Plenty of countries have universal health care without a single payor system (eg Switzerland, Japan, Thailand). BUT, government does set caps on costs, and all health insurance companies must be non-profit.
Right. I think many aspects of the Swiss and Dutch approaches have a lot of merit. Everyone has coverage, there is still competition, people can choose their insurer, folks with pre-existing conditions can get affordable coverage, etc. It's not what I would want in an ideal world, but it's probably better than socialized health care (i.e. care provided by government employees), a giant Medicare system (single payer), or the non-system patchwork mess with confused incentives and employer involvement we have today.
I'm not sure that we'd need to exclude for-profit companies--the 3-5% profit they would make in a competitive marketplace (including non-profit entities and co-ops) would be a drop in the bucket and would provide more new approaches, more competition, and needed capital. And, as far as capping costs for procedures--I don't know if we need that if we establish better price transparency, co-pays, and a more efficient marketplace for the insurance policies themselves. The advantages of getting the unwarranted third party (employers) out of the business would pay off big-time for everyone.
We may have legal/constitutional issues to overcome. If it turns out that it is unconstitutional to punish people for not purchasing a private product, maybe we need to back off the individual mandate and also the "guaranteed issue" in some cases. After all--the government doesn't (and shouldn't) get involved if a person wants to subsist on a diet of Beenie Weenies and Coca Cola, the government doesn't get involved if a person wants to smoke 4 packs of cigarettes a day, and the government doesn't get involved if a person wants to juggle chainsaws. If we set up a system whereby an individual can get basic health coverage and a catastrophic out-of-pocket annual cap of, say, 15% of their income (and maybe 5% of their net worth) and there are subsidies for the truly poor, I'm not sure why we, collectively, should be on the hook to pay any medical costs (incl emergency care) for a person who elects not to buy insurance and shoulder their own weight for their own benefit. No individual mandate but also no "guaranteed issue" if a person elects to go bare. Perhaps a considerable waiting period (24-36 months) for anyone who didn't sign up when first eligible (to prevent people from buying insurance only after the accident/diagnosis). "Society" (i.e. other taxpayers) would be doing everything reasonable to make life "more fair" (which seems to be a driving requirement), but an element of individual responsibility would be maintained. It seems like a workable compromise.
