Under this system, health care payment insurers would handle all payment to their network providers.
A hospital raises its prices to compensate for the fact that people often don't pay their deductible.
If the doctor wants $100, then the insurer would pay the $100, not merely $80. A doctor wouldn't have to charge $125 to get $100 and staff wouldn't have to bug you for $25.
Normally deductibles and co-pays are used to help prevent overuse and abuse of a health care and health insurance system.
I would get a $1,000 quarterly MRI cancer screen scan with biopsy follow-up like many rich people if medical care was entirely free.
A person unwilling to pay a $20 co-pay to save their own life won't like to pay a decent wage of $20/hour or vital taxes.
Paying Medicare-level co-pays and deductibles, even indirectly to an insurer, tells medical professionals that you have a serious problem that merits their careful attention.
Also, your insurer wouldn't have to raise premium rates about 25% to cover a change from 80% to 100% actuarial rate coverage.
United States mandated coverage rates might drop 1% if premium raises weren't prevented. The transfers would be done by computer.
The co-pay and deductible money is best collected in advance over time, as is the money that supports Medicare.
A new FICA-like mandatory contribution of four percent of income from an individual and two percent of earnings from your employer would fund one's personal, bequeathable, government administered, HSA-like account.
Account money would be invested in high-quality state and municipal general obligation bonds to earn interest.
If you run down your account, Uncle Sam would pay from a Treasury account, so you'd always get care. If you are uninsured, EMTALA care could be paid for at Medicare rates from the system.
The system might also be used to replace the unemployment compensation system too.
If you are unemployed over four weeks and not receiving Social Security, then you could withdraw through an unemployment office supplied ATM card up to 125% of your mortgage or rent monthly down to $2,000. If your state's unemployment is above 8%, you could withdraw down to $0 if unemployed more than 26 weeks. Letting people draw down to $0 increases the risk of the federal government having to pay for your EMTALA and other medical care, so it should only be allowed under what should be rare circumstances.
Note that 6% of $30,000/year paid for seven years is $12,600, 42% of one's annual income, and would normally be paid upon request. Right now only about 30% of unemployment claims are honored and the total 26 weeks payout might be 30% of your annual income. Under this system, unemployment funds could be collected without having to be able to work. The current system normally requires self-certification of fitness to work and at least two weekly employer contacts.
Employers quite often pay about 2% of wages into the current unemployment system.
Note that under this system the percentage amount employers pay for unemployment compensation doesn't depend on economic conditions, so employers don't have to worry about hiring even when unemployment is high. Employers currently don't like to hire long-term unemployed since an employer could get stuck paying for a new round of long-term UC if the economy takes a double-dip.
Once you reach Medicare age, 4% of your Social Security income would go into your account.
Medicare supplemental policies would get correspondingly cheaper since they wouldn't have to pay out on deductibles or Part B co-pays.
If you die, Medicare might levy most of your last seven days cost of care (100% of Part B except ER examination, hospital in-patient (or "observation") $600/day[ICU $2,000/day]) from the account.
If any money is left, then the money that was yours would be paid out to an heir.
A 97-year old dying without futile last seven-day inpatient care who got $700/month in Social Security might leave up to $12,080 ($2,000+(30*700*.04*12)) to an heir through the system.
All of the 4% that you put in will come back in the form of paid medical care, unemployment income, and money you can leave to an heir.
This forced personal savings with employer tax top-up system could also work together with a tax-funded "single payer" system.
The co-pays and deductibles could also be made income dependent. An $1100 annual hospital deductible might be changed to be 1% of one's last five years of income. It is hard for a commercial insurer to utilize income-dependent deductibles, but easy for the federal government to do so.
Also, many medical care items are such that a co-pay isn't really needed, such as treating open (exposed bone) fractures.
Note that I am an advocate of national, all the doctors prescribe, fixed budget prescription drug purchasing without individual drug co-pays.
