As Europe has moved from the left to the center, some people in the United States could benefit by moving from the right to the center - admitting that there IS a role for government to play in healthcare, especially when it is unaffordable, that does NOT create a bureaucratic labyrinth.

Obama has been very skillfully deploying cases where people actually die because of profit considerations. We can and should take a stand against any rationale that would put the bottom line before a human life. If a person dies because it is not profitable to help them, that is a social tragedy and something of which we ought to be ashamed.

Obama can only be successfully opposed by presenting a viable alternative. The time for Rush Limbaugh style indifference (i.e. "healthcare is a privilege, not a right") is absolutely over. It was unconscionable to begin with.

So, let's keep the alternatives rolling - I like the CMA proposal.

Joe H., sorry if it is not sufficiently clear -- the specific proposal here is my own. The general recommendation of health care reform based upon empowering people to own their own health care policy comes from the the Catholic Medical Association.

I like this proposal. I especially like this part:



This would hopefully cut costs by discouraging the use of the ER as one's primary physician, and also reward those individuals who take care of their health regularly. Great idea.

One question that the CMA doesn't cover in this article, and may not at all since it's not really their position to do so:

If this proposal would end employer-based health insurance and force the individual to pay for it himself, would employers raise salaries? They would no longer have to pay huge sums of money into insurance companies, and individuals would be in need of those additional funds to pay for their own insurance.

If they don't, I can imagine many employees taking a bath while employers get to make huge cutbacks.

The Bishops don't support an alternative to a government option because the Republicans have not put one out there. The Republicans continue to claim we have the best system in the world and never speak to the 50 million Americans who do not have coverage. Then they launch into a number of scare tactics and lies about health reform to try to stop anything from happening.

The alternative that you lay out would also likely not be supported by the Bishops over a government option because of the abortion question. Private plans support abortion services at a very high rate and there is little leverage the government can wage to prevent these plans from offering coverage for abortion. The Bishops know there is a far better chance of restricting coverage for abortion in a public option.

We already have socialized medicine, Medicare, Medicaid, Veterans Administration etc.

I think we should disband those programs immediately if we don't want the government to play a role in health care. It's only right.

To fix the pre-existing condition problem, here's a suggestion: require pre-existing condition exclusions to expire after holding the plan for a date certain. Then you can have a "patch" on the plan to cover you for pre-existing conditions during that time, and that's where government subsidies (basically risk pools) would come in.

I received the following comment this morning from Jack Whelan, formerly COO, President, and CEO of Golden Rule Insurance Company. Golden Rule was the major force behind getting HSA’s accounts into the law.

Deal,

The health care plan that you describe would work. The one provision that could be troubling is the requirement that an insurer issue to all regardless of pre existing conditions. This option to “put” my health care to the insurer (Guarantee Issue) has enormous value to an individual and encourages healthy persons to remain uninsured until they need coverage, to enter the market at that point and exit once again when they no longer need coverage. To compensate for that behavior the premium charged needs to be substantially larger than it otherwise would be. The higher the premium the greater the incentive to game the system and only have insurance coverage when you need it.

The concept of mandatory coverage is fine but in other markets, both health and other areas such as auto, has not worked as hoped. See MA health reform instituted under Mitt Romney or any of the numerous states that mandate auto insurance to title and license a car. Compliance is pretty anemic.

Another provision that tends to walk along hand in hand with Guarantee Issue is Community Rating, which means charging the same premium for all or having a very small range of difference in price charged between the youngest and oldest. Generally this results in raising the premium that a young person would be required to pay and reducing the premium charged to an older person. This means the younger person is subsidizing the premium for the older person. This further encourages gaming the system by the young and healthy and consequently ratchets up the required premium further.

Anyone with coverage should be able to move into the individual market without restrictions on pre-existing conditions. Children coming off a parents insurance plan should be guaranteed an individual plan of their own. Anyone entering the market without prior coverage should be required to apply and go through underwriting. Those who do not pass the insurers underwriting should be dealt with under the state in which they reside’s saftey net mechanism.

Oops. Sorry, I made the same mistake, too. Well, now that I know it was Deal's idea, I hate it.

What do you propose for users of Medicare and Medicaid?

Deal,

Thank you for the excellent coverage of this issue. Over the weekend it seems the Dems have conceded that non-profit insurance cooperatives could be an alternative to a government run plan. I wonder what the perspective of Catholics in health care is regarding this idea. It seems the Church is in an excellent position (as one of the largest non-profits in the country with extensive activity in the health care industry) to step up and offer the most competitive and morally guided health insurance in the industry. Does anyone else see it that way?

