must publish a price list and may not bill or accept payment at anything other than that price; doing so becomes a violation of Robinson-Patman and exposes the provider to civil suit for treble damages.  This instantly stops the practice of billing the uninsured or privately insured at a higher price than Medicare, for example - a practice that is rampant, particularly among hospitals.  Every hospital has a detailed price list for every function and thing in their health care panoply - this enforces even billing and even pricing for everyone, without discrimination.  The complaint that health providers cannot make a living at Medicare's reimbursement rates does not give that provider license to cost shift the expense of government-subsidized care to privately-insured or uninsured patients.   Everyone would raise hell if your car was three times as expensive if you worked for Ford than if you worked for GM, yet it is accepted that if you're not insured by Kaiser (for example) your heart bypass surgery costs a different amount.  If Medicare's "price schedule" is inadequate the solution is for providers to refuse to provide the service at that price and thus negotiate for a higher price for that procedure, not cost-shift the care of older Americans onto younger.  This is a more than $200 billion dollar a year rip-off of working-age Americans, it bankrupts the uninsured or those denied coverage after a health event, and it must be made explicitly unlawful.

If you show up without insurance or ability to pay with a life-threatening condition, you will be treated, but the hospital cannot cost-shift the bill - it instead bills The Federal Government.  We have created an expectation that if you show up needing emergency treatment you will get it, irrespective of ability to pay.  This creates a monstrous problem for hospitals and results in the $30 aspirin, among other outrageous distortions.  The solution is to have The Federal Government receive all uninsured and unpaid bills, with the debt being immediately paid by the government.  Said debt then becomes a collection item against the citizen - a debt to the Treasury, administered by the Internal Revenue Service.  If you cannot pay cash, that's fine - the IRS will be happy to take payments (at interest.)  If you're an illegal alien the Federal Government will be mandated (by statute) to collect from the other nation, and if they refuse to pay, to deduct any such amount from foreign aid of any type and source on a dollar-for-dollar basis.

We must reform the tort system.  The trial lawyers will hate it.  So what. The simplest proposal is this: you may sue only for gross negligence.  If the wrong arm is amputated, you have a lawsuit.  But we, as a society, must admit and accept that we call it practicing medicine, and by the very name - "practice" - we therefore admit and accept that outcomes will neither be perfect or predictable.  But while we must accept that medicine is not a perfect science and outcomes cannot always be predicted, every person has a right to know their physician's record.  In exchange for this partial immunity from suits all outcomes and counts of procedures performed, by the patient's own evaluation as to degree of success or failure, are to be published online in a searchable database for use by any person at any time in making medical decisions, and the intentional concealment or tampering with such reporting shall be made a felony.  The patient's evaluation shall be an absolutely protected form of speech.

If you want a health care solution, there's one that will work.

Four points that will:

1. Bring instant competition to the health care system, enabling citizens to choose between dozens if not hundreds of competing insurance plans for the precise same price that an employer pays to cover the same person were they working for that company.
2. Allow you to keep your current plan and doctor if you wish.  Since this does not tamper with any existing insurance program there is no impact for those who like their current health care plan.  If your plan is particularly good, in fact, it is likely to get cheaper as more people join it.
3. Stop the pre-existing condition problem dead in its tracks.  No large or mid-sized employer accepts this in their plans.  You shouldn't have to either.
4. Prevents illegal aliens and the uninsured from shifting their care onto your wallet.  You're free to be uninsured but you will get billed by the government if you need emergency care.  Illegal aliens will get emergency care but the government of their citizenship will be billed.  The day of the $30 aspirin will be over.
5. Prevent gouging for cash-paying customers. Level billing will stop the abusive cost-shifting that bankrupts tens of thousands of Americans every year.
6. Not cost the taxpayer a nickel.  No budget impact - period.  In fact forcing the uninsured and illegal aliens' bills back onto the responsible parties will almost certainly decrease costs for Medicare and Medicaid, thereby saving money.

In the current debate why isn't a plan like this part of the discussion?

If you have a Tickerforum Login ID please vote on which of the three proposals you would like - no changes, the Obama Plan, or what is outlined above (if you are not logged in you cannot see the poll choices.)  The entire thread will be faxed, with results, to Congressional Leaders and President Obama when the poll closes in 7 days.  Registration on the forum is free and while you must wait 2 days after a new registration to comment, you can vote immediately.

Back on July 7th I wrote a piece on Health Care Reform and laid forth some general principles.

