Normally when you want to build something, you do a comprehensive analysis of what you want and address potential problem areas. You look at other designs to glean what whatever knowledge you can from other’s experience. You review different proposals with both the users and the maker. But there has been no open effort to design anything. There has never been a public comparison of the systems that other countries use.

First decide what you want in general and then apply the restrictions. Start with the general goal of all health care including preventive care, treatment including hospitalization, prescriptions, psychiatric care, vision/dental care and hearing coverage. This is simply a starting point.

The Hillary care proposal and Obamacare never attempted to look at the whole issue. Current suggestions of “Medicare for All” are made with out understanding the shortcomings of Medicare which involve the Part A premium, the Part B supplemental policies and the Part D prescription purchased policies. It is complex, confusing and costly. The weakest part of the proposal is that it doesn’t include a source for the funding.

Going to a government run Single Payer system runs into the argument “It would be government run and the government bureaucrats can’t do anything right”. Unfortunately government suffers from the 20-60-20 that affects most operations which is 20% of the employees are fantastic, 60% are moderate and do their jobs, while 20% are real problems. This situation with no appeal process would not be in the best interest of the country.

A Competitive Single Payer system is one way to provide healthcare. Why not let government do what it does best which is regulate and oversee such as the FCC. And let business do what it does best which is to survive and to survive it must provide the best product and service at the lowest cost.

If the country were divided into regions and insurance companies were contracted to administer the health care system in that region for 5 or 10 years, they would have to provide the best service or lose the contract. The companies would be responsible for the cost of providing health care and controlling waste, fraud and abuse. They would also be responsible for medical malpractice.

A government agency would let the contracts and provide the money to cover the services. They would also provide the arbitration function for disputes between patients and the administrative insurance companies and would evaluate the companies’ performance for contract renewals which would consider cost and customer satisfaction. The agency would also be responsible for handling malpractice disputes.

The Competitive Single Payer plan is one way to combine the strengths of a social program with capitalism. Maybe there are others, but it would allow everyone to have the healthcare that they need to lead a productive life.

Regardless of what is the route chosen to achieve a form of universal health care and how to pay for it, the question of “How do we get there from here?” has to be addressed. Any meaningful change may require years to achieve. We need political leaders who will open this conversation as well as which method to use and how to pay for it.