The only thing that comes to mind is what the statistics are in the States where car insurance is mandatory; is it the same, lower or higher than the real number of uninsured for healthcare?
As we know, your driving record plays into the cost of auto insurance and so it would be interesting to see if we could take those uninsured individuals out of the statistics whose terrible driving record made their insurance unaffordable.

With my Health Benefit Administration background, I always resented the fact that I could not get the Health Insurance companies to incorporate a rebate for wellness. We thought that if our population got healthy and utilized the healthplan less, we should see a decrease the following year in our premiums, which we then wanted to give back to employees. Insurance premiums always went up which caused us to continuously use brokers to essentially cause a bid war for our business.

Your plan, Deal, would completely transform the Healthcare game.... FSA is a great way to put individuals in charge of their own quality of health/healthcare services. Corporations/small businesses would be able to add into the FSA as a true benefit, as it was originally designed.
Mandatory will never feel like anything but a shift toward a dictatorship.....

I truly hope that you will put this plan design out to a broader audience..... and most especially to your extensive list of politicians, and any general Insurance Underwriters you might have in your rolodex. NOW is the hour to get an alternative idea front and center!

And, there must be a way to intelligently discuss healthcare insurance reform without resorting to transparently silly distortions of what is currently under consideration.

Deal's political alternative reads like an insurance lobbyist's astroturf dream-script. Not to mention the (effectively) huge pay cuts for America's workers. All Americans would be totally and individually exposed to the heavily documented predatory practices of the insurance industry under Deal's plan. Greed seeks its own level. Any "regulations" imposed upon the insurance industry would be circumvented by new "work-around" abusive practices in a totally "free-market" based health insurance environment. These predators can be kept honest only with a government-run competitive public option (or equivalent) in play.

Imagine what would be happening today to our 65+ citizens if there were no Medicare and all seniors were the victims of the predatory practices of the health insurance industry. The industry would give euthanasia a bad name! We all need to comprehend that the for-profit health insurance industry's goal is profit, not "providing healthcare." The industry profits by denying healthcare, not by provding it.

I don't want to be at the total mercy of the predatory health insurance industry today or in a few years when I turn 66.

First of all I am not against some type of universal health care
BUT I am against Government owning and running it. I would like to digress back to when Medicare was started and I had just turned 30. I had an Uncle who was City Auditor for a small town in Ohio at the time. He was totally against the Medicare Plan and said it would end up being a disaster. His prediction turned out to be correct. However, the biggest part of the problems come from Government waste and dishonesty from big business (in some cases) which has gone on since the beginning of time. It's done by both parties but I do think the Democrats love to run all aspects of our lives more than the Republicans but I'm not giving them a pass either. If they ever got their priorities straight and not be run by the people in the background that own them we might make some progress but Don't Hold Your Breath.

I like the guy at that town hall recently meeting who shouted, "Keep your government hands off my Medicare!"

I, too, hope you'll put your ideas out to a broader audience. Why not consider sending it to your state's US senate and congressional representatives? Or allow us to quote your article in a letter we might send, for example.

I had a HSA with a high deductible health plan last year, provided through my employer. I chose to enroll myself and my husband in the plan, figuring that at the time, we were both reasonably healthy. It was the first time it was ever offered, and it caught on slowly with many of my co-workers. It was not, as some are, funded by my company. We had to set aside a certain amount from our paychecks to go into the HSA, and presumably, once it reached a certain amount, it would then be eligible for inclusion in a quasi-401k-type account where it would earn returns through a series of mutual funds.

My account never got to that level for the simple reason that my husband unexpectedly developed a blood clot in his ankle for which he had to be hospitalized for four days. To make a long story short, I used the balance of my HSA to pay for the portion of the hospital bill we were responsible for. Once the plan year was up, I went back to one of the traditional PPO plans on the urging of my hubby. I am paying more than I would with an HSA/HDHP, yes, but I do like the idea of HSAs - they do give you a level of control over your health care spending, much like following a household budget.

The only difficulty I had was trying to estimate costs for procedures and office visits. These were presented in a range format rather than a specific dollar figure. I automatically assumed that it would likely be the higher figure, and if it wasn't, then that would be a bonus. Of course cost was not an issue when paying for OTC medicines, vitamins, etc. at retail - it said on the receipt that it was eligible under an HSA.

