Yes, I agree with you for the most part. I think that we can do a much better job, and at lower cost, of providing basic medical care for everyone. Then, just as people buy supplemental insurance with Medicare, so could any person or employer buy supplemental coverage.
I can see downsides, though.
For a long time, the American healthcare system was willing to “do everything”. If, say, a treatment had only a 5% chance of cure, it would happen despite the lack of “objective” cost-effectiveness. Admittedly, that caused American healthcare to be more costly than in some places where they didn’t “do everything”.
The American system is transitioning to a perceived cost-effective system. That’s what “evidence-based medicine” is really all about. It is assumed, for example, that “preventive” care is effective in avoiding huge costs later, even though the studies show that it does not change outcomes. So, what it is turning into is a means of saving the system from having to pay for care in a lot of instances. Of course, it also has politically popular but cost-ineffective accretions like totally free birth control and abortifiacients that are inexpensive for people to pay for anyway.
Likely political accretions will continue, as will political deletions. Not too long ago, government programs increased reimbursement for “well care” while reducing them for “chronic care”. Again, the supposition (which seems to be false) is that preventive care will avoid later big costs.
More and more, medicine is turning into “computer medicine”. There is increasing institutional resistance to going outside the computerized “evidence based medicine” algorithims, because departures from them are questioned when it comes to reimbursement, or simply not reimbursed at all. Obviously, it wouldn’t take a lot of tinkering with the algorithms to avoid paying for treatments that might simply be undesirable politically to whoever is running the show. Already, the intrusive questions physicians, nurses and NPs are required to ask at least annually and document, along with the directives they must mechanically give, present the hazard of being declared “noncompliant” or “chronic”, in which event one is likely to be dropped by money-oriented providers. In the case of employment-based insurance, “noncompliance” already increases the amount the employee must contribute to his insurance plan. The computer says your BMI is too high, the NP tells you to lose 30 lb, you don’t, your premium goes up. Simple.
So, as perhaps an extreme example, “Suzie”, who has four children already, repeatedly hears suggestions from the nurse or the NP or the PA or the doctor that she might want to not have any more children, (which they do advise) and then has a fifth child even so, then how does “Suzie” get categorized? “Noncompliant” perhaps?
A totally private pay sector would avoid all of that because it could, and some percentage of the populace would have the kind of “do everything” medical care that nearly everyone once had. Where there’s a demand, a supply springs up.