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Monday, July 06, 2009
Terry Paulson :: Townhall.com Columnist
Health Care Reform that Puts You in Control
by Terry Paulson
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Will the Dems' health care Christmas Present to America be an improvement or detriment to our health care system?


President Obama seems committed to pushing through his version of health care reform whether we want it or not! Like his stimulus package, Americans wonder whether he will let politicians, much less citizens, read his plan before passing it! Everybody wants health care coverage as long as someone else pays the bill—employers, rich tax payers or the government! Unfortunately, at a time President Obama is promising more, the existing government health care plans and corporate entitlement programs are proving underfunded and unaffordable. But, what can be done?

America was built on personal freedom, personal responsibility, community and resourcefulness. Our self-reliant past can be a radical steppingstone to a more workable health care system for our future. We need a system that lets you take back control of your own health care needs.

Under such a plan, fears about portability would vanish. You wouldn’t be forced to stay in a job just to keep coverage. Prices would come out of the shadows as providers and insurance companies compete for your business. Instead of depending upon politicians or employers to look out for your interests, you’d be in control! You’d pick your own policy, making your health insurance portable, flexible and permanent!

To start, get employers out of the role of paying for health insurance. Let the money now spent on your coverage come to you as added income. To help offset the tax implications, give a health care tax credit to every American taxpayer.

Just as you are required to show evidence of liability insurance when you register or renew your vehicle registration, citizens should have to show evidence of major-medical insurance coverage when they file their taxes. Major medical plans have high deductibles but protect you from the high costs associated with serious illness. With everyone having to purchase a plan and companies competing for the business, the price for such coverage would come down.

Insurance companies should be required to cover all citizens without exclusions for prior conditions. Like the successful Swiss plan, a national high-risk fund could be established that all insurance companies contribute to that protects companies from suffering heavy losses in any given year. If necessary, as with utilities, a commission could be created to keep insurance company profit and coverage parameters reasonable.

To find coverage, marketplace resources would surface to give you access to more health insurance choices, better information, and more competitive prices. You use online searches to find the best price. Why not health care insurance and care?

Don’t require insurance to pay all health care costs. You don’t use auto insurance to pay for routine maintenance or our home insurance to pay for a paint job or plumbing repair. Health care coverage should be the same. Get coverage for the health care disasters with a deductible you can afford. Pay for the other costs yourself. When it’s your money you’re spending, you find the best deal!

Now, six-out-of-seven of your health care dollars are spent by third parties without any input from you. Choice matters. Milton Friedman used to say, “No one spends other people's money as carefully as he spends his own.” Competition has already worked for elective procedures—for facelifts, breast enhancements, hair grafts—those prices keep coming down because they’re not covered. When something’s free, you waste more. You eat more at an all-you-can-eat buffet than when you pick from a menu!

To help save for those occasional medical bills, all citizens should be encouraged to set aside money in tax free, health saving accounts to be used for medical expenses not covered by insurance. They exist at the federal level and in 48 states. It’s time to add California to that list!

We don’t need doctors for all care. In some states, nurse practitioners can open clinics and provide medical diagnosis and treatment. By 2013, companies like MinuteClinic and RediClinic will be operating over 6,000 retail healthcare clinics inside stores like CVS and Wal-Mart. Such clinics will save you time and money.

To promote prevention, good health habits should pay! In Switzerland, a healthy lifestyle saves you money on premiums. People might care more about their health habits if it resulted in a higher quality of life and lower healthcare costs.

Medications are often the treatment of choice and help us avoid more expensive, invasive treatments. Medications should be covered under major medical plans, but we should avoid price controls. Controls destroy the incentives for creating new drugs. Instead, focus on using generic drugs and avoiding unnecessary medications.

Demand national tort reform and realistic caps to help control frivolous medical malpractice lawsuits that add costs as well as unnecessary tests and procedures to protect those providing care. Institute standardized forms and digitized medical records to cut down administrative costs and increase efficiency, and establish a shared database of health care best practices.

Don’t fall for the illusion of “free” health care where someone else will pay for your care. Demand real reform that gives you control of your own health care and keeps the quality high!

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About The Author

Terry Paulson, PhD is a psychologist, award-winning professional speaker, author of The Dinner: The Political Conversation Your Mother Told You Never to Have, and long-time columnist for the Ventura County Star.

