Why is it so difficult to come up with a health care plan that provides reasonable universal coverage along with the benefits of private enterprise and freedom of choice? I’m certainly no expert in this area, but I think all we need is something along the following lines.

Insurance companies can offer any health insurance plans they choose, but in order to provide nationwide (rather than state-by-state) plans, they must agree to the following stipulations:

1. They must offer a BASIC MINIMUM PLAN (BMP) that meets requirements defined (and updated every 2 years) by an oversight coalition of bipartisan-appointed experts, insurance industry representatives, and consumer advocates, all reporting to the Surgeon General’s office.
2. They must contribute (through a new tax on insurance providers?) to a fund for citizens who cannot afford to pay for health insurance. This fund will also receive revenue from other tax sources.
3. Any citizen who meets federally-defined “unable to pay” requirements will be assigned to a BMP the first time they seek health care or apply for “unable to pay” status. These assignments will be distributed so as to balance the load between all nationwide health insurance providers. Coverage for the plan will be paid to the designated insurance provider from the above federal fund. “Unable to pay” status might actually be a graduated scale that determines the percentage the citizen must pay.
4. Any citizen who has not yet chosen a health insurance plan will be assigned to a BMP when they seek health care. Coverage under the BMP begins immediately. No payment from the consumer will be required until they have had sufficient time to apply for “unable to pay” status and receive a determination.
5. Any citizen can keep or change the plan they have at any time if they pay the plan’s fees themselves. Plans other than BMPs can attach conditions to entering and leaving the plan, so that consumers can’t just switch to a high-coverage plan for one procedure, then switch back.
6. In order to drive down the cost of health care, all nationwide health insurance plans must pay the provider immediately when services are provided (in exchange for negotiated service rates.) These payments will be treated like credit card accounts. Once the provider determines the charges that must be paid by the consumer (e.g. deductibles, co-pays, uncovered costs), that amount is added to the consumer’s account balance. The consumer can pay the balance in their account immediately or over time (at interest rates set by the oversight coalition.)
7. The oversight coalition will provide a process for consumers to appeal coverage decisions by their insurance provider. This will not affect or delay payment to health care providers for services rendered.
8. All health care payments, including premiums, are deductible from consumers’ pre-tax gross income.

The requirements for a Basic Minimum PLAN should specify at least these attributes:

• No restrictions on pre-existing conditions.
• No vesting period.
• Minimum required coverage levels.
• Limits on premiums.
• Limits on deductibles and co-pays.
• Limits on maximum out-of-pocket costs.
• Limits on the age and status of children and other dependents who can be covered by a consumer’s plan.

Throughout every political campaign, we hear that policy X would solve our problems and policy Y would be a disaster. In most cases, the arguments for each policy are no more provable than the arguments against. Why not put them to the test?

No matter what you think of President Trump, he’s clearly open to doing things differently. This leaves us with a unique opportunity to introduce controlled experimentation in public policy. I propose the creation of a new bipartisan federal program, the Public Policy Test Program (POLITEST), a clearinghouse for experimental laws and regulations to be scientifically tested within volunteer communities.

Consider this proposal a framework to build upon, rather than a fully developed plan. The details below are just an initial offering to illustrate the concept. Smarter people than I, with access to better data, need to define the actual parameters. If you’re interested in helping to develop this idea, please comment below, and I’ll respond to you.

The Board

The POLITEST program will operate under a bipartisan oversight board. The board is responsible for reviewing every Policy Proposal submitted to the program. The board assigns the following metrics to each proposal that meets the requirements (see Policy Proposals below.)

• Feasibility of implementation
• Confidence in the proposal’s assessment of risks, benefits, required time duration, community requirements, …
• Recommended priority (relative to other proposals) for testing this proposal

The board does not have the power to reject a proposal outright, unless it demonstrates a serious danger to people or property beyond the consent of the community, or the proposal requires federal funding beyond the scope of the POLITEST program. All remaining proposals, along with the board’s analysis, will be published on a public web site.