I have since done some more synthesis on this and have a more-fully-fleshed out, and yet simpler, set of proposals to solve the problem.  With no further ado, here they are:

If you sell "insurance" to anyone in a given state, you must accept all persons in that state on the same terms and at the same price.  If an insurer has a "we accept anyone at the same price" policy for a business, you must be able to buy into their plan for the same amount of money that the employer is charged on a per-person basis.  That is, all plans must be "open enrollment" for everyone within the state - period.  This immediately gets rid of the "tie" between employment and health "insurance", and it also removes one of the biggest issues that small business and self-employed people face - the inability to buy insurance at any reasonable price if there has ever been anything wrong with them medically.  The solution to the "adverse selection" problem is identical to that which exists in corporations - you typically can only elect out or in of a policy or plan on an annual basis - that is, you're obligated to participate for a full calendar year.  Enforcing the same terms (you can only opt in during one month, and are obligated for the entire year) solves the problem of someone deciding to buy only when they get ill, as you would have to wait for the enrollment window to open.  For acute conditions where adverse selection becomes most important this restriction resolves the problem.

All "insurance" companies must offer a true insurance policy covering only unlikely-but-catastrophic events on the same terms as their "full service" policies.  These were formerly called "major medical" or "hospitalization" policies, and have become very difficult to find.  They're relatively inexpensive as they do not cover routine doctor's visits or medications, but do cover catastrophes (e.g. a heart attack, cancer, stroke, etc.)  We must provide consumers with a reasonable-cost alternative to HMO/PPO coverage, and this is it.  If a company wants to sell "full-featured" policies that are unaffordable to a huge percentage of the population, we must mandate that they also offer affordable catastrophic coverage for those who prefer it (or can't afford anything else!)

All health providers must publish a price list and may not bill or accept payment at anything other than that price; doing so becomes a violation of Robinson-Patman and exposes the provider to civil suit for treble damages.  This instantly stops the practice of billing the uninsured or privately insured at a higher price than Medicare, for example - a practice that is rampant, particularly among hospitals.  Every hospital has a detailed price list for every function and thing in their health care panoply - this enforces even billing and even pricing for everyone, without discrimination.  The complaint that health providers cannot make a living at Medicare's reimbursement rates does not give that provider license to cost shift the expense of government-subsidized care to privately-insured or uninsured patients.  That sort of discrimination is outrageous and must be made unlawful.  Everyone would raise hell if your car was three times as expensive if you worked for Ford than if you worked for GM, yet it is accepted that if you're not insured by Kaiser (for example) your heart bypass surgery costs a different amount.  If Medicare's "price schedule" is inadequate the solution is for providers to refuse to provide the service at that price, not cost-shift the care of older Americans onto younger.  This is a more than $200 billion dollar a year rip-off of working-age Americans and it must end.

No event caused by the provision of your treatment may be billed to you.  Period.  Specifically, MRSA infections and similar contracted in a hospital cannot result in billing of that treatment to the consumer.  If you call someone to fix your roof and they break a picture window, they have to eat it - they can't bill you for the roof and the window which they broke!  The best incentive for better-quality care, particularly when it comes to controlling in-hospital cross-infection rates, is to make it ruinously expensive for hospitals to fail to prevent these adverse events.  Prohibiting by federal law the billing of any amount for a condition caused by the provider of health care (or a health facility) puts in place a very strong free-market disincentive for lax infection and process control. 

If you show up without insurance or ability to pay with a life-threatening condition, you will be treated, but the hospital cannot cost-shift the bill - it instead bills The Federal Government.  We have created an expectation that if you show up needing emergency treatment you will get it, irrespective of ability to pay.  This creates a monstrous problem for hospitals and results in the $30 aspirin, among other outrageous distortions.  The solution is to have The Federal Government receive all uninsured and unpaid bills, with the debt being immediately paid by the government.  Said debt then becomes a collection item against the citizen - a debt to the Treasury, administered by the Internal Revenue Service.  If you cannot pay cash, that's fine - the IRS will be happy to take payments (at interest.)  If you're an illegal alien the Federal Government will be mandated (by statute) to collect from the other nation, and if they refuse to pay, to deduct any such amount from foreign aid of any type and source on a dollar-for-dollar basis.

Five points and a fully free-market solution that brings affordable health care coverage to all who can buy it, yet protects those who cannot, while, to the greatest possible extent, forces everyone to bear the cost of their own decisions.

If you choose not to be insured and pay cash you are free to make that choice.  If you have a catastrophic illness or injury, insist on treatment but have no means to pay then you are subject to attachment of wages and assets by the IRS, a debt that is only discharged by your death.

Simple, fair, free-market and this path will dramatically control costs as free market competition will be forced to the forefront among health providers who will be compelled to make available their pricing schedules to everyone before they show up for treatment and are presented the bill.