Continuing the Healthcare Conversation

In the last rather lengthy installment, I talked about what I think are the problems with our current healthcare system. Namely, limited employer-sponsored plans; which limit market forces on the insurance companies; are especially burdensome on employers; and while offering limited coverage for routine medical expenses to the insured, resulting in an increased amount of claims, often fail to protect them from catastrophic medical events. A further burden on the system is unregulated litigation, which has made risk unpredictable, and therefore results in artificially high malpractice insurance rates, along with related increases in diagnostic evaluations and administrative record keeping, in order to protect caregivers.

The end result is a system that can't get out of it's own way. Insurers do a poor job of providing protection. Employers feel an escalating burden from their healthcare obligations. Doctors are being hit even harder; increased risk to their livelihood, combined with decreased financial incentive from educational, insurance, and administrative cost escalation, is pushing physicians out of fields they are otherwise inclined to, or forcing them to abandon their practice altogether. So where does that leave the patients? We are left with fewer choices about our coverage, trapped with an employer to maintain coverage, fewer available physicians to treat us, and the serious risk of financial ruin if we get sick. Seems to me, the only group making out in all this is...the lawyers. Didn't John Edwards just build himself a 20,000 sq.ft. mansion? No wonder he feels so guilty about "two Americas".

So how do we get out of this? It is somewhat understandable that many doctors, who feel that they have been yolked with an unfair amount of the burden (which they have), would prefer a single payor, "universal healthcare" system administered by the government, as it would lift much of the insurance and administrative burdens off of their shoulders, and redistribute it among the population (through the form of much higher taxes), as would some overstretched employers currently trying to keep their heads above water. However, that is a particularly short-sighted view, since, instead of paying higher rates to insurers and office personnel in order to administer the programs, that money will instead be fed to the government and its bureaucrats at higher and higher rates every year. Anybody who thinks the government is going to manage that money wisely to sustain the program, must be living under a rock, and have never heard of that great government program called S o c i a l S e c u r i t y. Nevermind the fact that, while we are not all doctors, or employers, we are all patients at various points in our life, and such a federally administered system will certainly not improve our healthcare, but more likely, make it much worse. No, "universal healthcare" is not the answer.

Instead, I think we should take a serious look at a two-pronged approach. First, health insurance policies must become like life, home, and auto policies - written for, and paid by, the individual. If my employer wants to offer me a health benefit, or otherwise, an incentive, to carry adequate health insurance, then that employer should be able to offer an untaxed amount of their choosing, say for example, up to $300 per month, towards my health insurance premiums. Therefore, regardless of the claims one employee makes relative to another (which is none of the employers business anyway), their contributed benefit remains under their control. Just like many employers offer a contribution towards an employees personal mobile phone at a "to not exceed" rate, rather than paying for the service in full and trying to limit it's useage, this approach would work in much the same way.

The second part to this approach, untaxed medical savings accounts, must also be greatly expanded. By building up an account, moving in a direction towards being self-insured, we become less beholden to our insurers, and gain even greater freedom over our own healtcare, or the care of our families. Again, it should also be available to employers who would like to offer a health benefit - to make a matching contribution, or a contribution of their own denomination, tax-free, to their employees accounts, if they so choose.

The approach I'm describing works much the same way any other insurance does. If a person limits their risky behavior, they are rewarded with lower rates. Eating healthy, exercising, and getting enough sleep, in other words; living cleanly, will have its rewards. If however, you still get sick, your insurance company will provide coverage to rescue you from financial disaster. Also, routine medical expenses such as checkups and prescriptions would be paid out of pocket, much as one pays for gas, oil changes, and tires on their car, which will inevitably result in much more competitive rates for these health services and prescriptions. This will result in a significantly lowered administrative burden on physicians, who will have less paperwork to process with insurance companies, as well as give them more freedom to run their practices as they see fit, being dictated to much less by those same insurance companies.

That is of course, if we decide to enact effective tort reform at the same time. The effect of this reform cannot be underestimated, as it would have the most dramatic result of all in reducing the cost of healthcare, and increasing its quality. A dramatic reduction in unnecessary procedures and tests would be one such contribution; cutting costs dramatically, and giving doctors more diagnostic authority. Insurance premiums for doctors could be reduced significantly, offering an incentive for certain practitioners, especially Ob/Gyns to return to practice. And, there should be less litigation, as the incentive to sue will have been reduced.

How we get from where we are, to where we need to be, will be difficult, and if our nation can't be convinced in a great enough majority, it may be impossible. Political opponents on the left need this to continue as a hot button issue in order to achieve their goal of a "universal" government run healthcare program. As conservatives, we must start talking about this issue, and about positive solutions to the problem, because right now the Left seems to own the issue. We must show that we are not the party of the "status quo", but that we have great ideas to reform our systems, and improve the lives of citizens. What do you think?