A Better Way to Fix Health Care
By Richard J. Morris, MD
Health care “reform” is on the ultra-fast track. As a patient and a physician, I am afraid we are being rushed into a disaster. If the federal government succeeds in creating a “public option” insurance plan, it will destroy the private market by subsidizing the public plan with new taxes. The public will then be left with government health coverage (the single-payer option) and less money in their wallets. The models for this are Medicare and Medicaid, which are disasters in terms of access to care and cost. In 2008, government studies noted that 28 percent of Medicare beneficiaries had trouble finding a primary care doctor and 72 percent of Texas primary care doctors wouldn’t accept new Medicare patients. In my practice, Medicare reimbursements don’t even cover my overhead; I serve my Medicare patients out of ethical duty.
For too long, health care costs have been rising faster than general inflation. There are many reasons why—the aging of our population, the advent of costly new technologies, malpractice suits, the growing burden of lifestyle-related conditions, and administrative inefficiencies. The least-obvious but probably biggest reason for runaway costs is that legislation has increased demand for care (the HMO Act of 1973, tax deductibility of health care premiums paid by employers, and entitlement programs such as Medicare and Medicaid). Anything that insulates consumers from price decisions is inflationary. That’s why a single-payer health care system will be more expensive to the country than private insurance and why higher taxes, skimpy payments, and rationing of services would be inevitable. The bureaucratic machinations stagger the mind.
In Minnesota, Medicaid payments are still on an outdated schedule from 1998. The result of government underpaying providers is that private patients are charged more. This is a hidden health care tax on consumers. Minnesota providers pay a 2 percent tax on revenue (not profits) to fund MinnesotaCare. A typical doctor spends untold hours doing government-mandated documentation and coding. This is tantamount to another hidden tax. Yet health care costs in Minnesota are 15 percent lower than the national average. Providers are not the reason for health care inflation.
Our state Legislature is rearranging the furniture once again. Those who previously gave us “managed care” (a failure) are now going to bring us “baskets of care,” “pay for performance,” “peer grouping,” and “essential benefit sets”—elements of legislation passed in 2008 and now being implemented by the Department of Health. They are tinkering and meddling with health care, and patients won’t find out until it’s too late. What has been lacking in the U.S. health care system is true consumer involvement. In a transparent market, consumers would buy their own group insurance and demand would force insurers to provide a choice of options with a range of benefits and premium costs. Consumers have the power to create market economies from the bottom up; governments dictate terms from the top down. Consumer power increases the quality and reduces the cost of auto insurance, food, televisions, and the many other things we shop for every day. If government would let health care costs be transparent and competitive, the marketplace would work.
If you listen to the extremists, only government can save us from ourselves. The truth is this: We have the most capable system of health care in the world, especially in Minnesota. If it’s not the most cost-efficient, we can blame poorly designed government intrusion more than any other factor. We can stabilize health care costs, but doing so will involve each stakeholder taking responsibility. Here’s what needs to be done:
1. Doctors and hospitals will have to compete on price and quality in the same way that lawyers, car repair shops, and barbers do;
2. Each person or family will have to decide what level of coverage they want to buy the same way they do with auto insurance. They also must remember that health insurance shouldn’t pay for everything, just like auto insurance doesn’t pay for gas and tires. (Deductibles are fundamental to all types of insurance.) We need to get back to what health insurance really means: coverage for unforeseen illness and the spreading of risk over a large group of individuals;
3. Employers will have to stop purchasing insurance for their employees. Instead, they should put that money into salaries and let employees in buying groups decide what they want and can pay for. Health insurance should be portable when people change jobs;
4. The young and healthy will have to buy health insurance. Most of the 40 million uninsured Americans are opting out of coverage because they’re young and healthy and feel they are invulnerable. That risky calculus raises rates for everyone else. Insurance is meant to spread risk across all groups. We mandate auto insurance; now we must mandate health insurance;
5. Health insurance companies will have to reduce the oppressiveness of their bureaucracies and stop expensive micromanagement of providers. A transparent market will take care of expensive providers;
6. Lawmakers will have to pass malpractice reform that will reduce the costly practice of defensive medicine;
7. Insurers will have to adjust premiums for those who live healthy lifestyles in order to promote and encourage wellness. They also will have to eliminate denials for pre-existing conditions; and
8. Government will have to stop patroniz-ing us by introducing socialistic “reforms” that will stifle innovation, competition, quality, and personal choice in health care. Consumers should be in the driver’s seat, not lawmakers who want to impose regulations.
Voters should tell their legislators today that they don’t want government taking over their health care; if they don’t, they should prepare for rationing, higher taxes, and bureaucratic inefficiencies later. As the bumper sticker says, if you think health care is expensive now, wait until it’s “free.”
Richard Morris is an allergist in Maple Grove.