Q: "If you make it mandatory, people will hate that."

This was a statement from a physician colleague I'm getting to know better.

Yes, I believe that "forced" anything is contrary to how Americans are coded. We love our free will and enjoy exerting it any time that we can.

With that said, each state will come up with their own version of "mandatory." Ideally, since each state's healthcare fund will be a private non-profit, people will have to right to "opt out" and not be involved in the company. But it's with the caveat that if a person opts out, they will lose the benefits of being part of a company that can leverage down the cost of medications, determine the board of directors, moderate the chargemaster and reimbursement rates, etc.

Additionally, physicians and other providers aren't required to "do" anything other than keep their license/registrations intact and practice within the rules of their governing boards for their respective states. There's no insurance panels to contract with or restrictions on what they can charge. In regards to the universal health record, providers aren't required to use it...but when you'll have a person's entire health history in one place without HIPAA and unnecessary billing hurdles, I think every physician will gladly use it. Besides, patients will come to expect that as part of their care so physicians will adapt to stay competitive (since we'll be in competition with each other more directly.)

There are offshoot questions to consider..."should the fund be funded once a year by everyone? Quarterly? Should there be open enrollment?" All these questions are state specific and will be determined by the shareholders (the people of the state) and their elected board of directors. That way, people are directly accountable to each other rather than the federal government.


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