How to Fix Health Care

Health care in the US faces two major problems. It's expensive, and because it's expensive, for some it's out of reach.
The employer-based system we have right now doesn't work. It may have worked when it originated--when people stayed with the same job their entire lives. But times have changed, and our health care system needs to change with it in order to meet society's needs.

Here are the changes I'd like to see.

First, basic cost-effective health care for everyone. Essentially, Medicare for all, but (unlike Medicare), a system that actually cares about costs. Is medicine "A" 99.99% effective and costs $1000/day, and is medicine B 99.98% effective and costs $10/day? Currently, (as far as I understand) cost is not a consideration in determining care (at least for Medicare), and the (slightly) more effective yet (absurdly) more expensive product would be used. Obviously, if we are concerned about costs (and as health care rates continue to rise, we need to be), we need to make some adjustments.

Also needed is a clear, reasonable voice in every non-emergency test/surgery/procedure to say, "is this really necessary? Is there a cheaper way to do this that's just as good?" A huge amount of health care expenses goes to unnecessary surgeries and tests that may benefit the doctor and the hospital, but don't actually help the patient.

Also, clearly we need what Sarah Palin so (cough) eloquently and accurately (cough) referred to as "Death Panels." People should be encouraged to write living wills and should be encouraged to talk to their families and doctors about end-of-life options. While families and individuals have the right to pay for whatever they wish to, I'm not sure the government (or an employer, for that matter) should pay for 90-year-old Oma's terribly expensive open heart surgery, especially when Oma has liver cancer and isn't expected to live another year anyway. (I've seen several incidents of close to $1 million spent on people like Oma--that's probably taxpayer money there).

An additional possibility: a 10% to 30% copay on the first $10,000 or so, to keep things competitive and keep costs down (but still allow people access to health care when they need it). Medicaid assistance if a person can't afford the copay.

Private or employee insurance (to upgrade to more expensive care such as having your own room in a hospital, etc.) would still be available to those who can afford it. And people could pay out-of-pocket for any upgrade they want.

I think it's a politically moderate proposal, as likely to offend Democrats as Republicans. I also think it's what we need to cut health care costs down to what other people in the civilized world pay (ie--half as much as we pay).

Thoughts?