There are few people I encounter these days who do not feel that the current model of healthcare in the United States is broken. Most agree they are displeased with the costs as well as the care they receive. I do not suppose I can fix health care or that my ideas are the best or even original, but let me present a model for healthcare that could change our world for the better.
Imagine a system in which all people are insured. This must first be established, whether or not you believe it to be legal, ethical, or moral; mandated participation is the only way a system works for everyone. So let’s set up the important tenets of the proposed program:
- A single payer system
- Non-profit private organization that insures everyone (not the government)
- Everyone is insured and therefore pays premiums
- Everyone has a high deductible plan (of say $5000 to establish some numbers)
- Everyone pays premiums that are based on the health of the individual
- Premiums have a cap despite the insured’s level of health so super unhealthy people can’t have exorbitant premiums
- Premiums can be partially paid by an employer as an employment incentive
- Health costs are required to be set and transparent for health care providers
Now what are the benefits of such a system?
Whether you agree or not we all need insurance, it is coverage for that catastrophic possibility in the future when you will eventually need care, and it is of the more costly nature. Many might argue they don’t need insurance, but their argument is always based on the here and now–not on the unpredictable and unknowable future. That is why there is life insurance: you can’t buy it when you die, but rather you pay for it knowing the inevitability of your death and hoping that it comes later rather than sooner.
The system I’m proposing puts the consumer back in the driver’s seat and offers both freedom and control of costs. If you are responsible for $5000 of your care, you will pick carefully where and when you spend that money. You will demand to know pricing, and you will demand quality for your care. This will force health providers and professionals to compete for your business. This is good for the consumer because it drives down cost through competition and improves quality of service (something we would all agree that healthcare lacks). Think of how we benefit from the competition of cell phone carriers. Costs go down and quality goes up.
Everyone is in the healthcare pool from a young age so it benefits the single provider to invest in the health of each individual insured. This means more preventative care and more incentives to stay healthy. This benefits both the insurance entity but also the individuals. The healthier you are, the lower your premium,and the healthier you stay, the more money you save and overall the less you cost the system. This inherently promotes a healthy population and creates an incentive for the insurance provider to keep you healthy.
Employers can no longer offer health insurance, which frees many people from the bondage of working for a certain employer or working to a certain age in order to qualify for government insurance. Everyone has insurance from the same entity, and everyone is required to have insurance, employed or not. The only benefit an employer can offer is to subsidize premiums. This then motivates the employer to hire a healthy population as well as promote health in their employees because it saves them money if you are healthy and they can pay lower premiums. This will then put a pressure on society to be healthy and maintain health as employers are looking to hire healthier individuals.
Health Care costs will be transparent. Right now if you come to my office and ask how much you will have to pay the answer is always “It depends on your insurance and depends on what we bill.” So in other words you don’t know the costs up front. In order for there to be real reform in health care, there must be transparent costs as well as lower costs for services. Imagine going to your provider and having a “menu” of costs. You see the provider which you have been told will cost $50. Then they tell you that you need a certain procedure and it will cost X amount. You then can shop around. You can look for providers with lower costs, better reviews, and higher quality of service. We all do this inherently when we are shopping for any other item.
I think cars are a good example. I pay for auto insurance in the case of an accident “catastrophe” in which the costs would be really high and could possibly bankrupt me or remove my ability for transportation. I pay for all maintenance to the car out of pocket. I can take care of my car and learn to do things like change my own oil to keep my costs low. I can also neglect my car and wait until things are poorly maintained and start to break down. I can go into an auto repair and get a quote for the repairs. I can elect what I will do or even shop around for better prices. These are all things we do inherently and that create competition and better service among auto repair shops. This is not done in health care and it seems so at odds with what is logical.
To summarize: the proposed idea could create a healthier population through incentives and external pressures, as well change social and cultural norms. Health costs could drop and would be driven by consumer demand. People would be free to move from employer to employer without the constraining factor of insurance. Employers and the insurance system would benefit from promoting a healthier population. As a consumer you would have more control over costs and would take responsibility for your health and care. Quality of service would improve from consumer pressure. Providers would be incentivized to make a healthy population instead of waiting to fix problems when there is more financial benefit. Insurance would be run by a non-governmental organization not fixed on profit margins but rather focused on the overall health of the pool of the insured.
What about this system sounds bad? Well there are obstacles, mainly economical, that would prevent change. Insurance companies would fight it tooth and nail. Theirs is a huge money making industry. The American Medical Association would resist in order to maintain status quo and protect its providers from the dangers of being required to provide transparent and quality care. Employers would resist because it takes away a currently tax free method to incentivize employees. Government legislators would resist because they are in the pockets of lobbyists and have no financial incentive to promote such a change; their insurance comes from the government and is better than most public options. The public itself would resist change because a high deductible is scary and the idea of being responsible financially for your health care seems so foreign to most. Most people don’t understand how much they are currently paying and responsible for the cost of their care. The proposed system would actually lower costs to some and benefit all in the long run. Most people, however, resist change even if it is for the better.
Overall it would benefit everyone, but it would be resisted, so change would not come. How could we make this possible if we did decide it was the best system for everyone?
First you would have to have government takeover (or nationalize) the current insurance system to thereby remove all power from the current insurance system. The government would then need to be benevolent enough to set up a private non-profit organization to run insurance for everyone. We don’t benefit from multiple insurance companies competing; that does not lower costs. We need the providers themselves, as well as hospitals, medical product manufacturers, and technology inventors to compete for the all mighty dollar. That will lower costs. A single provider can demand that, whereas our current system cannot. Consumers responsible for their care can demand that. But the power will have to be taken from the current insurance system; it will not be given up. And any attempt to alter the current system will just get bogged down in the same problems (look at “Obamacare”).
People would then be held accountable for their health and tested to obtain premiums just like you do when you buy life insurance. If the change was demanded and made for them, the entities that would resist would all fall in line. Put in the above rules that I explained and providers will start to feel the pressure from consumers. Employers (no longer able to offer insurance) will start offering premium subsidies to attract employees. People will start saving, knowing they are going to pay for their health care. People will then take responsibility for what part of their health care they are willing to pay for. The population as a whole will move toward a trend of healthier lifestyle because our culture will actually promote and incentivize health. That is how you encourage the general public to become healthy. That is how you bring down healthcare costs that just keep rising: more preventative care, a healthier population, and consumers that demand more for their money.
Is the change easy? No. Is it possible? Maybe not, but if enough of us start to change the way we think about health care, then maybe we can start to move toward an actual change that will help all of us and the broken system we have inherited.