Stanley Feld M.D., FACP,MACE
Question 1 – I, too, don’t like single payer. I don’t like single anything. Monopolies are bad, governmental or otherwise. But I believe we must get to true universal health care. How do we force the payers to do the right thing by the patients and doctors?
You can not force anyone to do anything. The effective method to create change is through motivation. I do not like single party payer either. The healthcare system needs a dose of innovative thinking. The healthcare system is way behind other business sectors in the use of information technology to create innovative and competitive systems of care. The two major stakeholders in the system are the patients and the physicians. All the other stakeholders should be facilitators for the patients’ and physicians’ needs. Presently, the insurance industry dominates the healthcare industry. The government pays for a good deal of our healthcare costs. If the government was wise, it would create an environment whereby consumers could own their healthcare dollar and drive their healthcare costs. Bureaucracies can not be successful. Both the government and the insurance industry have failed to control costs. If fact, due to escalating costs they have driven the consumer to become uninsured. Neither the government nor the insurance industry wants to give up control to the consumer. The excuse is the consumer is not smart enough and needs to be protected.
The insurance industry has also made grotesque profits because it controls the money, as well as access to care. It has taken advantage of the healthcare system at the expense of the patients. The insurance industry’s only interest is to maximize profit. If it was smart it would be trying to educate and motivate the consumer to promote innovation by the physicians. The insurance industry should provide incentive for patients to utilize medical care effectively and efficiently. The simplest way to do it is to let patients own and control their healthcare dollar.
If the government controlled the system with a single party payer we would have other troubles. We would have the usual cumbersome bureaucracy that we have in other areas of government. The cost of medical care is escalating partly because of the burden of bureaucracy and administrative costs. As the government is forced to reduce the increasing cost of care it is going to be forced to decrease access to care. The weakest link in the chain is the physicians. Physicians will continue to be blamed for the increasing costs. They will have reimbursement decreased even further. Patients will continue to have access to care restricted. The government seems unable to control hospital fees.
The solution should be to let patients make the decisions about their care with their own money. This is the beauty of my Ideal Medical Savings Account. Patients own the first $6,000 of the insurance premium. The insurance company can administer that money. It is the patient’s job to spend the money wisely. Consumers spend their salary on food and clothing themselves. Insurance for medical care should function as true insurance.
Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium. Insurer, in economics, is the company that sells the insurance. Insurance rate is a factor used to determine the amount, called the premium, to be charged for a certain amount of insurance coverage. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.
The insurance industry obviously doesn’t want to give up the power over patients and physicians nor the power over excessive money they accumulate from the present forms of insurance. However, they have priced themselves out of business. Excessive premiums to large and small companies have led to the 46 million uninsured consumers. You may recall the salaries and bonuses healthcare insurance executives collect for creating so much profit for their company. They make most of the money restricting access to care, reducing physician and hospital reimbursement, and holding the float. Naturally, the insurance company retains all the excess monies.
An innovative business group with sufficient information technology infrastructure will figure out how to instantly adjudicate claims for the patients and help patients manage their $6000 deductible. If patients want to spend money stupidly they will not have the opportunity to accumulate money in their Medical Saving Account for retirement.
The government should not be thinking of creating another entitlement they can not manage. They should be figuring out how to teach the patients how to take care of their medical care needs and spend their money wisely on medical care. The government should subsidize patients who are retired and have paid into the system already. They should also subsidize patients would can not afford the high deductible insurance. If a patient spends the money wisely and avoids a complication of a chronic disease he should receive a bonus from his employer or the government. The bonus should be deposited into his Medical Savings Account.
Question 2 “It seems like the system we have now is all about saying no. Can we have an affordable system that is about saying yes?”
My answer to the question is yes. You will recall 90% of the money is spent on complications of chronic disease. Decrease the complication by 50% and you can save $900 billion dollar in a 2 trillion dollar system without saying no to anything. The patient has to be the one that makes the decision and not the insurance company. If you empower patients through education to take care of their chronic disease and give them the appropriate financial incentives they will act to spend their money wisely. Any money saved in the healthcare system presently belongs to the insurance company. It is no wonder the insurance industry restricts the access to care. Their reasoning is that if the patient develops the complication of a chronic disease after they are no longer insured by that company, the complication of that disease is the new insurance company’s problem and not theirs. Where is the motivation for the insurance company to spend money now to prevent complications later? The complications will not be their problem today. The patients get stuck with the complications of the chronic disease. The entire healthcare system is stuck with the bill.
Consumers driving the system will force physicians and hospitals to become price efficient in order to compete with other physicians and hospitals. Every other industry is becoming innovative and efficient through the use of information technology. This has occurred because the consumer has driven these industries to compete. If they do not, they will vanish. The Healthcare System can also make the adjustment if the consumer has a chance to drive the system.