From time to time people who are inclined to support heavy government involvement in healthcare will ask me what the alternative is.  My answer has been a system that disengages health insurance from employment, drives down the cost of insurance, and creates incentive for people to make prudent decisions and spend wisely.

Basically, the law would end existing incentives to route health insurance through places of employment and ease mandates to make high-deductible plans that really are insurance, rather than health management programs, more feasible.  With that done, opening up the insurance market across state lines would be no problem.  To compete and to manage their own costs, insurers might throw in things like a free check-up every year, but the idea would be that the purpose of their service is to manage risk, like car insurance, not to negotiate every detail of a person’s medical consumption.

To fill in the gap, everybody would get health savings accounts into which anybody concerned could put money — the people themselves, their employers, the government (for low-income people), and charities.  It would be tax free and would be an asset that could (maybe) be spent in retirement or at least passed down.

I bring this up because a bill for Achieving a Better Life Experience (ABLE) accounts passed both chambers of the Rhode Island General Assembly, this session.  Basically, it would create accounts for blind and disabled Rhode Islanders that the state would manage and into which any supporters could put money.  As designed, the system probably has more government involvement than needed, but the concept seemed familiar.