I agree, it's too simplistic. I think his comments on healthcare were the most off-base things he said.
But it's an interesting idea, and he didn't say that the government wouldn't pitch in. Maybe the government contributes a certain amount based on your income, multiplied by how much you contributed. Just to throw out arbitrary numbers to help explain (and as a medical student, I don't have much more of an idea of what many of these things cost than the patients do), maybe the destitute people in our country get $40 tossed in by the government for every $1 they contribute. If you're making a million a year, your multiplier is lower. Then you look at what each chronic illness diagnosis a person has tends to cost in treatment, and you assign an additional multiplier on that. And if it was contributed to from birth and invested, that money would hopefully grow quite a bit by the time you were elderly and consuming a lot of medical resources. I still don't know how you'd fund a week's stay in the ICU (what is it, something like $5K-$10K every 24 hours there?) when you're paying as an individual rather than scattered across a bunch of people paying premiums to an insurance company.
But if it was a system where you were actually paying real money for care, maybe we could get away from this system where prices don't accurately reflect what tests and treatment cost, since the payments are only a fraction of the quoted price and we have to have a way to recoup some of the losses of all this "charity care." Then perhaps that $5K-$10K ICU figure becomes more like $1K-$2K. Still difficult to afford, but more reasonable. Plus, since these people have a little skin in the game, and can see those deductions coming out of their account, maybe they'll be inclined to make more reasonable decisions about how and where they get their care.
But then we've essentially gone to a government-funded system, which is what many people would like to avoid. Perhaps there's a way to privatize it, but it's not immediately obvious to me. Maybe include some employer matching, or encourage the creation of systems like one of my previous employers had where they essentially functioned as their own insurance company (though I think they had catastrophic coverage through a major insurer) and created financial incentives to see PCPs or urgent cares rather than EDs.
Plus, it completely ignores those who have severe medical problems early on that are expensive to treat and make it impossible for them to work. And there'd have to be policy changes that would enact real consequences for not having the funds you need to get care, while not causing innocent miscalcuations to cause a person to die on the street from an MI and still accounting for those who decided that they weren't going to work and they weren't going to contribute any money. It seems tough, maybe impossible, to recognize all these variables and design a system that makes every individual responsible for him/herself.
If we could implement the other parts of his speech and get away from all the "politically correct" cowardice, we could have a discussion about making meaningful reforms that we don't have to worry about spending so much on welfare, medicaid, police patrols, and the penal system. Reward good academic behaviors (which doesn't have to be expensive, as evidenced by Dr. Carson's own early life and the work of his fund), and start increasing the percentage of parents who hold their children to higher standards by reducing the number that are having kids so they can collect a bigger welfare check or out of sheer irresponsibility/laziness/stupidity. I'm sure we could wipe out most, if not all, of our country's most pressing domestic concerns if we were willing to be honest about what's going on and do something about it. Many of the problems facing our healthcare system are symptoms of a larger societal problem. There's problems here too, but we're forgetting about the forest and dealing with a few trees.
But any politician who would talk about that would be committing career suicide, and any attempt at the kinds of reforms many of us would like to see would be sued into the Stone Age. So we'll either work out some kind of half-measure, or slide downhill enough that major change is the only option.
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