An idea for health care reform is forming in my mind, being synthesized might be more accurate. As I listen to Republicans calling for a state-based system with a lot of preventive care and as I hear Obama speak about public-private collaborations and as I think about fundamentals of American culture it begins to form.

What I envision is that the federal government would establish the structure of this with regulations and then farm it out to each state. The reason it could be wise to have a state-based system is that different insurance companies may operate in each state and with a large number of insured there will clearly be a need for staff to handle problems. It also serves the Repub idea of keeping Washington government from growing even larger.

Within each state you would sign up anybody who isn’t already insured by their employer, Medicare, Medicaid, SCHIP or any other insurance plan. They would be taxed at a set percentage of their income (if they have any income) and that money would be pooled. The state would negotiate with regular existing insurance companies to get the best plans and rates for this pool of individuals. The federal government regulations of what kinds of plans and so on would apply. The difference between the cost the state could negotiate and the pool of money already collected would be made up by the federal government.

Separately, to create more competition within the health care system, the federal government should create more medical schools (or at least expand the student body) and create incentives for students to become general practitioners (least cost care for individuals). Also, government should somehow encourage the creation of more clinics or multi-purpose health service companies (there’s one near me which does almost everything except beds for in-house services, ER and surgeries) in order to produce more points of easy-access for patients and to produce more competition. I believe it’s quite common for a community to have one or two large medical centers which gobble up all the business and set the prices. Funneling everybody there through their ER is highest-priced service and bad.

Finally, the thing we’ve already heard most about and which I agree is tremendously important, federal government changes in incentives, best practices standards, information technology for medical records, prevent insurance companies from interfering with doctors and other ways to improve the overall system to save money.

Save the health care money through better systemic practices. Induce more competition to restrain prices and to increase accessibility. Begin requiring best practices to get cost reduction and better care for patients. And, insure everybody!