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I need some help understanding the difference you see between a system with an undesirable governmental health entity, and one you see as acceptable. Daschle states his model is David Mechanic's ("Truth about Health Care") notion of a Federal Reserve like entity only in the sense of political independence from stakeholders but explicitly states it "wouldn't be a regulatory agency". Instead, "... the goal is a Board that is a standard setter that allows a private delivery system to operate within a public framework. A highly regulatory approach is unlikely to succeed." (page 179). This is not in the model you portrayed, of socialized medicine like those in Europe, and not what Clinton was proposing in 1993. But I don't want to focus on that- my confusion does not concern whether or not your characterization of what Daschle was proposing was fair.

I am instead interested in what you are proposing. This is not a hostile query- I appreciate the value of mechanism design, but I am having some trouble understanding how the rules of your proposal are enforced minus some authority charged with oversight, and with ability to probe abuses.

For example, your Medical Savings Account proposal states that it is mandatory that there be "price transparency". Does this requirement for transparency cover scenarios when a patient might have had their bill padded with services of questionable medical value? What is the mechanism of enforcement? Is there a person knowlegable in the art who examines complaints, or performs spot checks to insure compliance? If so, what authority does that person operate under?

"Innovation and inventiveness will be suppressed."

My take on the expression of "Innovation and inventiveness" is tweaking a pill so another round of patent protection can be had, and advertising to the public because the drug is not effective and will not otherwise be used.

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