 
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Abolish perverse incentives.
Exactly the right approach. It replaces the perverse incentives of employer-provided prepaid health care plans which led to "managed care" with a rational combination of catastrophic indemnity policies for the low risk, high expense unforeseen event along with HSAs for routine care. Wife and I switched to that combination several years ago, and we couldn't be happier with it. There are NO benefit manager bureaucrats to worry with---decisions are made by us and our docs. That arrangement would work for the 85% of Americans who already have resources committed to their care through employers or through some government program, and without ANY increase in spending. As a matter of fact, with the unleashing of market forces that this reordering of incentives creates, there would likely be substantial overall spending reductions. And the very best justification is that it avoids third party rationing decisions. Paying out of personal HSAs encourages prudent consumption decisions, taking some of the heat off of an overburdened system. And those who are too poor to participate could be subsidized through the establishment of HSAs in their names. Think along the lines of the food stamp programs where cash is deposited into personal accounts. The same could be done with monthly deposits into HSAs belonging to the impoverished. Out of those accounts could be paid indemnity insurance premiums as well as routine care.

FeargalX
Actually, only Spain and Japan dispense codeine OTC. In Hong Kong, it is a strictly controlled substance, just like here. Other countries (Germany, Switzerland, Austria, Canada, and the UK) have complicated rules regarding codeine (depending on the preparation's strength), but for the most part it is more a "behind the counter" drug - controlled by pharmacists, and sometimes physicians. Besides, do you have any reason to remove it from the controlled substance list other than "Let's follow all the really cool kids"?
I understand Vioxx was taken off the market, but what's your complaint against Celebrex? It's a good drug, with fewer side effects than Codiene and no potential for abuse. Codeine is still prescribed for short-term usage, ie: post-op.

Jason
Certainly the war on pain meds (and the push of expensive/deadly alternatives) was not the exclusive domain of the GOP -- but about 90% of the GOP supported those policies (while about 50% of the Dems). You have no answer to the point that codeine it OTC in most of the developed world, but not in the U.S. (but I also have no doubt that the U.S. gave way more Vioxx or Celebrex to people -- so much for great medical treatment). The GOP could have learned a lesson from Rush Limbaugh (who had a legit pain issue). Other people in Florida have gotten what amounts to life sentences for what Limbaugh did. What he did was not wrong -- people who need pain treatment, need the treatment -- not the run around you get in the U.S. If I were a doctor, while I like to think that I would have the courage to treat someone with proper meds, I might not want to risk the consequences. This is but one example of how our system frequently does not work.

Lilly:
I know what medical care costs. I have survived cancer. And I was self insured at the time. Which means I paid out of my own pocket. Of course that was 15 years ago, and costs have gone up. And I have had many tests and an emergency room visit in the last two years. And paid the bill when it came. (I should have asked for a cash discount but didn't.)

But you see, Lilly, I didn't think you should pay for it.

And I'm certainly not saying you shouldn't have insurance. If you want it. I'm saying that its stupid to have mandatory insurance. Or worst of all, one size fits all single payer government "insurance".

Lilly:
Actually, I'm well over 60. And my health, while still good for my age, isn't what it was 40 years ago.

replies
to I: Simplify the health care system by going to SINGLE PAYER (PRIVATELY delivered, NOT government delivered or socialistic) and getting rid of the intrusive health insurance industry which gets between you and your doctor and limits your choice of doctor.

to Red Obama: No, I am not getting over it, and in spite of what you may think, SINGLE PAYER is not off the table.

to Voice of reason: Health care should be a right, where food is not. The reason? An individual is, or should be able to, earn the money to satisfy his requirement for food, as that is a pretty fixed amount.

Health care can be totally different. One person, by the luck of the draw, can incur catastrophic health expenses he could not help and has no way to pay. We are the only country that thinks it is OK to let such people be totally ruined financially on top of being ill. That is inhumane.

That is why we have programs that are supposed to share the losses, which is the definition of insurance. The problem with the (non)program we have now is that we are paying into the system, but fully 1/3 or more of that money does not go to provide anyone health care. It is wasted.

The solution? Get rid of the health insurance industry. Simple.

It Won't Work
This plan will not work. The solution is to return the ratioing decision back to the user of the service. I do not claim to know how to do that, but unless we create a system where the user of the service is using their own money to pay for the service, they will not make the rationing decision. If they do not make the rationing decision, I know of no way to effectively control costs. And if you cannot effectively control costs, costs will rise. When cost rise, this insurance scheme has the same basic problem as Obama's insurance scheme. Inflation will result in the insurance costing more and more over time. Medical savings account is a good idea, only "if" the individual has the "choice" to build a real savings account. Then it will be their money that they will have to spend to pay for their medical needs. When it is their money, they will make the rationing decision about what they will use the money for. Encouraging companies to contribute to their workers Medical Savings Accont, will mean the worker has more money in the account. If the government "helps" the individual to have more money in their medical savings account, that also would help people to have more money set aside for the time they may need to use that money. Having the ability to transfer what money is not spent to future generations would eventaully increase the size of the enxt gerneration of people. Then and only then, have you actually fulfilled Milton Friedman's thought of giving back control of a persons life back to that person. Only then do you achieve the maximum amount of freedom at least in the area of medical care.

