So what do you propose? What is your alternative healthcare reform?
So on Tuesday, March, 23, 2010…President Obama signed into law the new health care reform bill. In the months, days, and hours leading up to this bill becoming a law, there are LOTS of voices in complete opposition to this piece of legislation. There are even people in agreement there is need for reform, but this is not the best piece of legislation to achieve the goal at hand. There are states currently working overtime trying to pass legislation to block this federal law.
So here is the context, I am a thirty-six year old husband who owns a house, small business owner, helping a 23 year old pay her way through college, shopping to afford healthcare. This piece of legislation speaks to me…provides me some sense of hope. But, there are so many that believe this is not the correct path. But I have not heard one time, one suggestion that would be an alternative to this plan. Seriously, for all those who do not like this legislation, who are screaming out loud against this new law, what is your plan? What is your recommendation? What is your alternative?
So…here is your chance to let me know what you would propose. I want to be educated. I want to know what you think is the alternative? The current system is not working…I want reform. What is your reform. I want you to use the comment section to sound off with your alternative. I will approve all who write legitimate ideas, not party bashing ideas…real, legitimate ideas that provide people like me an opportunity for healthcare. I want to see if you can live up to the screaming and articulate a proposed solution. No foul language, no party bashing, no slanderous accusations….a real idea with real vision. Prove it…back it up.
Let’s see what you have!
1. LEARN WHAT INSURANCE _IS_. This will provide insight into the issue.
2. LEARN WHAT A RIGHT _IS_. This will provide insight into our inter-societal obligations.
3. LEARN WHAT THE CONSTITUTION _IS_. This will provide insight as to the things that our government is and is not allowed to do.
4. Allow cross-state competition among insurance companies.
5. Allow consumers to buy what risk coverages they actually need. I shouldn’t be forced to buy maternity insurance if I’m a single male.
6. Do something about the parasite lawyers.
Haven’t had time to craft a plan (working on it) but would love to hear how this plan gives you hope (I may be in the same boat as you).
Bobby
The legislation that just passed created a health care culture similar to the public education – high cost, mediocre quality at best, with no to low innovation.
You know the solution. You live it every day, working your butt off to attract customers by providing a quality product at a fair price.
The problem with health care (and public education) is that the people who consume the product have no incentive to shop for the best service at a fair price. So there is no incentive for entrepreneurs to create new business models to serve poorly served customers.
The alternative is simple and powerful – medical savings accounts more competition and greater individual control over health spending. Here’s one example (http://online.wsj.com/article/SB10001424052748704231304575091600470293066.html) and another (http://online.wsj.com/article/SB10001424052748704804204575069133264585068.html).
If people who had health care now provided by their employers had medical savings accounts, we’d see an explosion in innovation in packages of health care services at dramatically better prices. That how the market works.
Not only that, but because MSAs are portable and employees were no longer tied to their employers to get their health care, you’d see an explosion of entrepreneurs. That would be a boon to your business.
The is a role for government involvement, primarily in providing universal coverage and eliminating problems with preexisting conditions. But those issues can be addressed with a regulated, market based system without heavy handed government price controls, which at the end of the day never work.
Bottom line, empowering you to make better health care decisions for yourself and your family will empower health care entrepreneurs to seek out ways to meet your needs.
How’s that for a real idea with real vision?
John,
John,
These are the type of ideas I am searching for right now. I want to break through the noise and hear from smart people their vision and ideas for better healthcare. I am looking into the HSA option, like you said…it empowers the community to take control of our healthcare and provides innovative opportunities. The best part about the HSA from an entrepreneurial position are the tremendous tax advantages over a “traditional” plan.
You know that you and I want to do more than just work for a paycheck, we want to be in control of our destiny. Not only from an income position but from a thought leadership position. Current healthcare providers create a system that are attractive to corporate workers: OK with just collecting the paycheck and not questioning how much is deducted for healthcare.
As a young entrepreneur that is getting ready to start a family, navigating these options can be scary especially when lots of insurance providers gravitate to quote traditional plans…those are expensive especially for those who are healthy. Your points are well taken and provide re-assurance that I am considering the right option.
It is my wish that those who oppose the current plan (Washington) would step away from the typical mud-slinging and provide alternative plans. If that was the case…I would be more apt to listen.
Thanks for your note!
