National Health Care STAT!

Previous Post(s) in this series here.

In other words, the insurance companies are trying to perform the function that would naturally occur between doctor and patient in a normal market: to set a proper price for medical services that balances the doctor's ability to supply the service with the demand for the service by patients. But the insurance company is not in the market for the services in question, it is in the market of providing money to pay for the services on behalf of others. So it has no first-hand knowledge of what any individual patient wants or needs, only wonkish statistical studies of its policy-holders' expenses, and its own profit or loss in the aggregate of all transactions.

So, I advocate a simple change to the system by requiring all doctors and hospitals to publish line item fee schedules for all services they perform, right down to that nurse practitioner who takes my blood pressure and temperature before any visit with the doctor. This will be another bit of paperwork that the medical establishment will have to produce at a time when it is inundated with paperwork from all sides, but the effects would be important.

With this information, I and others could begin the process of weaning ourselves from the insurance policies we are now forced to purchase and begin the process of self-insuring over normal and necessary yearly medical expenses that shouldn't require an insurance company at all. Right now, I know I am getting screwed; I am paying much more in premiums than I am incurring in actual medical expenses. The reason this is so, however, is that I am uncertain as to what my actual medical expenses might be. If I had full cost information, I could better fine-tune my out-of-pocket medical expenses, producing, I am sure, a large reduction in my medical expenses over a years time.

Ultimately, the result of the change I am proposing would be a system whereby health savings accounts would receive most of the money that is now devoted to insurance premiums, with a supplemental premium being paid to insurance companies for true catastrophic coverage. Those that like the current system whereby the insurance company bargains for health care services on their behalf would be able to continue in that system, preferring, in essence, the convenience of not having to perform the exacting pencil work on medical expenses that enervates the rest of us Scotsmen-like people.

Before I close, a quick word on Health Savings Accounts as set up under the Bush Administration. This was a great concept, reflecting almost exactly what I am proposing herein, but a joke in actual implementation. For one, as I state above, the medical marketplace lacks the information that I or anyone needs to decide whether to switch over from the current system. But more important, it limits the amount of health savings anyone can have to $3,000.00 per annum. Why does this make sense? I have one stress test in a hospital clinic, coupled with a hemorrhoidectomy in the same year, and my out-of-pocket expense will easily exceed $3,000.00. Therefore, I can only start on an HSA when I feel reasonably assured that no such twin devils will occur for at least the next two years.

Which is to say, HSAs would have to be changed to accommodate the better healthcare system I envision, as would a whole host of tax and regulatory perversities that mangle up our day-to-day health services today. The problem is that most proposals for healthcare reform see the solution as in some way fine-tuning the existing perversities, eliminating some, modifying others, tacking on additional mandates and requirements, in a process designed to graft some grand vision of healthcare over a rickety, worn out structure. One classic example: the Obama Administration believes that HSAs are a problem within its new national healthcare model and is proposing they be eliminated. Why this is so and what they think it will fix to eliminate an option for citizens to self-insure against normal medical expenses can only be described as an insanity induced by ideology.

What’s needed is not incremental or even radical changes to the existing systemic perversities, but to root out the problem at the source, which is the Cone of Silence surrounding the doctor and the insurance companies, leaving the patient on the outside with no real knowledge as to what his healthcare costs are and how much he is paying therefore.

The simple change I propose herein would be the fundamental first step in changing the system as a whole to something that makes sense. It leaves the doctor as the primary determinant of healthcare and allows the patient a greater degree of involvement in his own healthcare and its costs. And it promises to reduce costs as the choking inefficiencies are weeded out of the system over time.