A four-step plan for American national health care.

doctorHere’s a 4-step plan to secure health care for all Americans.

Step 1: All children are covered without charge until they reach age 21 or graduate from college. This is a moral and economic imperative. Period.

Step 2: Medicaid is converted to a program that exclusively covers these children.

Step 3:  Everyone under age 65 splits the national healthcare bill by a politically-agreed-upon formula.

A political consensus is developed over income brackets. All persons in the bracket pay exactly the same monthly premium. In most cases it would be deducted from the individual’s pay or benefit check.

Medicare remains unchanged.

Step 4: Insurance companies can only charge the agreed-upon bracket rate and must take everyone who applies, period. Insurers would compete with each other based on efficiency and customer service.  Medical decisions would be made by doctors. Insurers would administer the plan its paperwork.


  • Two government-paid programs, Medicaid for youth and Medicare for the older citizens. The federal government oversees the programs, but the nurses, doctors etc do not work directly for the government
  •  Working-age people pay their own way in an equitable and affordable system.
  • The insurance companies must evolve, but are not put out of business. They would press for better outcomes, much as auto insurance companies do. They would join the two government agencies in negotiating fairer costs for pharmaceuticals. Better health outcomes, and preventive medicine, would increase their profits.
  • Mothers and fathers would be relieved of the burden of worrying about how to pay for children’s health care. No child would be denied health care under any circumstances.
  •  Japan, Italy, Spain, the UK, Australia, Sweden, Belgium, France, Germany, Austria, the Netherlands and Canada all spend $5000 or less per capital on health care. Eventually the American system could operate as efficiently.

Yes, working out the details would be hair-raising and complex, but that’s what the political process is for.

Your reactions are welcome. 

See Politifact’s estimate of the total cost of a single payer plan: $1,380 Billion