The Supreme Court has heard the arguments on both sides on whether the Affordable Care Act is in violation of Constitutional rights. The particular focus is on the provision of the ACA to mandate that every American buy insurance, or be fined. There is an alternative if the Court rules the law unconstitutional that could result in every American being covered.

Instead of forcing Americans to buy health insurance, we should simply state that all Americans must pay a deductible equal to 10 percent of their annual income. All health care expenses beyond that 10 percent deductible would be covered by the federal government. The health insurance industry would oppose this measure because it would in effect make every American Medicare eligible. The insurance companies could continue to sell policies that cover the 10 percent deductible. This approach makes sense for several reasons.

One: Making every American, except for the economically dependent, responsible for some of the cost of their health care would put the responsibility firmly where it belongs: on the individual. The 10 percent deductible would make health care consumers behave like responsible consumers who would consider the costs and benefits of care. Provisions could be made to cover things like immunizations and well baby care outside of the deductible.

Two: The program would bring into the system the people who are currently opting out of the system. The “young and the healthy” and the radical libertarians can have this without forcing them to buy something while at the same time limiting the costs they impose on all tax payers and health care users because they still show up in the emergency room. Now at least they have to pay something: like everybody else.

Three: The 10 percent deductible would finally make this a real insurance program instead of a pre-payment program which is what we have today. Insurance is best designed for low probability - high cost events. Having a program that assures that no household would be bankrupted by health insurance provides the comfort that most Americans want.

Four: The administrative cost of a program like this could be significantly less than the current system or the program being deliberated on by the Supreme Court. Every American could be given a health care smart card that would charge them up to 10 percent of their income.

Five: This type of payment system combined with opening up the market for health care providers to compete for consumers would result in lower prices and more alternatives.

Six: This change would unlink employment from health insurance coverage. Whether you work for Company A or Company B or don’t work at all, your 10 percent deductible will be in effect. This is an important competitive force that would free employers from the burdensome responsibility of providing this “benefit” and would make our corporate community competitive with our economic rivals around the globe who do not have the uncompetitive requirement to insure their employees.

Nothing is as easy as it seems, but if the individual mandate and the ACA is overturned, there are alternatives that might make sense and might even be constitutional.

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