Sensible Health-Care Reform (Part 11): Components of True and Viable Health-Care Reform (Part I)

This is the eleventh of a series of commentaries, written from a free market, individual-centered perspective, examining the serious deficiencies of our current health-care system, the underlying root causes of those problems, the looming government fiscal catastrophe secondary to health-care entitlement spending, the failure of the recently passed health-care “reform” to address the grave problems facing our nation related to health-care delivery, the harm the recently passed health-care “reform” will cause to our seriously ill economy; and a proposal for a framework to truly, effectively, and sustainably reform our health-care delivery system. This report begins the outlining of a framework for true and viable health-care reform.


Components for True Health-Care Reform

There is a better alternative, a better way. The following proposal could be written in comprehensible terms in a bill under 10 pages; as opposed to over 2000 pages of unintelligible government speak. These proposals would enhance an individual’s right of self-determination, not unjustly appropriate that right. These proposed reforms would not create yet another fiscally unsustainable entitlement or another massive impersonal and unresponsive bureaucracy. (The passed bill creates 159 new Government agencies.) While not an all encompassing solution to our health-care system’s short comings and not without some difficulties that would need to be worked out, the following rational and viable framework for reform would bring us a long way to more affordable and responsive health-care for all and to financial viability of health-care expenditure in the public and private sectors. I must point out that not being all encompassing is a strength of the proposal and not a deficiency. The more expansive the reform and the more the reform attempts to address and control every aspect of health-care, the more detrimental unintended consequences will occur. Experience has demonstrated time and time again that massive, “intelligent” central planning can not begin to achieve the remedial and beneficial outcome of the “invisible hand” of the free markets. Some might argue that the system requires radical and immediate reform. And although this and other reviews of our health-care system has enumerated significant deficiencies in our system, we must still remember the system remains operational and has served most of us very well. Incremental reform allows assessment of a policy intervention, including the unanticipated consequences, and then adjusting or adding further policy based on that reassessment.

Components for True Health-Care Reform: – A More Patient-Centered Utilization and Payment System

To truly reform and improve our health-care system, first and foremost, reform must restructure health-care insurance payment, shifting from the current 3rd party payer system to a more patient-centered system. There is a better alternative, a better way. First and foremost, reform must restructure health-care insurance payment, shifting from the current 3rd party payer system to a more patient-centered system. Patient-centered means not simply financial responsibility for but also financial control of utilized health-care services. Employing a combination of tax credits and tax deductions along with eliminating the Federal bias for employer-provided insurance would return the funds currently being transferred to the 3rd party payers – private thru wage reduction for health-care benefit and governmental thru taxes – to the individual consumer to fund high deductible policies and associated health savings accounts (HSAs). Individual financial control and responsibility for health-care expenditure would not only stimulate more informed and thoughtful utilization of health-care services, but would also bring significant competitive forces to bear on providers (physicians, other practitioners, and facilities) and would result in greater accountability and transparency with regard to indications for health-care services, as well as, with regard to cost, quality, and customer satisfaction.

In such a system, individuals, just like for their automobiles and homes, would be primarily financially responsible for routine medical care. For non-maintenance health-care issues, high deductable policies in conjunction with HSAs would similarly help contain costs, improve service, and discourage waste. Finally, for more extraordinary conditions and expenses, medical services payment should be structured so that 3rd party payers progressively assume more and more of the cost, but ideally never all of the cost. Always maintaining some consumer responsibility will maintain a degree of beneficial disincentive for excessive health-care utilization. Such a system would also put more of end of life expenditure decisions into the hands of individuals and families, and their physicians; rather than, God forbid, government panels.

As mentioned above, restructuring the payment system to make health-care services utilization more patient-centered would further promote development of readily available health-care service resources regarding indications for those services as well as for cost, quality, and customer satisfaction measures for practitioners and facilities providing those services. Market forces would promote development of measures of quality as well as transparency in reporting of those measures. That transparency would not only identify higher quality medical care services and thus stimulate broader higher quality but would also promote elevated quality of those services that currently generally are inadequate – management of chronic disease. The medical societies of the various medical disciplines, who in the present system have never felt compelled to do so, would be motivated and professionally bound to formulate guidelines outlining indications for diagnostic interventions e.g. imaging, physiologic testing, etc, as well as expected outcome measures for medical and surgical therapeutic interventions. Such information would significantly inform patients in their utilization of health-care services but patients would still depend on the expertise, ethical standards, and professionalism of their physician.

Let’s look at a case example how a more patient-centered system would work. It was previously mentioned in our current 3rd party payer system, patients not uncommonly demand specific diagnostic testing despite their physician’s opinion that the test is not necessary to appropriately care for them. In a patient-centered system, if a physician orders an expensive test such as an MRI, most patients would want to be assured by their physician that the MRI would significantly contribute to the evaluation and treatment of their condition. Likely, that person would have earlier chosen a physician recommended to them by friend or family, or based on information from an internet physician rating site. That person would further select an MRI provider on the basis of readily available transparent costs and quality measures because that MRI provider would be competing with other providers (the more, the better) for their business.

The next Dr. Right will outline further the components of true and viable health-care reform.

Call to Action: Though passed by an appalling political process and with complete disregard of our Constitution, though containing ineffective and even harmful policy, though disregarding the inalienable rights given to us by our Creator, the passed health-care reform bill is not the end of the debate but rather a new beginning. It is an opportunity to contrast irresponsible policy with prudent policy, to contrast misconceived policy with thoughtful policy, and to contrast policy that places government in the center with policy that places the individual in the center. Get in the fight and stay in the fight. We have learned, the hard way, the consequences of leaving it up to the career politicians. Contact your legislators and demand they exercise the privilege the voters gave them to represent us to effectively address health-care delivery and the other problems facing our states and nation. Learn about the issues and talk to others about the issues. We must join and financially support conservative think tanks that promote traditional American economic principles, personal freedoms, and values; and that shine the light of accountability on irresponsible or faulty government action and policy. Those organizations include The Heritage Foundation, The State Policy Network, The Commonwealth Foundation and your state’s conservative think tank (see SPN for your state’s organization). We must join and support our local grass roots organizations like the York 9-12 Patriots, York County Action, York Campaign for Liberty, and others, so we can take back the political process that has become corrupt and ineffective. We must work to bring up, from the grass root level, candidates – principled persons (Republicans, Democrats, and Independents) who will actually solve problems, who will respect the Constitution of the United States, and who will honor the “consent of the governed” entrusted to them by the citizens of our counties, states, and country.

God Bless and God Bless America!