WHO SHOULD PAY

WHO SHOULD PAY?

At the risk of my own pocketbook, I must tell you that too much health care is consumed in this country. There is legitimate concern about healthcare costs that outpace all the other costs of living; indeed it seems that the cost of providing care has an insatiable appetite that will eventually consume all our resources. It will in fact unless we make some changes.
Most health care consumers shop with other people’s money. Whether its Medicare, Medicaid, or employer funded insurance, with some exceptions of course, the majority of purchases are made with little concern on the part of the consumer as to the cost. In the case of employer provided health insurance coverage, employees lobby for plans that provide for the smallest copays and deductibles. It is natural and logical, at least on the surface, to seek a situation in which we are least responsible financially; after all, health care costs can be huge, right?
Why this disparity between how we view health insurance coverage and the way we view other forms of insurance? We purchase home, auto, and other forms of insurance in order to avoid financial calamity and bankruptcy. We do not expect those policies to pay for new paint, carpeting, or a remodel. Yet we do expect health insurance to pay for most any health service we want or that our doctor recommends.
Consider this: Some time back I was prescribed one of those pills we all see on television for prostate problems. After taking it for a month, I had no difficultly deciding it was not worth the $300 per month it would have cost toward my $5000 per year deductible. Would I have felt otherwise if someone else was picking up the tab?
We swallow a lot of pills, undergo a lot of tests and surgeries in this country. Many are critical, lifesaving treatments. Many are not. There are many treatments and tests we would forego, after educating ourselves about them, if we had to pay a significant amount of money for them. And yes, we can educate ourselves about health care just like we do when shopping for any other commodity.
When educated consumers shop with their own money, free market pressures drive prices down and efficiency up.
It is right that we take care of those who cannot take care of themselves; it is wrong to provide for those who can be expected to do so for themselves. With respect to Medicare, we can make changes that provide benefits commensurate with the ability to pay, rather than providing full benefits to all. Result: more people shopping with their own money. With respect to Medicaid, we can ask for small copays for each doctor visit and prescription. Same result.
With respect to private health insurance, we need to discontinue employer purchase of health care on behalf of employees. Rather, employers provide a cash benefit with which employees shop for their own insurance product, that meets their needs, and receive a tax deduction for their health insurance payments. Spend their own money, become discriminating consumers.
An important aspect of this approach to health care policy change is that it preserves our freedom to choose, and preserves availability of all kinds of health care services to choose from. Any policy which widens the separation between consumer and financial responsibility will inevitably result in explosion of costs. The payor will in the end have no choice except to control costs by involuntarily limiting treatment options. Consumers will begin to lose their options, and some of these options could become unavailable to anyone, regardless of ability to pay.
I personally would be unwilling to relinquish any freedom in exchange for a guarantee of lousy health care.