I would hope that if HSAs caught on in a significant way, the issue of cost for medical procedures would be clarified and be made transparent for the consumer.

"UPS and FedEx are doing just fine. It's the Post Office that's always having problems" - President Obama, August 11, 2009

I'm sorry, but Deal's proposal is just as much a no-go for me as the currently proposed reform. Although he puts forth some changes I like, such as the portability; in the end the result will be the same or at least delayed - government bureaucrats will be overseeing citizens' health insurance.

Mandating that I must carry an HSA? What if I don't want to - will the government fine or imprison me? And the idea that I must carry a minimum amount of insurance or that insurance companies must provide coverage for certain services is just appalling. Perhaps for now Mr. Hudson would approve of a "minimum" requirement. But once a federal agency is given the authority to set the rules that agency also will be able to change those minimum levels in the future. And this will most likely not be done by legislation but policy changes set by unelected officials.

Nor should different service providers be forced to offer care at the same prices. Why would the Mayo clinic with it's highly skilled doctors remain in business if it must charge parity rates with an underperforming doctor? And conversely, who would be able to afford insurance if all the rates would be set high enough to keep the best doctors paid well enough to stay?

In the end, mandating what actions individuals must take will not provide a solution. It will only shift the burden and make the problem worse.

Governments do nothing to create healthcare. They do nothing to create goods and services. They do nothing to generate wealth for a nation. Why in the world does anyone want to put our very personal survival in the hands of perennially bankrupt government entities???

American workers and businesses are the right people to give good healthcare to the greatest number of people at an affordable price. The answers are in the private sector, as always.

BDK, please stop it already with the 50 million uninsured meme. When someone uses that figure we know immediately that that person is not playing fair. One third or one half of those 50 million are illegal immigrants--if the country wishes to make taxpayers responsible for their health care, fine. But people deserve to know that that's what's happening. Other large chunks of that 50 million uninsured are people who are between insurance, uninsured for a few months at most. Are they "uninsured"? Well, in one sense, yes. But if people knew that a large chunk of the 50 million formerly had insurance and are on the way to getting it again, the effect of the statistic would be different. Another chunk is people who can afford insurance but refuse to buy it.

Those who truly cannot afford insurance need to be helped. But they make up perhaps 5-8 million. Those temporarily between insurance plans also need to be helped. But to imply that they are totally without insurance is misleading.

I suspect that you knew this already but chose to use the inflammatory 50 million figure (which was 47 million only a few days ago).

I have not respect for people who argue their case this way.

The insurance exec's comments were wonderful.

I'm skeptical that mandated coverage is feasible. Tens of millions aren't covered today because they can't afford to be and forcing coverage on them in a (as I believe) permanently weakened economy will force millions into bankruptcy. Why mandate coverage by a medical system already out of control--far too expensive for what we have to pay? The larger problem, IMHO, lies in the medical system itself, not in how we pay to enter it.

The "health insurance problem" began back in the 1960s when Lyndon Johnson created Medicare. It was a noble idea but (Government being what it is) costs soon ran amock and nothing anyone did since brought them much under control. Insurance companies added more to the costs rather than reducing them.

I do not think we can fix this system by any known methods. Deal's proposals may ease some problems but the medical system itself is broken. In any case, since I don't think the economy is going to come back, the whole discussion may turn out to be academic. We will "solve" the problem of costs by making medical care too expensive for more and more people.

But, Deal, I hope you can prove me wrong.

Matt wrote: "Mandating that I must carry an HSA? What if I don't want to - will the government fine or imprison me? And the idea that I must carry a minimum amount of insurance or that insurance companies must provide coverage for certain services is just appalling."

"Mandating that I must carry liability insurance on my automobile? What if I don't want to--will the government fine or imprison me?"

You'd better believe the government will fine or otherwise punish you. Because uninsured motorists harm, injure, do injustice to other motorists.

Quibble about exactly how to go about mandating health insurance coverage, how to help those who can't afford it etc. There's plenty of things to argue about in the details.

But your blanket statement denying that laws requiring people to protect other people around them from things they do or things that happen to them are reasonable as part of concern for the Common Good is incoherent.

If people want to self-insure and have the resources to do it, fine--set things up so that's an option and then trust but verify that they've truly set aside the resources. But to permit those who can afford insurance but refuse to buy it to cause others to pay for their foolishness is wrong.

