Some ideas snatched from the air (I mean, internet):
1) The current system profits from sickness, not health. Hospitals, doctors, nurses, clinics, pharmacies, and drug companies earn profits only when people require treatment. If these services are operated as businesses, their goal is to increase profits, either by decreasing costs or increasing their 'customer base' i.e. number of patients. High quality patient care becomes a secondary concern (a means to an end of attracting patients, unnecessary if patients have nowhere else to go).
2) Competition between healthcare providers is actually highly limited. There may only be one hospital that is accessible in a geographical area. It is further limited by insurance companies that limit a patient's choice of providers to those within their 'network.'
3) Lots of money is lost in the insurance system: administrative costs, processing claims, insurance company profits, etc.
4) Current insurance and healthcare costs are out of reach for many people, even those steadily employed.
5) The individuals most in need of healthcare are often the least able to pay for it. They and/or their families must incur massive debt and/or declare bankruptcy.
6) Getting sick or injured is largely a matter of chance; a person with a perfectly active and healthy lifestyle can still come down with cancer and is probably more likely to break a bone (e.g. skiing).
7) There is an uncomfortable partnership between employers and healthcare. There exist healthcare practices that are considered immoral by certain groups of people (e.g. blood transfusions, abortion, contraception). The current system allows an employer to impose their moral compass on employees.
8) A civilized society has a responsibility to its members, as a group. To exist as a collection of independent individuals is to be in a state of anarchy.
From the other side:
1) The market solution applies from the 'customer' perspective; having to pay for treatment is an incentive to take care of oneself; there is some control over preventing minor illnesses and chronic diseases through lifestyle choices.
2) Customers have the choice to buy insurance and/or establish an emergency fund or deal with the consequences of not taking these actions.
3) It is not fair to take money from one person to pay for services offered another, without the consent of the first.
4) Government programs are not subject to competition, which removes the incentive for effectiveness. There is an argument that a government program will accomplish less with more money than a market solution.
5) Socialized medicine gives government lots of control over citizen's lives. Even if we except direct, clearly unethical interference, this can allow systematic propaganda for or against specific health practices.
Hard truths:
1) Depriving someone of lifesaving medical care is condemning them to death. This holds true for penicillin for pneumonia or chemotherapy for cancer. The Declaration of Independence establishes 'unalienable rights' first and foremost 'to life,' then 'liberty, and the pursuit of happiness.' A major founding principle of the USA is that people have the right TO LIFE. HOWEVER, it is clear that it is not possible (as in, we do not have the resources) to provide every individual with every treatment. It is not possible to know ahead of time that a treatment will be successful, hasten death, or postpone it only briefly. There is an element of risk and probability. THEREFORE, the healthcare system will necessarily offer some individuals more care than others. The question becomes, what criteria will be used for this determination. Is affluence really a just, moral criterion for this?
2) Given the choice between curing a 5 year old of leukemia or a 90 year old of lung cancer, assuming equal chance of success, who do we pick? How about a successful car mechanic versus a successful venture capitalist? Doctor or medical researcher? If we provide half treatment to both, most likely outcome is both will die, but withholding treatment from both makes it a sure thing. The hard truth is this: logically, different individuals have different value to society, although morally (in most systems I am familiar with) all lives have equal weight.
2b) Regarding age, specifically, should the fact that several decades vs several months or years of healthy life will be gained from a cure affect the choice of who to cure?
3) Eliminating the option to exchange personal or family money for treatment will undoubtedly cause corruption and bribery due to the high value we place on life. And also the desirability of money.
4) "Life is not fair." Some will get sick and some will not. Some will have the money to pay for all the treatment they can get, and some will not.
Case studies:
1) Colleges typically have 'health centers' providing basic care for common conditions to students for a flat fee of a few hundred dollars per semester (but also subsidized by the institution). Services that may be offered include doctor visits for treatment of minor illnesses or injuries, women's health services, consultation for various non-illness issues (e.g. weight loss), vaccines, and pharmacy services. Not all services are offered by doctors; some are by registered nurses, or 'advanced' nurses as their qualifications allow; this increases efficiency since the most advanced training is reserved only for the cases that require it, rather than routine tests/exams.
Could this be extended to a larger demographic? I see it as a sort of 'gym membership' type of arrangement--you find a center that suits your needs with the right group of professionals, pay a monthly or annual fee, and have your routine and incidental care covered. Use may vary but it wouldn't make sense to cease it entirely in case something happened, and the cost would be predictable. Furthermore, the flat fee system gives professionals (centers) an incentive to promote lifestyle health rather than treat individual conditions--the less their customers visit, the more customers they can serve, the more profit they can make. This would also promote competition between centers; those that result in the most healthful lifestyles (and therefore efficient operation) can afford to offer cheaper services than others.
2) Car insurance. Typically, it is not expected to cover routine maintenance, but rather catastrophic events. You pay a small fee regularly but due to a large customer base and a low incidence of catastrophes, the insurance company can pay for very expensive car repair, property damage, or medical fees. I have heard an argument that medical insurance should function the same way; that it makes sense for hundred-thousand dollar surgeries or emergency room visits, but not so much for regular care. I could see this system working if something else provided routine care. See Case Study #1.
3) Religious communities (e.g. Amish?) I don't know much about this but I recall reading that certain isolated communities (Amish?) did not subscribe to the insurance model, but rather had a community fund which could be drawn upon if deemed necessary. This seems a bit of a 'rose by any other name' situation to me, but it merits mentioning. I don't know how well it works.
Design criteria:
Basically, the problem comes down the design of a system to meet certain needs within certain limitations. Perhaps this is an engineering way of looking at it, but i am an engineer! The requirements, as I see it, are:
1) Provide a basic level of routine/incidental care to every individual (at reasonable cost, which means free to the poor).
1a) ESPECIALLY important for CHILDREN.
2) Provide advanced treatment (e.g. hospital, surgery, emergency) with ethics and justice, to maximize societal benefit and happiness.
3) Free of direct government control, though perhaps uniformly subsidized or otherwise supported.
2) Encourage competition to promote efficiency and effectiveness.
3) Profit the business and the customer from increased health, not treatment. Or, alternatively, be universally non-profit.
5) Ethical decisions should rest with patients, doctors, and professional medical organizations (e.g. licensing boards); not with any other party.
6) Minimize administrative costs.
7) Encourage programs and measures that improve lifetime health of customers/patients.
8) Encourage research and innovation.
9) Include a plan for transitioning from the current system to the new one.
What have I missed?
