I have been thinking about how many bad policy decisions are made because the good option is not politically feasible. The exmple I have been thinking of recently is Health care. I am going to simplify the current debate. Democrats, need to have more health care, taxing to get it is ok, government can allocate (ration) the spending.  Republicans, We need to do something, Taxes are bad, we want a free market, lets get employers to pay for it. Remember I am simplifying. The key to both of these solutions is that they would like to hide from you (we the people) what you are paying. They are ding this by making businesses, pay the cost. I would like to point out that all businesses are owned by people. I hope to show that my guidelines for a solution are better but politically difficult.

1. Make the individual cost transparent. Government provided or free market insurance, Make the cost to the individual completely transparent. i.e. paid by the individual directly. I’m ok with income transfers/subsidies but don’t hide the costs.
2. Medical conditions fall into to categories. Those with rapid feedback and those with long term. Playing sport is a rapid feed back, you know that you could get injured and you try not to. I see little reason to add a cost penalty to “risky sport” Pain seems like an adequate deterrent. Smoking, obesity, and other life habits have a much more delayed feedback. These types of habits should be penalized. It does not seem that the future risk of cancer, heart disease is an adequate deterrent. I think the cost of there health insurance should be adjusted so that there is a real time cost. I would also not allow the adjusting of cost based on past care. If the incentives are right don’t penalize for bad luck.
3. Let patients choose there quality of care. The current system tries to provide the best care standard of care to everyone. I am sure you re asking why would you not always want the best. Well if you are asking that you are not the one paying. My example is; I had a mole on my face. I didn’t really care who removed it. I didn’t need a plastic surgeon or a dermatologist to do it so that there would be no scar. I am not that concerned about my appearance. I would have chosen to have my GP do it. But no I had to see another Doc. I had to see a dermatologist.  Well I wasn’t paying. Even if I was under our current system it is unlikely the GP would do it. Not because they can’t but because the standard is that a dermatologist removes facial moles. Next time I am doing my own.

Point 1 is clearly not political practical, We what to think health care is like Manna from the sky. Point 2 is not political practical because we don’t ike the ide of being told what to do, or eat or …. and I don’t think the AMA would support point 3 for a lot of resons I wont’ go into now.