I pay for the bare minimum insurance coverage on my car. Do you think I drive more carefully because of this?
For starters, you could get rid of insurance and let people pay for their own medical bills except for catastrophic coverage, kids, and the very old. That way if you're a fat slob alcolohic, you have reason to change, or you remove yourself from the gene pool like people did in the olden days. That's pretty much the definition of personal responsibility, rather than relying on the pooled money of others (insurance) or the ponzi scheme of reproduction to provide taxpaying youngsters to fund for your care (medicare).
Insurance is a fine example of the tragedy of the commons. It's abused by a lot of folks. "I pay for it, so I might as well get my money's worth" leaves the person who actually needed the insuring empty handed.
QFT. The third-party payer system is the most direct cause of the high per capita cost. Neither doctor nor patient have any incentive to reduce costs, and there is no motivation for either doctor or patient to actually change lifestyle.
I know that "preventative care" is the buzzword, but neither physicians nor "preventative care" can do anything for diseases that are either caused or exacerbated by poor lifestyle. Type II diabetes can be maintained and even cured by improved diet and more exercise, but it is easier both for physicians and patients to perscribe metformin.
If you let people pay for their own medical bills, the vast majority won't. Not just fat slob alcoholics, but just about anyone who isn't rich. Students, people who are unemployed, those who are employed but have trouble making ends meed
There are two possible realities. We either cut the excessive costs and make everyone financially responsible for their own medical services, and accept that many will not do it and thus suffer the consequences, or we spend billions more dollars and hold everyone's hand, babysitting our patients and maybe save a few more than would be saved otherwise.
In my opinion, the cost is not worth the benefit. My plan would consist of many steps.
1. Make all dollars spent on medical care tax-free. That way those who are not offered health plans through their job can still purchase insurance at the same rate.
2. Possibly consider requiring employers to offer employees "opting out" of coverage, and getting a reasonable corresponding increase in salary.
3. I would require everyone to purchase basic catastrophic care coverage for sudden diseases, extended hospital stays, trauma, etc.
4. I would expand the use of Health Savings Plans to allow people to save for health care.
5. Care for certain chronic illnesses, severe disabilities, and other cost prohibitive treatments will be covered for everyone by the government.
6. Drastic tort-reform. Doctors will be virtually sue-proof. If a patient feels themselves a victim of mal-practice, the case is submitted to a review board consisting of physicians, nurses, public health specialists, etc. who review the case and determine whether or not the doctor was negligent. If so, then appropriate action, removing the licence of the physician or simply compensating the patient, is taken.
7. For the very poor, and children from poor families. Medicare is changed from comprehensive to catastrophic type care, coupled with a set dollar amount for prescriptions, PCP visits, etc.
8. For older patients, medicaid is similar to number 7, except that doctors are given more discretion regarding end-of-life and futile care. If the patient is beyond medical help, then rather than spending hundreds of thousands of dollars for extensive yet fuitle care, the patient is removed to a hospice facility and allowed to die with diginity.
I appreciate comments.