Wouldn't it be prudent to first help those in most need and force our notoriously irresponsible government prove that they can handle that task responsibly before expanding the system?

Here's my proposal. The Federal Government will provide health insurance for:

- Every citizen starting at the age of 65 (their obligation to pay property tax should end at this age as well)

- Every citizen who cannot get health insurance due to a pre-existing condition.

- Households making less than $30,000 per year and people currently unemployed (excluding illegal aliens).

The expansion of the system will be paid for with cuts to unfunded Federal employee pension programs, starting with elected officials. So as the Fed wants to expand the "system" they will in effect be reducing their own retirement benefits. That way we will know just how sincere they are about helping the poor as opposed to merely expanding the role of the Fed Gov.

Why can't they...

1. Remove the employer tax deduction for health insurance.
2. Make available Health Savings Accounts for anyone who wants one.
3. Allow an annual tax deduction equal to the health insurance premium plus a contribution to the Health Savings Account that is equal to the deductible amount of the insurance.
4. Provide tort reform to limit the amount of malpractice insurance required by doctors.
5. Make Health Insurance Vouchers available to those who cannot afford health insurance on their own.

Of course as a practical matter, it would likely make sense to provide some sort of phase out of Medicare and Medicaid instead of ending them outright.

The problem is that health insurance already is SOCIALIZED medicine, it just happens to be run by 1000s of "little governments".

Insurance is intended to protect you in the event of a MAJOR catastrophic event. In other words, you buy insurance to protect you when your house burns down, not to change light bulbs in your house every three months.

To solve the problem, only three steps are necessary:

1. Tort Reform - Reduce doctor's malpractice costs.

You just can't sue for every bad luck mistake that happens. Sorry. If it is criminal negligence - fine. Bad luck - you should get a refund, and that's it.

2. AMA - Break its power to limit the supply of doctors.

The AMA artificially lowers the supply of doctors. They are a labor union like all others. Bust them up - if someone wants to be a doctor, and they meet the requirements - let them. No more quotas.

3. Non-Catastrophic Health Insurance - Illegal to sell.

Non-Catastrophic health insurance is just socialized medicine, pure and simple. Not needed. We should pay for ourselves.



But, what about the poor? They (and we) should follow the Church's teaching on subsidiarity - they have an obligation to do all they can to take care of themsevles, and we have an obligation to take care of them when they honestly cannot.

VJM is right on the mark.

I can't believe how much nonsense talk is out there about the "success" of Medicare & Medicaid. How do they measure success? If raw coverage ... okay. If coverage compared to cost ... I question it. There is so much waste and abuse that exists in those programs it can make your head swim.

Tsk, tsk. Obama would be disappointed (or should I say pleased?) in your spreading of disinformation...

There are likely other reforms being proposed but here are two that are actively in the House & Senate:

1) Patients' Choice Act (H.R. 2520) - Rep. Paul Ryan (R-WI)

2) Health Care Freedom Act (S. 1324) - Sen. Jim DeMint (R-SC)

*Notice the R.

Most of the comments are well meaning and very thoughtful, however this battle is not about fixing health care. It's
about total control over all aspects of our lives - moral, physical and financial.
Advocates of government control have been on this march for the last hundred years. Each manufactured crisis affords them the opportunity to seize more and more power. They do not care what the cost is in terms of death and destruction. Every program they get passed goes bankrupt. Kindly reference federal income tax, the federal reserve, social security, war on poverty, medicare, medicaid - just to cite some of the more obvious examples.
This health care debate is starting to arouse us because it is threatening our existence as a free people. The hyperbole 'Death Panels' used by Sarah Palin to describe very troublesome aspects of HR 3200 has inflammed passions on both sides of this issue. It has resulted in people taking a keener interest in what is at stake.
The House and Senate bills need to be killed. Lawmakers who are perpetrating this fraud upon the American people need to be voted out of office and term limits put in place for all of our elected officials. These people work for us. They are not our rulers!!!
This will be the only way we can begin to undo the damage that has been done to our representative republic over the last one hundred years.
Should a "health care" bill pass - it will be the final nail in
our coffin.

Party, Schmarty
There are good reasons why many Republicans (since party has apparently, and in my view unnecessarily, become part of the discussion) are opposed to the current plan. Many Democrats are opposed for the same reasons -- though others are not, for various reasons ranging from not wanting to politically undercut "their" side to simply not knowing better.

