Health
Care: It's Not About Health Care
We have the finest health care in the history of the world. Why would we want to change that?
The debate is not about health care, it's about medical insurance. But campaign consultants have determined that no one could get excited over medical insurance reform, so they named it "health care reform." There are still a great many people who simply haven't paid attention to the distinction.
We didn't always have medical insurance in this country. In fact, any form of insurance is a relatively modern contrivance. Even so, up until the end of World War II, medical insurance was uncommon, and employers did not contribute to it on any grand scale. To attract workers to their companies following the war, employers started offering medical insurance as an employee benefit. Remember, of course, that this was in the day when whole towns worked for one or two companies, and whole families worked for the same company throughout their lives. There was little job mobility, and, with fresh memories of the Depression years, many were thankful just to have jobs in peacetime.
Eventually, medical insurance became ubiquitous and an expected benefit of employment in large and medium-sized businesses. Benefits varied by premium cost, contribution of the employer, amount of deductible, coverage, etc. As time went on, we started taking it for granted. Taking a benefit for granted causes us to view it as an entitlement.
As an entitlement, many feel it necessary to "get their money's worth." They go to the doctor for reasons other than what many of us would view as appropriate. What do they care what it costs? After their deductible and co-pay are paid, all the rest is "free." In any given year, why not take advantage of it. With a good supplemental insurance policy, there may be no out of pocket expense at all.
If a consumer doesn't pay for a desirable product or service, what can be expected to happen? Of course, the supply will decrease, the cost will increase, and the quality will decrease.
Given that the problem is actually the disconnect between the demander of the service and the one who actually pays for the service, what "solution" that has been proposed could be expected to solve the problem? None that we've heard, other than our own.
Let's suppose that what a patient pays on a given insurance plan is a flat rate deductible plus a variable deductible. The figures would vary with the insurance plan selected and the premium paid, of course. The variable deductible would be some small percentage of the actual cost of the health care. Let's assume your doctor recommends a CT Scan as a portion of the diagnostic process to find out what ails you. He/she looks on his/her computer and determines that, for example, your out of pocket expense will be your $50 fixed deductible plus $60 as your variable deductible (2% of our example's $3,000 actual cost), for a total of $110. You say to the doctor, "But I want an MRI!" The doctor refers again to her computer and tells you that your out of pocket expense will now total $250 because of the increased cost of the MRI.
You might ask the doctor what benefit can be expected from the increased cost, as you should. Making patients aware of–and party to–the cost-effectiveness portion of the equation can do a great deal to infuse discipline into the entire health care industry. Not to mention the incentive for all stakeholders in the process to be more sensitive to costs, as well as efficiency.
Adding accepted protocols, which, if followed without error, would exempt physicians from malpractice suits, could be a huge step forward, as well. It should be noted that State laws govern medical malpractice, not Federal law. So-called "tort reform" suggests that the Federal government should override all State laws, whether a given State has enacted meaningful and effective laws or not. We are against that. Maryland enacted a reasonable ceiling on malpractice awards in the early 90's. Further Federal involvement in our State would be inappropriate.