Board Member Selection

Board members should be selected from experts with diverse backgrounds and experience. None of the board members may concurrently hold elected office. To balance political agendas, a set number of board members will be appointed by the Democrat members of the House of Representatives, with the same number appointed by the Republican members of the House. Any House members elected under a different party, or as an independent, will each appoint one board member. These appointments can be renewed or changed at any time.

Community Selection

Any community that meets the requirements of the proposal can volunteer to participate in the test. Depending on the proposal, a community need not be restricted to a geographically constrained area. Some proposals could be tested within a community created from individuals across the nation who volunteer and are accepted to the test.

The board and the originator of the proposal will determine if a volunteering community meets the proposal requirements. If accepted, an announcement will be made of the upcoming experiment, and a period of time will be allotted for additional communities to apply. When that time expires, implementation of the proposal in the accepted communities will begin, and will continue for the specified duration (unless the test triggers predetermined early termination criteria.)

The Test

Within the accepted communities, the test parameters are sanctioned as federal law, superseding existing law, for the specified time period. While the test is underway, no member of the test community may be prosecuted under any federal law superseded by the trial parameters. Prosecution of individuals under the laws changed by the trial would be limited to measures defined in the proposal.

Throughout the duration of the test, the affected communities will submit regular reports to the board, including all measured progress metrics. All experimental data (minus confidential personally-identifiable information) will be publicly available for independent analysis and evaluation.

At the end of the test, each participating community will publish their analysis of the test results, and the board will publish their own analysis, independently. They will each assign one of the following three grades, with details explaining and expanding upon the selected grade.

• Success
• Failure
• Warrants More Study (perhaps with modified parameters)

Policy Proposals

Anyone can submit a Policy Proposal, but every Policy Proposal must fully document the following:

• Intent — what is the benefit, to whom, in what ways, and how much?
• Risks — what might go wrong, who loses, in what ways, and how much?
• Policy Details — specific changes to be tested in identified federal laws, regulations, Executive Orders, procedures, …
• Specific duration of the experiment
• Specific progress metrics and how they’ll be gathered
• Early termination criteria (based on progress metrics, unexpected costs or dangers, or other factors)
• Projected cost range of the experiment
  • Amount provided by POLITEST
  • Amount provided by the community
  • Amount provided by private investors, charitable organizations, and advocacy groups
• Evaluation criteria for assigning a grade at the end of the experiment
  • Success
  • Warrants More Study
  • Failure
• Community requirements
  • Minimum / maximum size
  • Geographic / environmental / demographic constraints
  • Resources the community must provide on its own
  • Degree of consensus / unanimity required of community members
  • Entry strategy — how does the community transition from existing federal law to the test parameters?
  • Exit strategy — how does the community transition back to existing federal law at the end of the test?
• Impact on federal resources

Changes to Federal Law

The results of an experiment conducted under the POLITEST program would not, by themselves, cause a change in federal laws or regulations. The intention is to provide objective evidence in support or opposition to such changes, so that public policy debate can be grounded in empirical data. Successful experiments should find advocates for change in the House and Senate who will sponsor bills through conventional processes to codify the tested policies into new federal laws and regulations.

State and Local Laws

As a federal program, POLITEST can only experiment with modifications to federal laws and local community laws in which the legal community authority has given explicit permission. States may wish to enact their own POLITEST laws, or work with the federal POLITEST program to allow experimentation with state laws and regulations as well.

Funding

A funding mechanism for POLITEST could be established in a number of ways (to be defined.) Some amount of revenue could arise from taxation of financial benefits returned to the test communities during the experiments, but this is not expected to cover the entire budget of the program.

Conclusion

In the long run, testing proposed policies in controlled experiments prior to enacting them across the country will help weed out inefficiencies and invalid hypotheses and promote quicker acceptance of genuine improvements—resulting in a more efficient, more productive, and more fair society.