No civilized society allows people to die just because they don’t have money for medical care. The United States is the only developed country without a universal health care system and where medical bankruptcy is a problem. Even people covered by insurance may suffer bankruptcy when insurance covers only 80% of care that runs into the hundreds of thousands of dollars. According to the Center for Public Integrity, UnitedHealth Group, the largest health insurer, reported in 2015 that it made $10.3 billion in profits in 2014.
Catastrophic care might be something that a state should cover for citizens, since most ordinary people do not have the funds necessary to pay for high unexpected medical costs and they can’t shop around and do price comparisons when there is a health emergency. This is why serious medical care is not something that can be provided by the free market.
The insurance industry we have today replaced earlier insurance plans, non-profit co-operatives or fraternal associations that were more efficient and effective. In a Direct Democracy, major medical care could be run like a giant non-profit co-op, paid for by fiat Treasury notes (for buildings and equipment), consumption taxes, and sliding scale fees/co-pays or high deductibles.
Could these programs just cover hospital and emergency care and wellness check and screenings? If everyone paid out-of-pocket for ordinary visits to the doctor would this help bring the cost of ordinary medical care down? Or could the poorest people be covered 100% for all medical bills and others pay according to a sliding scale for ordinary visits? Catastrophic care–hospital and emergency care–could be provided by state-run hospitals, leaving other doctor visits and routine care to the free market. How would the costs of medical treatment to the state be controlled?