One issue is a big disconnect between user and payer. Government is especially prone to that, but any big organisation can have this problem.
Right now we basically end up going to Mexico if we can help it, where there's basically no real oversight or regulation to raise cost so long as the doc/pharmacy pays off the cartels.
I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.
Eg the FDA ought be to dissolved, and replaced with state level agencies. The state level agencies are, of course, free to cooperate and coordinate. Comparable to how the traffic signs work already in the US.
It's good for Hawaii and New York to have the same road signs, but they can agree on that voluntarily. No need to have a central party force them. Similarly, it's good for both states to have the same or similar rules on drugs, but no need to force them.
See also how the recent wave of cannabis legalisation has been driven by the states. I want to see more of that innovation and experimentation.
> I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.
In what I suggest each state would most likely still have mandatory regulation, but it's a lot easier to move between states to find a place that suits you best, instead of moving between entire countries.
I have lots of sympathy for your position, and I would hope that at least some states would take a more laissez faire approach. But the policies you get will ultimately still be decided by what's popular with voters, and they can be a fickle bunch.
I can't wait for drugs having to be certified safe in 50 different jurisdictions, instead of one, with 50 different agencies, each with a different set of politicians putting their thumbs on the scale having their own rules for them.
That'll really bring down medical costs, and will not at all destroy the incredible economies of scale that a single 350 million person national market creates.
I also can't wait for the cross-state litigation when an upstream state's equivalent of the EPA will be paid off to allow a firm to dump toxic waste into a river, that will be poisoning the people downstream.
> I also can't wait for the cross-state litigation when an upstream state's equivalent of the EPA will be paid off to allow a firm to dump toxic waste into a river, that will be poisoning the people downstream.
How much is that happening between eg Canada and the US at the moment?
Is that really what you want? It sounds absolutely mad to me. Your ideology is driving you to ask for a monkey's paw.
And yes, voluntarily following an example is better than being forced to follow an example. Duh.
Other states get the choice between not having cars, and following California's rules, despite having no input into them. Because it's uneconomical for manufacturers to produce custom, per-state models.
You're still forced to follow the rules, except that in the case of federal rules, you have democratic input into them, because you elect both the federal legislature and the executive.
In the case of non-federal rules, the largest state will set the rules for you, and you won't have any say in it (at least, if you want to have things like cars and drugs). That's not a choice.
Or, you could always take a look at how abortion rights are currently handled. Texas is suing people who get abortions in Colorado. Truly magical stuff. I'm sure the people in Colorado 'volunteered' for that.
The only way this works is if the government subsidizes the regulated market such that it is accessible (and sustainable) to an appropriate market. It also generally puts some populations at severe disadvantages, and usually those populations are disadvantaged to begin with.
This may seem good to you but, unless your fellow man is equally wealthy, it is problem detrimental to your fellow man.
If you play the idea out (I’ve thought about this for years, perhaps you have fully considered it).
I think this works for people of all economic backgrounds.
There would be multiple competing standards for lower cost businesses, will the low standards business exist if people get sick, or will a slightly higher priced but much safer low cost standard excel in the market?
I think many of the issues you bring up already exist in the current market.
Is that a good idea for an industry that seems filled with completely immoral bastards that'll screw over everyone ("they'd sell their own grandmother!") to make an extra cent, or save themselves a cent?
I could see it might be a good thing where an industry has a good reputation for fair dealing. US health care doesn't seem to fit that description though.