muy bien

I don't quite agree with all of these proposed solutions in total (in part because I think he just pulled some numbers out of a hat at that point after having done research personally and presumably at his own expense in other facets), but he's definitely diagnosing the blame and responsibility of the problem accurately in my opinion. The idea for things like monthly fees for primary service or low cost clinics is certainly worth examination within a market spectrum. I am not sure that an HSA, even an HSA system with an extremely high deductible of 50k a year is necessary to address and control costs by shifting the costs to consumers and removing the disguise of cost and value assessments for doctors. There are still some asymmetric information issues that doctors or pharmaceutical companies would need to have addressed in some way (perhaps by changing our advertising regimen for drugs and medical procedures for example). But if the costs incentives are shifted from a fee for service model to a salaried position with fixed costs, as it would roughly have to outside of very specific, usually voluntary, medical procedures in an open market, we may not see this as a huge factor in the run-up of cost. I know I pay in this way for veterinarian services (for now). I'd probably would just budget the cost once my cats eventually perish and I get new animal companions. But it's certainly more efficient and still must be a profitable business model with some broad consumer appeal. It's not much of a fee for service system at that point since most primary things like vaccines and exams are covered. Why such a model couldn't work efficiently to help manage people's basic health care costs while ensuring that they still receive basic, preventive, medical care is somewhat questionable.

As far as why we won't get anything like this now, or why nobody is talking about it with this level of seriousness (despite health care policy wonks who have studied the issue in this way from all political and economic sides advising various schemes similar in nature), I think the problem is that many reformers have simply assumed that the costs are caused by profits and inefficiency of health insurance within a market economy, and that's why we're getting a bill that mostly targets health insurance costs and reforms or proposes to compete with that using a government system (something we already have in the form of medicare and it only works very slightly to curb costs). Also the conception that regulation has too often failed to serve its intended purpose and instead reinforces those complained about corporate boundaries and profits cannot be admitted. It's far easier to vilify those boundaries and profits without attempting to examine why they exist in the first place. In all what we have so far is an attempt to regulate the insurance market model using employers to subsidize cost and some vague assessments that will reduce some costs, but which have to be born by the public rather than the actual industry that's putatively being reformed. That's totally inadequate. A "comprehensive reform" would examine that many of the costs are endemic to how we pay for health care and how we (over)value it as a commodity and seek to break that model. Smash it into dust and start over.

Maybe that's too radical for people to accept as it would upset the established order too much, but in my mind, continuing to paper over difficult problems is not why we, as a public, elected someone on a mantra of change. Truly transformative politics aren't likely to happen without someone making some bold and assertive decisions somewhere and getting behind them with the full force and fury of their ability to argue for them emotionally and intellectually.