WASHINGTON, D.C. March 26 (DPI Commentary) As the Supreme Court reviews the constitutionality of the 2010 Health Care Act,  American health care remains a problem and a paradox: It’s often miraculous in its effectiveness yet it’s financially byzantine and economically unsustainable, and still inaccessible to millions.

Whatever the court rules,  there’s a basic problem with the 2010 legislation: The insurance industry benefits most from it. With individual mandates and penalties for non-participation, it is nothing if not a product of the political influence of insurance interests – from the Medicare/Medicaid establishment to the heavily regulated carriers, including the likes of Blue Cross/Blue Shield and Kaiser Permanente.

My view is that the most sustainable and sensible solutions for American health care are beyond our reach — we simply cannot introduce any serious change without vested interests on both the Right and the Left opposing anything that doesn’t benefit them economically.  Meaningful change seems politically impossible.

But if the “Obamacare” legislation is struck down, here’s a two-pronged proposal:

Prong 1) The federal government should take over hospitals in poor areas, and build networks of field services for Americans who will never be able to afford modern health insurance.  The government-provided services will not be free, but they will  be low cost – a doctor’s visit about the cost of a pack of cigarettes.

Delivering the services directly will cost the taxpayer much less than any insurance program, especially the fraud-riddled Medicaid program.

These same services — Uncle Sam’s hospitals and clinics — are offered to anyone, yet they are intended as a true safety net.

Such an approach raises many issues about the relationship between the individual and the state, as well as privacy questions. But they are surmountable issues, and they may improve that relationship.

What’s more, direct delivery of health care services is the only sustainable and humane solution at a time when we can’t afford to continue expanding the current public/private insurance model.

For most of us, endorsing such a shift would be a huge ideological break. But we should give direct delivery a chance, and try it for at least 25 years or so.  Assess it and ridicule it every year if you want, but commit to it.

Prong 2) The middle-aged, employed — those striving to maintain their health and their well being — as well as anyone aspiring to wealth and financial security for their family  should be allowed to maintain and expand Health Savings Accounts. New HSA programs would serve a broader and more flexible role than they do today.  Their assets may be transferable to sick family members, for instance.

Current HSAs are a sideshow in health care today, largely because of the influence of the insurance industry. But there is no question that HSAs achieve something most people want —  some control over the way they live, what they choose for health care and how they purchase it.

The current economic malaise, the economics of health care and the changing demographics of America make the above two-pronged solution necessary.

Traditional health insurance programs would not go away, but they would change — new risk pools, greater disclosure, more direct delivery of special services, such as cancer treatment, by the institution offering the insurance.

But in this new two-pronged system it would be assumed that not everyone has health insurance — of course, many people do not have health insurance of any kind today. A government program of baseline services would at least address the matter of access.

I can go into great detail about the above approach, which I have examined for several years and I believe is sensible, practical, and virtuous in that it pisses off both entrenched elements of the Republican and Democratic parties, who are responsible for the mess we are in today.

I am no health-policy expert.  But I am a former benefits writer, and as a business owner I have purchased health insurance for myself and my staff for years.  I have watched this time bomb tick for 30 years now.

We are running out of time – we are headed for an inevitable systemic breakdown in which Washington defaults on its many obligations. We can’t afford the status quo, and we for years we’ve been failing the most vulnerable among us.

This problem of affordable and accessible health will not go away without major new thinking.

The American Health-Care Insurance Establishment will never go away, but to date we’ve allowed it to dictate the terms of “change” to us — and to those whom we’ve elected to govern us.  –Stephen Clark