But enough about parties. Good ideas are good ideas no matter who has them; ditto for bad ideas.

Certain Attributes
There are certain attributes the solution ought to have; there are others it shouldn't.

Mostly it shouldn't be too central; it shouldn't disguise price as a message of value; it shouldn't establish perverse incentives or prevent people from feeling they're spending money when they buy health care. Yet the ability of the poor to afford health care should be brought closer to the ability of the wealthy, and the children and elderly should be assisted most of all.

Candidate Plan For Your Perusal
Here's a possible plan which would meet those attributes:

- Universal, Mandatory, Catastrophic-Health-Expense Insurance selected from private insurance carriers. Just for the unexpected bombshells, doesn't cover normal office visits, colds, broken ankles, and the like;

- Replace "Insurance" with Health Savings Accounts for non-catastrophic expenses;

- Eliminate employer-tied coverage; each individual has his own HSA and his own individual Catastrophic Coverage;

- Let Catastrophic Coverage be paid out of the HSA;

- Let payments into the HSA have mandatory monthly minimums proportional to income (higher-income means higher mandatory monthly pay-in);

- The mandatory monthly minimums are cut in half once there's a given threshold amount saved up in the HSA, and this amount varies by age but is the same for everyone of a given age;

- Let government "matching" contributions feed into the HSA's to increase the amount in them quickly, and let these be inversely proportional to income (lower-income means higher matching funds added);

- Eliminate "copays" and anything which disguises the true cost of health services to the consumer;

- Expenses for children and elderly paid from their HSA's are reimbursed back into the HSA by the government at some percentage based on age as follows: Under 2 years: 90%; 2-4 years old: 70%; 5-7 years old: 55%; 8-10 years old: 11-13 years old: 40%; 14-16 years old: 20%; 17-60 years old: 0%; 61-70: 20%; 71-80: 40%; 81-90:60%; 91-100: 80%; 100+ years old: All paid. (All ages 60 and higher are adjusted over time as average life expectancy increases);

- The funds in an HSA are private property. While they aren't transferable to others while the owner lives, they can be willed into the HSA's of inheritors as part of an estate, tax-free;

- The funds in an HSA are usable for health expenses only;

- The expense of this plan to be paid by local governments, with assistance from state governments in the form of matching funds; and by state governments, with assistance from the federal government in the form of matching funds. The role of the federal government will extend to infrastructure and standards for data management, the payment of matching funds, and the involvement of federal law enforcement in tracking down corruption or fraud in the system.

There you go. The benefits are:

(1.) People buy health services and products as true consumers, producing transparent pricing signals and incentives to shop around, producing competition between providers;

(2.) Low-income folk get greater matching, thus partly closing the affordability gap between low-income and high-income folk;

(3.) Catastrophic care is handled and both children and the elderly become more easily-afforded by their respective caretakers, but adults are responsible for making prudent decisions;

(4.) There's private competition between catastrophic-coverage plans as there currently is between auto- and home-insurance carriers;

(5.) Employer lock-in is eliminated;

(6.) Central federal control over treatment choices is eliminated;

(7.) Taxpayer dollars don't get spent to pay for abortions, sterilizations, sex change operations, and the like except in the form of matching funds to the low-income HSA's, or in the rare cases where such things are purchased by/for a kid ages 14-16 (and then only reimbursing 20% of cost), or in the even rarer cases where such things are purchased for a person over 60 years of age (a threshold which will rise along with life expectancy).

There ya' go.

It's a straw-man proposal. Don't like it? Fine, come up with something better, my feelings won't be hurt.

But I think it illustrates a lot of features that the proposed Obama plan gets entirely wrong, and thereby gives us a checklist of features we ought to demand when we go shopping for a real solution.

I have been advocating for several years the exact proposal you are making. Thanks! I hope yours gets a better reception than mine did.

Deal,

The HSA, "health Savings account" plan is the one I have. I love the way is works. I save money by selecting the options I want.On a National level people would support it.The left, however despises this approach. Not in the cards right now. Actually I believe that the main house bill outlaws an HSA option.

Thanks,

Doug Moore

All,

HSAs are the direction to go. They empower the individual to choose that which is in her or his best interest (actually, a tenet of liberalism in the classical tradition). They eliminate the problem of portability because it is a contract with the individual, and therefore should follow the individual. With a few exceptions, the pitfalls of "pre-existing conditions" go away, and instead it cultivates a long-term relationship that encourages wellness practices by the policyholder, to the benefit of the underwriter.

