What I’m proposing probably won’t make me the most popular libertarian in the world, but I’m looking for something which is actually going to pass and still manage to do some good. So, this article won’t be about abolishing Medicare or Medicaid or public healthcare, nor eliminating licenses to become a doctor. It’s also not going to be about calling for spending cuts; in fact, it could increase spending. Writing this, I’m not expecting every commenter on Facebook to love my idea, but it is our best option. I call it the Competitive Care Act.

Before jumping into what I think needs to happen, let’s just look at history: if a person has lived on Mars under a cardboard box with his eyes closed and fingers in his ears, they might only have heard about the healthcare debate in this country about six times a day. If they are a normal person on Earth, they likely hear it 45 times an hour since every medium of news won’t shut up about it. It’s been this way since 2009 when a newly sworn in Barack Obama was asked what he wanted for Father’s Day and he joked, “A healthcare bill.” Obama’s first term was basically spent in a single issue debate between Republicans & Democrats over what to do with healthcare. It cost the Democrats the House and a huge chunk of their Senate lead in 2010 and arguably Romney being seen as too unwilling to change in 2012 lead him to lose his race for lack of conservative turnout. With millions not being able to keep their healthcare plans, the Democrats got killed in 2014 Senate races. In 2016 a Queens-born socialist was running for president with a lifetime record of supporting single payer medicine. His name was Donald Trump and he won.

Right now, in the realms of healthcare, there are basically four groups in Washington:

Berniecare – A bunch of people who can’t admit Ted Cruz took Bernie and turned him into the new Michelle Bachmann over healthcare. This ridiculous and expensive push for single payer medicine which would lead to the biggest post WW2 tax hike ever and a series of other issues the cronies in Washington are sure to make happen.

Obamacare – Behold the sea of Cory Booker’s and Chuck Schumer’s in Congress who don’t see the massive issues in American healthcare and will pretend Obamacare is actually working.

Ryancare – A plan that is worse than Obamacare. It takes away the mandate, keeps the pre-existing conditions and adds a ton of corporate interests. It is such an awful plan it might be worth just holding onto Obamacare.

Randcare – A good plan which will never pass.

So, what is a libertarian option which could potentially pass? Here is what I call the Competitive Care Act.

The first plank is America joining the rest of the modern world in healthcare. What I mean by that is trade. America is one of the only countries where consumers can’t buy pills, products or services from other nations. An American patient can’t fly in a doctor from another nation to get a cold pill from Canada under current law. Laws that stifle international trade is likely the single largest reason for the high cost in medicine. If doctors and nurses from other nations could practice medicine here and if pharmaceutical companies had to compete with the rest of the world, the price of drugs, services and more would go down rapidly. This is a basic fact both the right and left are bribed to not ever mention. It’s something I could see even Bernie Sanders hanging out with Milton Friedman and saying it’s a good idea, but with Pelosi and Ryan in power, it’s never going to get mentioned.

The second plank is actual FDA reform. The simplest thing is to make it easy to get drugs passed through testing and allow the market to monitor things and tort laws serve as regulation for companies. The money saved here, and new investment in medicine, would be so much it’d not only cost less, but also spur innovation.

Third is to deregulate medical schools. Make it easy to open up new medical schools and thus increase the supply of new doctors entering the market.

Fourth, immigration reform for automatic citizenship for doctors, nurses and anyone in Pharma. Give everyone with an MD or valid degree in nursing the right to become a citizen and extend it to their families. Make America the place people with degrees in medicine, biology, nursing and so on can come and contribute to increasing the supply of labor in the American medical pool.

Fifth, change the tax code to encourage people to get private health savings accounts and instead of requiring or incentivizing companies to buy employees insurance, let taxpayers keep more of their own paychecks so they can shop for their own insurance plans.

Sixth, allow people to buy healthcare plans from any region of the world they’d like. If a company in Japan says the American health insurance market has weaknesses in it, allow them to offer alternative plans.

Seventh, change Medicare from directly paying doctors to subsidizing insurance plans retirees choose themselves.

Those are the basic ideas that make conservatives’ and libertarians’ mouths water. Let’s talk about what it’d take for Bernie Sanders to vote for this. What is going to get the left to agree to signing onto a great deregulation in medicine?

Growing the government to pay for people’s healthcare.

Right now, Medicaid has a quarter-trillion in yearly spending, with other subsidies thrown in. There are 15 million people who can’t afford to buy insurance or get much in terms of health care. There’s also a wide amount of low-income people struggling to pay for the plans they currently have. The key here is the negative income tax. Have a model in place which will give every person $5,000 a year with the intention of that $5,000 being used on healthcare. Meaning that it’s a $5,000 cash credit given to all people as a form of income, but it’s focused purely on healthcare related expenses; it can go to buy insurance, but any money saved will be returned to a health savings account. Reform the tax code so that if a person makes $0.00 a year, they will get $5,000 for healthcare expenses, and a tax rate of, say, 12.5% on the first $40,000 of income so that someone making $20,000 a year will only get a $2,500 subsidy. The mission is to cover every single American and basically pay for the gap in people’s care.

The purpose here on spending is to significantly cut Medicaid costs, allowing funds to transfer over. This is going to require more government spending and thus higher taxes. For that, I’m going to say the goal should be to make a bill Chuck Schumer or Bernie Sanders could vote for while keeping this plan something Rand Paul & Ted Cruz would vote for. The goal is just time and balance. Revenue always increases as the years go on and there are programs which can have costs gradually cut from them. Have the bill set in a ten year time frame with the goal of new basic income geared at health expenses to be budget neutral. Require it to make gradual cuts to the budget on a decade long plan, gradually phasing it in while throwing in new revenue. Have this plan only get done if two thirds of the House and Senate agree and put it to a vote where modifying this budget plan would set the goal of giving this basic income back to people if budgets aren’t eventually balanced. Keep as an incentive that House and Senate leaders have to balance the budget over this time frame. Model it strictly to work to cut or not grow spending for this goal and in a decade, there will be a clear 100-300b left in the budget to give people the subsidy to cover everyone. It’d work and the only way libertarians should support it is if its budget neutral.

Why do I support this? I dream of cutting government spending by 70%. I want laissez-faire capitalism; I am a free markets guy, but I would back single-payer healthcare if there was an agreement to move towards unregulated medicine. Single-payer isn’t good for the fact there’s a lack of incentives. A basic income structure with economic incentive in a free market system allows people the ability to hunt around for the lowest cost insurance, the chance to get medical savings accounts and makes things simpler.

The model I’m proposing is about writing a bill both Ted Cruz & Bernie Sanders can vote for. I don’t want a bigger government and more spending, but if this trade off is what’s needed for less regulation, make it happen!