Stanley Feld M.D., FACP,MACE
The only way to empower consumers of healthcare is to allow them be responsible for their health and healthcare dollars.
The delivery of medical and surgical care has progressed markedly in the last sixty years. Life expectancy has also increased.
At the same time medical care has become unaffordable and the cost of healthcare has become unsustainable.
The incidence of obesity has risen every year. Over fifty percent of Americans are obese. The percentage is rising yearly.
Obesity begets many chronic diseases and subsequently the complications of these diseases.
Physicians can treat these complications fairly well but the treatment of these complications comes at a high cost.
How do you decrease obesity in America?
How do you get people to be responsible for their health and healthcare dollars?
One of the key elements in decreasing obesity is to give consumers financial incentives to use the healthcare system efficiently.
“ObamaCare went in the wrong direction. Its regulations—including required “essential benefits”—raised prices on these plans and limited their availability.”
The only incentive Obamacare provided was the incentive to overuse the system. This was especially true for patients on Medicaid. They had zero premiums and deductibles.
A second tool for motivating patients to consider price is large liberalized health savings accounts. These tax-sheltered accounts are generally used to pay for the noncatastrophic expenses that form the bulk of medical care.
First, equip consumers to consider prices.”
“ Critics always claim this is unrealistic: Are you supposed to shop around from the back of the ambulance?
The critics use the ambulance excuse argument to eliminate the possibility of consumers using their own judgment to make price decisions.
“But emergency care represents only 6% of health expenditures.”
“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “
The critics argument is that consumers do not know how to shop prices. Consumers are smarter than the critics think. It would be easy to teach consumers to shop prices.”
“My ideal medical saving account provides that financial incentive to not overuse the healthcare system. The many articles about my ideal medical saving accounts are attached to this link.
“ Likewise, nearly 60% of Medicaid money goes to outpatient care.”
Medicaid patients also overuse the healthcare system.
“ For the top 1% of spenders—a group responsible for more than a quarter of all health expenditures—a full 45% is outpatient.”
These patients can be identified as outliers and educational vehicles can be created to decrease this overuse of the system.
In my opinion Medical Savings Account are better than Health Savings Accounts. Medical Savings Accounts take the money out of the healthcare insurance company’s hands and delivers it to consumers.
Both HSA’s and MSAs have the unique advantage of providing and financial incentive to save.
When people have savings to protect in HSAs, the cost of care drops without harmful effects on health.
The financial incentive decreases the overuse of the healthcare system.
“ According to a 2012 study in Health Affairs if even half of Americans with employer-sponsored insurance enrolled in this kind of coverage, U.S. health expenditures would fall by an estimated $57 billion a year.”
My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.
“ HSAs should be available to all Americans, including seniors on Medicare. Given that seniors use the most health care, motivating them to seek value is crucial to driving prices lower.”
Scott Atlas has publicized the obvious. This would apply to Medicaid recipient also. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “
The maximum contribution to a MSAs should be raised to $6000 or $7000 dollars. If a consumer get sick and experiences a cost of $6000 he should receive 100% (first dollar) coverage through a reinsurance policy that would cost less than $6000.
There can be many variations on this theme for the consumers benefit.
When a person with an HSA dies, the funds should be allowed to roll over tax-free to surviving family members.
This financial incentive should be added to My ideal Medical Savings Account.
“The information that patients require to assess value must be made radically more visible. A 2014 study on magnetic resonance imaging showed that price-transparency programs reduced costs by 18.7%.”
A consumer driven system would force providers to compete for patients. Information on price could easily be provided to consumers by the government and the healthcare insurance industry.
“The most compelling motivation for doctors and hospitals to post rates would be knowing that they are competing for price-conscious patients empowered with control of their own money.”
In his age of technology and rapid communication telemedicine should be promoted and paid for. One way to do it is to permit physicians to practice telemedicine across state lines.
It would supply instant access to expertize at an affordable cost.
Everything possible should be done to encourage consumer responsibility and provider competition.
The present tax code does the opposite. Consumers’ in-group plans provided by large and small corporations receive their healthcare insurance from the corporation with tax-free dollars.
The larger the corporation the more leverage the corporation has for negotiating the premiums with the healthcare insurance companies.
The younger and healthier the corporate employees are the lower the premiums.
This is where the formation of associations with larger memberships of all ages fits in to lowering the price of healthcare. Large associations would have great leverage in negotiating price with insurance companies. They would also spread the risk.
If financial incentive with my ideal medical saving account was added to the price the association negotiated and the consumer paid for the premium, usage would fall and the cost of insurance would decrease.
Tax deductibility must be given to these “individual” insurance policy holders and association policy holders so they are, in reality, paying for healthcare insurance with pre-tax dollars as the corporate group plan policy holders.
These simple changes in the law would result in an affordable healthcare system that was market driven by consumers. The changes would force providers and the healthcare insurance industry to become competitive.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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Consumers Need To Take Back Their Medical Care And Healthcare Dollars | Stanley Feld M.D., FACP, MACE