On Medicare:
Well, Medicare spends almost twice as much per patient in Dallas, where there are more doctors and care facilities per resident, as it does in Salem, Oregon, where supply is tighter. Why? Because doctors (particularly specialists) in surplus areas order more tests and treatments per capita, and keep their practices busy. Many studies have shown that the patients in areas like Dallas do not benefit in any measurable way from all this extra care. All of the physicians I know are genuinely dedicated to their patients. But at the margin, all of us are at least subconsciously influenced by our own economic interests. The data are clear: in our current system, physician supply often begets patient demand.
Translation: Cut care for seniors.
Typical businessman mentality:
Our society will always keep creating new treatments to cure previously incurable problems. Some of these will save lives or add productive years to them; many will simply make us more comfortable. That’s all to the good. But the cost of this comfort, and whether it’s really worthwhile, is never calculated—by anyone. For almost all our health-care needs, the current system allows us as consumers to ask providers, “What’s my share?” instead of “How much does this cost?”—a question we ask before buying any other good or service. And the subtle difference between those two questions is costing us all a fortune.
Who else would attach a "whether its worthwhile" to a break-through cure or treatment or test that adds productive years to one's life or makes someone more comfortable?
He compares getting an MRI or CT Scan to buying a new DVD player. If hospitals had fewer machines, the price would come down.
He even opposes the government proposal to invest money on digitizing medical records.
His overall solution: Let's have
...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.
Here comes his catastrophe plan, the one in which a catastrophe equates with $50k or more. We would have a
...single program of catastrophic insurance open to all Americans—indeed, all Americans should be required to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives.
The least of my fears is how to pay for a catastrophic illness. It's the ones in between a few grand and $50 grand people want -- and need -- insurance for. His shorter version:
...How would we pay for most of our health care? The same way we pay for everything else—out of our income and savings. Medicare itself is, in a sense, a form of forced savings, as is commercial insurance. In place of these programs and the premiums we now contribute to them, and along with catastrophic insurance, the government should create a new form of health savings account—a vehicle that has existed, though in imperfect form, since 2003.
...Every American should be required to maintain an HSA, and contribute a minimum percentage of post-tax income, subject to a floor and a cap in total dollar contributions. The income percentage required should rise over a working life, as wages and wealth typically do. All noncatastrophic care should eventually be funded out of HSA's.
Next we have more discrimination against the elderly:
What about care that falls through the cracks—major expenses (an appendectomy, sports injury, or birth) that might exceed the current balance of someone’s HSA but are not catastrophic? These should be funded the same way we pay for most expensive purchases that confer long-term benefits: with credit. Americans should be able to borrow against their future contributions to their HSA to cover major health needs; the government could lend directly, or provide guidelines for private lending.
Catastrophic coverage should apply with no deductible for young people, but as people age and save, they should pay a steadily increasing deductible from their HSA, unless the HSA has been exhausted. As a result, much end-of-life care would be paid through savings.
What about people who can't afford to use the money in their mandatory HSA's for preventive care and check-ups? The Government will provide vouchers for a check up every two years.
And he supports a new private industry: Health care agents who charge consumers to guide them through the myriad of new choices open to them once they no longer rely on insurance. Just what we need (no thank you.)
Oh, and that specialty treatment you need? The one where you might want a certain doctor you know and trust to perform it? Why bother, when you can go to one of the many "Convenient, lower-cost specialty centers" he says will proliferate.
A really funny part is where he addresses critics of his plan, only to say they are right and he has no answer to their valid points:
Many experts oppose the whole concept of a greater role for consumers in our health-care system. They worry that patients lack the necessary knowledge to be good consumers, that unscrupulous providers will take advantage of them, that they will overspend on low-benefit treatments and under-spend on high-benefit preventive care, and that such waste will leave some patients unable to afford highly beneficial care.
...They are right, of course. Whatever replaces our current system will be flawed; that’s the nature of health care and, indeed, of all human institutions....Because health care is so complex and because each individual has a unique health profile, no system can be perfect.
He ends with:
It would take a full generation to completely migrate from relying on Medicare to saving for late-life care; from Medicaid for the disadvantaged to catastrophic insurance and subsidized savings accounts.
Let's hope it's a lifetime or two -- or never before such a silly plan comes into effect. And that this writer sticks to whatever business he's in, because as he said at the beginning, he knows nothing about health care. If I didn't know better, I'd suspect the article was satire written by someone in the insurance industry who wants to make us realize how lucky we are to have our expensive and flawed insurance policies. It worked. After reading this article, I hope even more that the Government leaves its hands off my Anthem and my Medicare and provides a public option for those without access to either.
Garbage in, garbage out. From start to finish. But hey, go give it a read.