Bobby:
Health savings accounts are a useful tool, but building healthcare delivery around them is flawed for a number of reasons. The biggest, for me, is that “consumer-driven” models effectively ration health care on the basis of one’s ability to pay. Health care is a privilege reserved for those who can afford it. For the rest, it’s an endless series of often untenable decisions concerning the treatment of disease.
My second issue has to do with whether it is even possible for individuals to make the kind of informed. rational choices necessary to make a model like this work. Rational decision making is severely compromised when your child has a 104 degree fever. There is a good reason why doctors always have doctors: because they know it’s impossible to look at their own care objectively. Even assuming you could, how do you deal with the lack of market transparency? What sort of database would you build to replace a physician’s training and empirical experience? How do you deal with privacy issues?
My third objection has to do with management of risk. Insurance works when risk is spread across a large population. The consumer-driven model takes the cost of non-catastrophic medical treatment (not health care, but disease interdiction) and drives it into micro risk pools at the household or individual level. Not only does this put a disproportionate burden on the sick and less economically privileged, but it locks up capital at the bottom of the income spectrum that could be deployed more productively – to save for retirement, start a business, purchase a home, or send a child to college.
The assumption behind consumer-driven care is that the current system costs so much because people “consume” too much medical care. This alone cannot account for why U.S. per capita healthcare expenditure is two and a half times the average of other industrialized nations, nearly all of which offer universal health care through public or public-private models. The most successful of these begin with the explicit understanding that the healthy bear a share of the responsibility for the care of the sick.
Rather than betting on the marketplace to deliver a fair and equitable system, a better approach might be to design a model that rewards both provider and patient for positive outcomes. There are experiments in outcome-based care all over the country. We can and should encourage such experimentation without shifting the burden onto the backs of the less fortunate and hoping for the best.
Bobby
1) The challenge with you getting a MSA account as an individual is that there are not enough of you right now to make a market. So it is difficult for entrepreneurs to bring innovative services to the market. The opportunity we had and lost was to truly restructure the way health care was delivered in this country. Instead we are exchanging an insurance industry bureaucracy for a government bureaucracy. That’s not the answer.
2) A market based approach to health care had been proposed all along, as demonstrated by the WSJ articles I cited. Those in power in Washington were heel bent in the government running the system, and they weren’t willing to listen to anything else. At the end of the day they crammed through a dramatic change that half the country bitterly opposed. This war will is not over.
3) What I would like to have seen, is key elements of what the Democrats wanted, including universal coverage and elimination of preexisting conditions, and key elements of what they Republicans wanted, eliminating barriers to selling insurance across state lines, and the creation of a health care market and portability of coverage through everyone in the country have a medical savings account that they controlled rather than their employer and insurance company. That would have solved the big societal problems, while driving innovation up and costs down. The Republicans punted on addressing legitimate concerns when they were in control, and the Democracts are hell bent on the government running the economy from the automotive industry to health care. Pox on both their houses.
I’m politically homeless in a broken society. We need a fresh political wind. http://www.swampfox.ws/2010/03/23/politically-homelessthe-broken-society
To those who are vehemently opposed to this legislation, pleae take a quick read of this:
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed,
When these words were written, medical treatment still involved blood letting and tinctures of bat guano. But, through the innovations that these words helped create, we as a species, now have the ability to save lives, extend lives, and improve people’s well-being to a degree that was unimaginable 230+ years ago. I think some form of Health Care Reform fits in with the founding father’s intent.
Bobby, as someone in a similar boat, the message to me since I graduated from college in 2002 has been: (1) don’t get sick or hurt (2) don’t have children. And if you do either of those two things, you should definitely work for a large stable company or be married to someone who does. The option I took was to avoid large stable companies and keep a high deductible catastrophic insurance plan with an HSA for incidental expenses. I’m just lucky that I haven’t had any significant medical expenses in a decade. The kicker is that I was born with asthma. Luckily, I largely grew out of it, but — can you believe it — asthma treatments are specifically not covered by my policy. I still fear what might happen if I get sick or hurt. I’ve never had an insurance claim actually get covered. Ever. I’ve never had a positive experience with a health insurer. Ever. And since they have a monopoly, I can’t really vote with my dollars–short of opting out completely (which I did for several years). It’s been a rigged system for a long time and, if not perfect, I’m glad something has been done to shake things up.