I certainly do not want to be too PolyAnnish, and have no doubt about the desire of insurance companies and the like to make a profit, but I believe that God created us with a free will - as free agents so to speak. This, I was taught, is liberalism in the classical tradition. To the extent we incorporate freedom (or liberty) in how we structure our society and laws, is the extent that we will take advantage of our created capacity. It is one of the reasons why free countries seem to enjoy such abundance.

[At the same time, we are fallen creatures, therefore need governing or regulating by appropriate laws. It is one of the reasons why free countries seem to be challenged by various elements of excesses or decadence...perhaps a discussion for another time.]

On the question of healthcare, HSAs seem to strike this necessary balance between liberty and law - between God's creative genius and our fallen nature. [See Federalist #51, I think]

One thing for sure, I do not trust government with my healthcare provision or even management. It is not because they do not intend good, they do. Rather it is because government folks are just like any other folks: they are fallen human beings and cannot escape the consequences of such, magnified by bureaucratic circumstances. When you lump all those folks into one bureaucracy, ugly things happen.

HSAs take the power of choice away from the government and put it in the hands of the individual - a liberal (and liberating) concept!

Just the opinion of one geologist and ex-legislator.

Hopper Smith

I like a lot of what Deal and RC had to say. Some other comments are pretty far out there (of the genre, I've got mine so forget about doing anything for anyone else).

However, there needs to be a mechanism to protect the individual from their insurance company and to provide choices between insurance companies. Currently we have no defense as an individual (and one can only get very expensive, limited policies then). Even working for a large company is still a somewhat weak defense against predatory behavior of insurance companies to maximize profit. I don't believe anything save some national mechanism to protect individuals can be truely effective in all parts of the country. Some states now have only 1-2 insurers available to them which means they're at the mercy of the insurer and other components of the health industry. I don't much care what that mechanism is or how or who operates it, but it must be a key component of any national health plan.

I would prefer that Congress scraps all the current bills and passes one that is no more than 25 pages and which an average citizen can read without the help of a lawyer.

Tom:

I agree about the risk of predatory behavior by insurance companies.

Yet I do not think centralizing all the decision-making power in the government solves the problem. Quite the opposite: It gives insurance companies far greater incentive to buy politicians, and thereby ensure the politicians don't do anything that cuts into their profit margins.

In that sense, I see the Obama plan as offering no change: It remains an empowerment of the insurance companies against the insured sick.

In a market environment, one chooses an insurance company on the basis of its rating, and consumer choice combined with consumer watchdogs of the Clark Howard variety help to damage the public image of insurance companies that get too stingy.

But when government is involved, the situation changes: One sick person who may die before the next election is trying to get the attention of a politician in order to turn him against the insurance company that's funding his re-election campaign. This is true with or without Obama's plan.

Now there are regulatory agencies in the states (insurance commissioners and the like) which, together with consumer advocacy groups and personalities like Clark Howard, can assist the sick "little guy." But these means are effective in reverse proportion to how big, monopolized, and in-bed-with-government the Insurance Company In Question happens to be.

If it's really big, with few competitors, and has lots of government policy and subsidy to support it, all the outraged consumer watchdogs in the world won't help: Only a change at the ballot-box will be able to "punish" such a company.

But if it's small, with many competitors, and is not part of a system of government protection, then it must fight to keep its reputation, lest it loose its customers!

This is why my proposal has two important provisos (one stated, one unstated):

(1.) Use HSA's to pay medical expenses up until they reach the "catastrophic" threshold. In short, for normal purchases, there IS no insurance involved; and,

(2.) Make sure there are lots of options for obtaining the catastrophic insurance, which is mandatory. (I didn't explicitly state this in my proposal, but my intent is for this market to operate much like the market for auto insurance, which is similarly mandatory, and -- as I think everyone has noticed -- has lots of competing players.)

By reducing the insurance market to only "big expensive cases of catastrophic care needs," we give insurance commissioners less to do; they can focus their attention on fewer disputed claims.

Or that, at least, is my hope.

This is basically the health care system we had between 1800 and 1882, which failed so badly that Blessed Father McGivney started the Knights of Columbus to help families impoverished by the illness and death of a breadwinner.

I'm amazed that Catholics could be so ignorant of history to propose a system that has already failed miserably.