I Agree, totally
We Americans are in a brain-lock about this: Health+Insurance...If I can take my dog or cat to the local vet when I need to, without proof of insurance; if I can make an appointment with my dentist when I need to without proof of coverage--and get a discount for out-of-pocket private pay--why are we continuing to deepen our involvement in a system that builds a wall between us and our doctors?

I refuse government assistance! I want to see a doctor or nurse practitioner if I have a medical issue that is beyond my own self-remedy, and pay out of pocket. And also find good insurance against tragic consequences--like the extended warranty I buy for my auto. Third party entities have no business in my medical condition.

How did it really get this complex and this bad, and why does the average American continue to go along with it?

unfunded liabilities
Two of the largest unfunded liabilities are social security and medicare. Killing off the senior citizens by controlling (denying) health care goes a long way to reducing both.

Unfunded Liabilities

We currently have anywhere between $50tn and $99tn in unfunded liabilities. If the Federal Government could confiscate all of the wealth of citizens and it would not pay down our debt.

SINGLE PAYER is off of the table. Get over it.

Bad ideas responded to
Telling people to "take control" of their health care is a joke if they have no way to compare doctors' outcomes, much less a price list.

In our private plans, we don't have choice of doctors anyway.

HSAs are a terrible idea. They do nothing to provide health care and do nothing for the people who really need it. They also add much more needless complexity at tax time.

If people have to pay co-pays and deductibles, they are going to neglect the basic care they should be getting, which would avoid progression of their conditions. Read the article The Health Care Battle Lines on http://www.tikkun.org.

There is one plan that will largely solve all the problems we have now. It is called SINGLE PAYER, which is government-funded but privately delivered health care, much like Medicare. (It is NOT the same as the public option, which will NOT work.)


Does ObamaCare Spell Death For Roe?

An absolute must read as to why ObamaCare may spell the death of Roe v. Wade:

http://spectator.org/archives/2009/06/30/is-obamacare-the-e nd-of-roe-v/2


Choose life, even for the most despicable.

healthcare
I am a retired nurse. I was a nurse before medicare came in. It nearly doubled costs to the private paying customers and their insurance companies. A urinalysis went from $7 to $11 overnight. The next month it was $14. However, the truth is that medicare is well loved by seniors. If they pay for a supplement (a good way for the insurance companies to continue to show a profit) then they absolutely do not care what the bill is. Trust me, I have heard it from too many of them. Cost is no problem for us, just to the rest of you and that is wrong. Further end of life care is profoundly expensive. If we can do such a remarkable job for elders like myself why not the middle class? I would submit one caveat. Like medicare, it must be paid for by the recipient. Leave the employers out of it. People should at the very least, be aware of the true costs of their health care.

Heres what we do know.

Liberals oppose letting you control your healthcare.

Liberals oppose letting you control your own reitrement savings.

Liberals oppose letting you control your choice of schools for your children.

Liberals oppose letting you control which firearm you may or may not purchase.

Liberals oppose letting you control which type of automobile you may or may not purchase.

Liberals oppose letting you choose the most cost effective energy to purchase.

There is one time when Liberals don't oppose people taking control and making their own choice. It involves the killing of innocrent unborn babies.

Pre-existing medical conditions
Private insurance companies avoid individuals with pre-existing medical conditions by any means possible. They deny those individuals coverage outright; or, they charge those individuals $50,000/year or more for coverage; or, they offer plans that exclude treatments that those with pre-existing medical conditions require. All Republican plans would allow these 3 techniques to remain; in fact, Republican plans would remove what regulations that exist on plans.

Most individuals have pre-existing medical conditions because of God's will, and not because of "individual lifestyle choices".

Any successful reform of healthcare would: (1) require insurance companies to take all comers; (2) require insurance companies to charge one rate to all individuals who buy a coverage; and (3) require coverage of the treatments that those with pre-existing conditions require; and (4) no more caps on annual payouts (I've looked at plans that state that the plan will payout a maximum of two thousand dollars per year!)

What the Rush?

For over 25 years the GOP has been trying to reform Healthcare. Each and every attempt has been blocked by the Liberals.

FeargalX
So it is just the GOP that is doing this and not Democrats? It's amazing how democrats haven't had any power in the last 40 years. Don't you think there is enough blame to go around? But most of the responsibility lies in government and insurance companies working together to create a completely uncapitalistic industry (not against one another like liberals like to make-believe would happen/happens).