The problem with John’s plan above is that it only addresses competition at the bottom end of the buying spectrum. When you’re being rushed to the hospital with a traumatic brain injury or a heart attack, you’re not likely to quibble over the level of service or how much it’s going to cost. And for expensive treatments like, say, chemotherapy I just don’t think many people are going to have $120,000 in their HSA accounts to cover that. At the pace I am able to diligently add cash to my HSA account, I would not have $120k until I’m about 130 years old (assuming I’m drawing a salary that whole time and not spending anything along the way). So HSA/MSA’s are not the silver bullet.
Medical procedures are patentable, so I’m not overly worried about stifling big-time innovation here. If you’re a hotshot surgeon / medical scientist, you still have the opportunity for enormous wealth. At the ground level though, I feel like there’s so much added expense for basics (prescriptions, check-ups, x-rays, lab work, etc). When I spend 15 minutes with a doctor, have my pulse and temperature taken and then have to write a check for $280, there’s something a more than a little off.
So sure, create more competition at that lower lever, as John suggests above. But also incentivize good health and wellness using solid evidence-based medicine and nutrition. Shorten the leash on malpractice attorneys and drug companies and please install some death panels (I kid! I kid!).
Bobby,
Here’s my story…
I am a 37-year-old woman, married to a man with pre-existing conditions requiring life-long maintenance medication. I have four children, ranging in age from 15 to 10 months. My husband and I co-own our small business, which is comprised of us and two freelancers who work with us on various projects.
We pay about $900 a month for health and dental insurance. It’s crippling, yes, but less crippling than the maternity bills would have been without it.
I cannot, even for a day, be without insurance. I live in fear that I will forget to send in a payment, it will lapse, and my husband’s condition will no longer be covered, ever.
That said, I am not in favor of the government’s plan. I don’t pretend to know what the founding fathers were thinking or what the intricacies of medicine dictate. I do believe reform is necessary. I just think the current plan treats the symptoms and not the cause.
I would like to see the government first tackle those things that are undeniably within the realm of government… tort reform and medical malpractice award limitations, to start with. If the insurance companies have less risk to prepare for, premiums need not be so high.
Next, let’s tackle access. Rather than funding universal insurance, actually fund health care. Put the dollars into clinics, hospitals and facilities and providers who can actually tackle the problem of poor to no medical care among those who don’t have private insurance. If we’re all healthier because we all have access to primary care, overall risk again goes down. The burden is lessened on hospital emergency rooms and they can again do their primary job.
There were other ways to address the core issues of access, cost and risk without legislating that I know have to carry the burden of my insurance and anyone else’s necessary. My $0.02 🙂
“Here in the United States,” Mr. Becker says, “we spend about 17% of our GDP on health care, but out-of-pocket expenses make up only about 12% of total health-care spending. In Switzerland, where they spend only 11% of GDP on health care, their out-of-pocket expenses equal about 31% of total spending. The difference between 12% and 31% is huge. Once people begin spending substantial sums from their own pockets, they become willing to shop around. Ordinary market incentives begin to operate. A good bill would have encouraged that.”
http://online.wsj.com/article/SB10001424052748704094104575144011906222520.html?mod=WSJ_newsreel_opinion
Bobby
1) The challenge with you getting a MSA account as an individual is that there are not enough of you right now to make a market. So it is difficult for entrepreneurs to bring innovative services to the market. The opportunity we had and lost was to truly restructure the way health care was delivered in this country. Instead we are exchanging an insurance industry bureaucracy for a government bureaucracy. That’s not the answer.
2) A market based approach to health care had been proposed all along, as demonstrated by the WSJ articles I cited. Those in power in Washington were heel bent in the government running the system, and they weren’t willing to listen to anything else. At the end of the day they crammed through a dramatic change that half the country bitterly opposed. This war will is not over.
3) What I would like to have seen, is key elements of what the Democrats wanted, including universal coverage and elimination of preexisting conditions, and key elements of what they Republicans wanted, eliminating barriers to selling insurance across state lines, and the creation of a health care market and portability of coverage through everyone in the country have a medical savings account that they controlled rather than their employer and insurance company. That would have solved the big societal problems, while driving innovation up and costs down. The Republicans punted on addressing legitimate concerns when they were in control, and the Democracts are hell bent on the government running the economy from the automotive industry to health care. Pox on both their houses.
I’m politically homeless in a broken society. We need a fresh political wind. http://www.swampfox.ws/2010/03/23/politically-homelessthe-broken-society