I’ve read a bunch of stuff about our health care system. I’ve also thought about it a lot … not just in the last three months … but over the past 34 years. Being in a medical family will do that to you, or at least it did to me.
I think that none of the remaining proposals for “health care reform” address the critical, foundational issue driving our health care problem.
The problems are legion, but I think that they all pretty much devolve to the fact that “access to health care” is synonymous with “coverage under a comprehensive health insurance plan.” If this were not the case, we could address the problem without resorting to any sort of insurance. We could just give poor people money. Or vouchers. Or something similar.
Instead, we need to tinker with insurance and so on because it is nearly impossible to buy your own health care directly. Even if it were possible to get prices ahead of time and to comparison shop, nobody can afford health care at its current rates.
This is truly odd because we supposedly have a very large collective bargaining group working for us: The insurance companies.
However, it becomes clear when you think about it a bit: Insurance companies, medical provider companies, and pharmaceutical companies look at each other in this situation and say “how rich would you like to be?” The answer, naturally, is “I would like to be very, very rich.” Without any influence from actual consumers, hospitals can charge insurance companies any amount they feel like. It’ll only be felt indirectly because employers will find it harder and harder to keep up with the premiums. Insurers make money on the margin. The margin on a large amount is much larger than the margin on a small amount. Insurance companies *like* large bills. It’s just math to them.
Consider eyeglasses: You can get custom made eyeglasses in an hour or so at the mall for less than $100.
Consider Lasik. When it was new, it was insanely expensive. Now it’s down around $800 per eye, with providers charging more for the use of newer equipment.
Consider breast augmentation or reduction surgery. Same deal.
Consider an MRI. 20 year old equipment, requires a tech and a radiologist about half an hour. They billed my insurance over $1200 when I got mine. Seriously?
The real solution to lowering health care costs is to get the market re-involved on both sides. Medical care providers should post price lists. Insurers should do what my auto insurance company did and offer me some concrete benefit for going to “partner” providers. Employers who choose to offer health benefits should offer them as pre-tax dollars that can either go into insurance or into a flexible spending account. I should be able to take my insurance program with me when I leave my job.
Consumers should make up their own minds on both sides. We would very, very quickly see radical adjustments in the way the industry runs.
As to the unemployed, the impoverished, and other unfortunates – I don’t know – but it would have to help them to have prices come down and be payable in cash – no?
