4 ms·

Healthcare insurance isn't the best example given that several cantons want a single payer system but can't have it right now.

m_mueller 10y ago
The insurance is only one component of a healthcare system though. What I have in mind is a decentralisation of the whole system (which is distinct from a privatization though, which I oppose for the most part). Allow me to explain. Here's the components of a health system as I see it: * infrastructure in general, I'd call them infrastructure nodes. These would be hospitals, clinics, ambulance services, care services or even preventive institutions such as public sports grounds, public cantinas or public tooth brushing lessons. In fact I'd extend this to every piece of infrastructure where free market doesn't work due to economic hazards, both unwanted (monopolies, asymmetric information, ..) and wanted (nurses and doctors who go the extra mile for each patient instead of being forced to go by the numbers only). So this includes roads, airports, public transport at least in less dense areas, electric infrastructure, emergency services etc. * tracking of health conditions & outcomes and transparent data, for each infrastructure node above a certain size. * a health care cost model that's centrally governed (luckily we have that already in Switzerland). * a certification system for infrastructure nodes above a certain size that's centrally governed (so everyone can still start one). * a tax system that I can subscribe to that includes access to a specific set of infrastructure nodes (others are still available, but need to be payed individually according to the steered cost model). This essentially forms a virtual commune. This being bound to local or regional areas may often still make sense, but there could be other models, for example business travellers could subscribe to an 'all-cities-and-interconnects-included' model. These are basically just funds that anyone or any organisation can start to manage, that has inflow (taxes) and outflow (payments to each infrastructure node for their provided services according to the tracked data). You can also look at this as a privatisation of local government. * policies by either big reinsurance firms or the central government that back these decentralised tax funds. Essentially, a potentially decentralised / privatised version of the cantonal fiscal balancing. * mandatory public education where everyone can learn about what makes up infrastructure nodes and why or if we need each one, so everyone can make informed decisions about which tax fund to subscribe to. * a basic tax fund operated by 'classic' government that allow people to stabilise their economic situation (and allow their dependents the highest education) if they fall through the cracks of the system. This would also fund everything that still needs to be kept centralised, such as a military. Financing this could be done through VAT or through to-be-defined tax flows from each private tax fund into this basic fund. After you're done with this, together with crypto currency, you could have a really small central and local government. Military and police would probably be the number one cost drivers there, but that's maybe 30% of what we have now.

m_mueller 10y ago

The insurance is only one component of a healthcare system though. What I have in mind is a decentralisation of the whole system (which is distinct from a privatization though, which I oppose for the most part). Allow me to explain. Here's the components of a health system as I see it: * infrastructure in general, I'd call them infrastructure nodes. These would be hospitals, clinics, ambulance services, care services or even preventive institutions such as public sports grounds, public cantinas or public tooth brushing lessons. In fact I'd extend this to every piece of infrastructure where free market doesn't work due to economic hazards, both unwanted (monopolies, asymmetric information, ..) and wanted (nurses and doctors who go the extra mile for each patient instead of being forced to go by the numbers only). So this includes roads, airports, public transport at least in less dense areas, electric infrastructure, emergency services etc. * tracking of health conditions & outcomes and transparent data, for each infrastructure node above a certain size. * a health care cost model that's centrally governed (luckily we have that already in Switzerland). * a certification system for infrastructure nodes above a certain size that's centrally governed (so everyone can still start one). * a tax system that I can subscribe to that includes access to a specific set of infrastructure nodes (others are still available, but need to be payed individually according to the steered cost model). This essentially forms a virtual commune. This being bound to local or regional areas may often still make sense, but there could be other models, for example business travellers could subscribe to an 'all-cities-and-interconnects-included' model. These are basically just funds that anyone or any organisation can start to manage, that has inflow (taxes) and outflow (payments to each infrastructure node for their provided services according to the tracked data). You can also look at this as a privatisation of local government. * policies by either big reinsurance firms or the central government that back these decentralised tax funds. Essentially, a potentially decentralised / privatised version of the cantonal fiscal balancing. * mandatory public education where everyone can learn about what makes up infrastructure nodes and why or if we need each one, so everyone can make informed decisions about which tax fund to subscribe to. * a basic tax fund operated by 'classic' government that allow people to stabilise their economic situation (and allow their dependents the highest education) if they fall through the cracks of the system. This would also fund everything that still needs to be kept centralised, such as a military. Financing this could be done through VAT or through to-be-defined tax flows from each private tax fund into this basic fund. After you're done with this, together with crypto currency, you could have a really small central and local government. Military and police would probably be the number one cost drivers there, but that's maybe 30% of what we have now.