I liked Tulsi Gabbard's "two-tier" proposal for healthcare reform back in 2020. Grant state or federal government full control over emergency care and only the most expensive and obscure cancer treatments all of which act economically as a natural monopoly. Then for every other segment of healthcare where competition can exist, keep them as private markets but greatly enhance antitrust enforcement.

The only thing missing in all the good talk about healthcare is what to do about health insurance, which is the middleman that drives up prices. I propose making all forms of price discrimination illegal in healthcare, i.e. uninsured and HSA patients cannot be charged more than health insurance companies.

I also propose standardizing healthcare into 5 different health plan contracts, then requiring all health insurance companies to make all of their health plans fit into one of those contracts with zero modification to the terms and conditions. This will make litigation faster and easier, and it will avoid fraud disguised as "fine print".

Then, finally I propose requiring all health insurance companies to pay for the services up front and then sue the patient to get the money back, reversing the existing pattern where the burden of proof falls on the patient and the patient has to wait until the insurance provider relents. Think of it like a patient suing an insurance company and getting an injunction to pay out the claim while the legal ruling is pending, but faster.

The entrenched interests would fight tooth and nail against this but I think that the drive towards simplifying billing and pricing is a generally good thing.

That being said, in my view, one of the fundamental problems with healthcare is that outside of truly elective procedures like cosmetic plastic surgery and lasik, it's nearly impossible to have free market economics function.

- There are HUGE information asymmetries between doctors and patients - Judging performance of doctors is very challenge. Reviews are terribly inaccurate, data can be better but has big problems, and even other doctors aren't good judges of doctors outside their specialty. - Right now at least, price discovery is nonexistent so you can't price shop and compete on price vs quality - Insurance means that consumers of healthcare are not actually footing the bill so they have no incentive to price shop. And most healthcare procedures are completely unaffordable so there's no way we can do without insurance - and finally it's really hard to make an economic decision that is literally life and death. Am I going to forgo a $100k surgery if it means I'll die? There's no choice there

All of these things lead me to the conclusion that healthcare is fundamentally incompatible with classic free market economics, and some form of single payer is the only solution to avoid us bankrupting our country spending on healthcare

> I propose making all forms of price discrimination illegal in healthcare, i.e. uninsured and HSA patients cannot be charged more than health insurance companies.

As long as it's left generic so it goes both ways. Currently it's usually the uninsured patients who are charged less (since they're paying the whole thing out of pocket instead of having insurance cover most or all of it), not the insured patients.