Sunday, August 23, 2009

And now for an entirely different view

A friend referred me to this article by David Goldhill in the Atlantic. It raises some provocative thoughts about whether the current Washington approaches to health care coverage will help. It is worth reading in its entirety, but here are two key paragraphs from the conclusion. I'm still mulling it over. See what you think:

The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.

A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.


Anonymous said...

First off, I would advocate that readers read the entire article, not just your excerpt, which sounds absurd absent the context and his caveats. Our diminished attention spans exacerbate our increasingly ill-informed status.

Having said that, you have made my day! He articulates clearly what I have been trying to say, in my muddled way, about why insurance companies are not the right sort of company to be involved in health care. His paragraph below illuminates exactly what type of company is better suited for this role:

"Many consumers would be able to make many decisions, unaided, in such a system. But we’d also probably see the rise of health-care agents—paid by, and responsible to, the consumer—to help choose providers and to act as advocates during long and complex care episodes."

Of course, his idea about paying for most health care from "savings and credit" seems, and is, ridiculous at today's prices. (I have an HSA and, as currently structured, it is completely inadequate, even if I had started it at 25.) And the devil is certainly in the details, especially those of implementation. He seems to have some bandaids of his own with government vouchers, etc. But if the transition were made over a generation as he describes, I think this model has a real chance for viability.
The article also addresses the known conundrum that every time a government regulation is passed to "fix" something, another unexpected side effect needs ANOTHER regulation, etc. etc.; leading to our current, completely screwed up, “system”.

Perhaps, as my right wing husband advocates, government really does need to exit health care. But so do the insurance companies.


ER doc Greg said...

Thank you for posting this article. The author has done a great job of describing our problems. His solutions are similar to some of the conservative proposals out there. On the whole I’d take his proposal over anything being discussed in Washington today.

Not surprisingly he didn’t mention tort reform. What does surprise me is that he doesn’t address how his proposal would work in the emergency setting.

Right now, because of EMTALA we are the default source for those who can’t (or won’t) pay for care. We still need to find a way to get paid for the care we give to illegal immigrants and other people who are outside the system. People will continue to show up in the ER without an “HSA card” and get free care.

Engineer on Medicare said...

The proposition of routine care funded out of income, major predictable expenses funded by savings and credit, and massive unpredictable expenses funded by insurance may work for a media executive and former investment banker with a net worth probably north of $10 million and annual income probably greater than $1 million, but it won't work for the vast majority of citizens in this country. Each of the elements that he describes must be considered in the context of the available income and expenses of the person needing health care.

Consider the large number of people of moderate and adequate income who can't manage their lives when faced with the more predictable expenses of food, shelter, transportation, and education of their children. They run up massive credit card debt, have mortgages they can't pay, and consequently have no savings or credit to fund major predictable health-care expenses; and they don't have adequate savings to care for themselves in retirement. All they would have for their own end-of-life-care is a map to find the nearest temperate-zone equivalent of the proverbial Eskimo ice flow.

Massive changes to societal systems must include provisions for transition from the present state of affairs to the final goal. That will require time on the order of half a lifetime, and adjustment of economic relationships and practices that make it possible for society to adapt to the new paradigm.

Anonymous said...

Note to my Facebook friends: There are LOTS of comments on this post there. Look on my profile page under Notes. I won't be reprinting them here.