[TheMercenary]

It would require a major realignment of professional and economic power on the supply side.

Third, on the health insurance facet, the president would like to develop a well-functioning market for individually purchased health insurance, as an alternative to the employment-based system which covers most insured non-elderly Americans.

There now is such a market, but it covers only a small fraction of non-elderly Americans, primarily because it is highly fragmented and, moreover, in most states pegs the individual’s insurance premiums to that individual’s health status. To reform this market, the president would establish a National Insurance Exchange.

This can be thought of as the analogue to a farmers’ market on which competing insurers offer their products, subject to a set of regulations that make transactions in the market transparent and honorable, and the competition among insurers fair.

A major contentious issue here is whether the insurers competing in this market should include a newly established public insurance plan like Medicare, but for the non-elderly.

It would also disseminate information from what should be called “cost-effectiveness analysis,” but, as was discussed in earlier posts, has been constrained to be mere “comparative effectiveness analysis” (see this and this for more on this subject).

Finally, to make all of these pieces work harmoniously together — toward the social goals of improving the health status of Americans by providing all of them with access to timely care, and of protecting their budgets from undue inroads of medical bills — there would have to be a whole set of additional government regulations, mainly on the health insurance industry.

From one of my previous links:
http://economix.blogs.nytimes.com/20...c-health-plan/

Germany has one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage. The health insurance reform 2007 requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment.

The options available to you for health insurance while living in Germany are the government-regulated public health insurance system, private health insurance from a German or international insurance company or a combination of the two.

http://www.howtogermany.com/pages/insurance.html

This is the normal health care cover that most Germans have. Essentially, you pay a fixed percentage of your salary to an insurance company and your employer does the same. Then, the insurance company provides you with health cover.

The percentage varies from one part of the country to another. For example, in Konstanz, which is a popular retirement destination, large numbers of old folk are subsidised by those in work and the percentage is high. Also, if your monthly earnings are above (currently) DeM6300, you only pay the percentage on that first DeM6300.

This is a much more extensive scheme than the UK and that sounds good until you consider a few things:

You are paying for it yourself. If you are contracting, then any employers contributions that you pay are coming out of your own money.

The scheme is actually rather more comprehensive that you might ever want or need and remember, you are paying for it!

There are some benefits for which you are unlikely to be eligible even though you are paying for them.

If you are earning a good income, you may well find that you are paying an awful lot of contributions.

In the Krankenkasse, highly paid single people are subsidising poorly paid people with large families.

The main alternative to the Krankenkasse is the Privatkasse. This is a private scheme where you pay an amount linked not to your income but to your health outlook. So, if you are old, have a poor medical history or a large family, you will pay more than a young single person.

If your income through a German employer is higher than a certain level, you are permitted to leave the Krankenkasse and join a Privatkasse. In the Krankenkasse scheme, you pay a fixed percentage of your income and so, young healthy single workers end up subsidising the old, the sick, the unemployed and those with large families.

This ability to opt out of the need to subsidise those other groups is the main appeal of the Privatkasse scheme. There is of course a drawback. Once you enter the Privatkasse, you are not allowed to go back into the Krankenkasse scheme. So, you have to be certain that you can fund your private cover for the rest of your life.

Rather than the pooled social fund structure of the Krankenkasse, the Privatekasse is an insurance scheme and so your premiums will increase as you age or as you aquire dependants etc.

When you are in employment, your employer must match your contribution to the Privatkasse scheme but, after retirement, you have to pay for the whole deal from your pension or other resources.

As with the Krankenkasse, you need to be an employee of a German company or a self employed person in order to join the Privatkasse scheme.

http://www.jpoc.net/countries/german...anschemes.html