Dan Hanson’s recent post proposed a healthcare solution that includes universal, single-payer, catastrophic health insurance. In his plan, non-catastrophic healthcare would be paid for by individuals, often utilizing various private insurance products and (I presume) HSAs. It generated a vigorous response, both for and against. The chief objection to his proposal is that any type of universal health plan smacks of socialism. His critics say that we need to find a solution that does not include such an odious thing. (Progressives strenuously object to plans like Dan’s for the opposite reason: because such plans allow individuals to make many of their own decisions regarding their own healthcare.)

I have proposed a plan similar to Dan’s elsewhere, which I’ll sketch here. My plan has three tiers. In Tier 1, people would be responsible for the first, say, $2,000 of their annual healthcare expenditures, supported by a tax-deductible HSA. Teir 2 would be universal, catastrophic, taxpayer-funded health insurance that kicks in after that first few thousand dollars are spent. To keep Tier 2 spending spending at some pre-determined level, it would operate under a strict, but transparent, system of healthcare rationing. That is, some things simply would not be covered for financial reasons. Teir 3 would be an optional, super-catastrophic, private insurance plan that people could choose to buy on the open market, that would cover some (or all) expenditures that the Teir 2 plan deems insufficiently cost effective.

I can — and have elsewhere — offer a detailed justification for why this is the best plan available. Here I will offer only a justification for its major sticking point: that it includes a universal insurance component.