Your plan has merit. I especially like the 'normal' care out of pocket idea as its aim is to address COST!, which the current arrangement (pre/post PPACA) doesn't. I do feel that there could be an issue with the 'major medical' provider side of cost. Currently insurance companies negotiate reimbursements with the provider/institutions often in a competitive free market arrangement (between the various Ins. Cos.). With the gov't being the only reimbursement negotiator in 'major medical' the providers won't have the ability to 'shop for a better arrangement'. This potentially could reduce availability of various services as Medicaid has done of late.
Another may be (as I believe PPACA will do) is a two tier provider system on the MM side. Those who can afford it will get better care and those who can't will just get whatever is available. The system is currently employed this way and outside of socialized MEDICAL care I see no way around it. It seems some want to address this and perceive that medical care providers (read doctors) should just take whatever we (euphemistically) are willing to pay. I believe this is shortsighted and that this will either lead to a shortage of care providers, broadening of specific care providers duties (nurses/practitioners doing 'doctor's work') or less qualified doctors and the 'profit motive' will be reduced/eliminated. I mean, why be a surgeon if the only 'paymaster' is the gov't and compensation is dictated...?
I'm not suggesting the government dictating prices. I'd much prefer to see the private market determine prices than even insurance companies. If people have to pay for the bulk of the cost of their medical care, they will price shop (which we don't really have now), and prices will fall because medical care providers will have to compete for your business based upon price and quality, just like happens in every other industry.
Notice that I suggested that even above the $5000 deductable that there should be a first party payer component, even if it is just a few percent. This keeps the consumer involved in selecting how much medical care they get, and from whom, because even a few percent of a $100,000 medical bill is worth the effort to price shop.
The doctor that I now go to has her prices posted on her website and on the wall in the waiting room. There are never any price surprises. If I can't afford the "fluff" treatment, like the B-12 shot, or to have the recommended once a year EKG, then I skip those procedures until another month.
Even with our current system, most doctors use "superbills" to compute your total bill, and the prices for each procedure are sometimes preprinted on the superbill. But most people aren't aware of the costs until they get the bill, and even then they really don't care because their insurance covers all but the $20 copay.
When I go to get my script renewed for bloodpressure medication, there is really no point at all in me seeing a MD, when a PA or a registered nurse can renew that script for me. One of the things that being able to price shop for medical care would do would be to stop wasting the time of MDs, and to shift procedures and care that could be given by a lower qualified (and thus less expensive) individual to the most appropriate and cost efficient care provider. Price shopping can improve the efficiency of care without reducing the quality of care.
As far as the concept that insurance companies save individuals money by negotiating lower prices, thats really bs. Before I changed doctors, I had noticed that our old doc was charging my wife less than I was being charged. So on my next visit, I told them that I no longer had insurance, and I received a 30% price discount. I asked why, and it was explained to me that it was the same discount that insurance companies get. So essentially, the doctor was just jacking up the price in order to give discounts, very much the same way that the jewelery store at the mall does.
The best party to negotiate price is always going to be the individual, and the easiest way for them to do that is simply by price shopping, just the same way we do for gas, or for a house, or anything else that we buy. We certainly don't need the guberment to do that for us.