This what I don't understand about "the let's hate Republican crowd." Let's say this healthcare is utopia incarnate. Let's say making government 60% of the GDP is a swell idea. What happens when evil Republicans eventually retake control? The laws of probability make it pretty likely that they will eventually, given time, retake power. If you believe the GOP is evil incarnate then you should want less power in government so evil GOP can not hurt you anymore.

Say what you want about conservatives. Their strategy/ideology is consistent. They want government and idiots to have less power. Including government sponsored monopolies.

Doctors perspective
To have pharmacists and nurse practioners provide some healthcare is like having pharmacy techs do what pharmacists do, or LPN's (2yrs of nursing school) do what NP's do? For that matter, have anyone with a pilots license fly a 747. There is a reason it takes 4 yr of college,4yrs of med school, and 3-7 years of residency/fellowship to be a doctor. The human body is more complicated than people realize. The simple things that people believe a pharmacist or NP can treat i.e. (common colds etc) usually can be treated with OTC remedies.
Also removing patents from drugs would be a disincentive for future drug developement for the fact that drug developement is costly and rarely successful. Mr Paulson's article has many good points. How can Obama not want to include TORT reform? Why is it that lawyers have the extra time and money to be in politics. You don't see too many doctors in politics. So who is really being over paid?

Government Healthcare

Today my 59 Year old brother-in-law had his leg amputated.

He needed a Nylon Artery Replacement in his leg. After 18 months and test, more test and still more test the VA was not able to replace the artery in time to save his leg.

Liberals support Government run healthcare.

To Stan
Ah Stan. I guess you are young and healthy. I have a young friend who was diagnosed with cancer before she was 30, a soft-tissue sarcoma of the thigh muscle. In the next two years she had chemotherapy, radiation, and twelve major surgeries trying the save the leg, which, in the end, had to be amputated anyway, then she had months of rehabilitation. I imagine the bill for all of this would be pretty steep to write a check for.

I wonder if you realize how much good modern medical care can cost. Fifty years ago my pediatrician made house calls for seven dollars. Currently my husband is undergoing a diagnostic workup before surgery: CAT scans $4600, Ultrasound scan $915, blood tests $1334, and we haven't even gotten the bill yet for a 4-hour scan using a radioactive-isotope-labeled dye but I can guess it's going to be in the high numbers. And that's without the surgery that all this is leading up to. Thank God for insurance since "shared risk" makes good care affordable (not free) for all of us.

True, my husband is no longer young, but a young person can have an auto accident or a ski accident that smashes a leg into smithereens. His appendix can burst and cause peritonitis.

"Time and chance happenth to them all."

And whatever do you mean by "you don't need to be able to pay for anything insurance would pay for"? The reason the reason our hospital is billing Blue Cross so much is that it has to cover the care it must, by law, give to the uninsured. In other words, the next time you are admitted to a hospital and provided with emergency medical care or surgery, in spite of your being uninsured, I am the lady who is paying your bill. Feel free to send roses with your thank-you note.

don't kid yourself
This GOP, bigtime, is in favor of government control to enrich those who contribute. Thus, the U.S. has no access to pain meds (compared to most of the developed would where codeine is OTC) -- but gives out Vioxx and celebrex like candy -- even though they are not really for pain (and are expensive, can kill you -- but make big $$ for drug companies -- codeine makes nothing). If we had any choice with our treatment, according to the GOP, we would all become addicts (probably devil worshipers and child molesters too). Also, more obviously, if you have a heart attack or are in an accident there is no way to negotiate costs of medical care. I would like our laws to be closer to where they were in 1900 than 2000 (very few "conservatives" agree).

Why the hell should I be required
to have health insurance? If I'm willing and able to pay my own way why should I have to have insurance?

As an example, does Bill Gates need to have insurance?

I'm certainly not in that class but you don't need to be to be able to pay for anything insurance would pay for (most insurance policies have an upper limit).

Paulson's message is mixed
I agree with most of his proposals. But how can putting you in control conincide with requiring proof of insurance when filing taxes (and there are a lot of people who don't file). Can I purchase insurance that only covers costs > $1 million dollars (that shouldn't cost much). Or how about an insurance plan that only covers TB? Will that be sufficient or will the fed/states mandate coverage for wigs, viagara, AIDS, and alcoholism so I have to pay for that even if I don't want it?

How can insurance companies provide incentives for healthy lifestyle choice (like not smoking) and yet be required to cover all citizens without exclusions. Should people with a healthy weight get better rates than those who don't maintain their weight? Worried about losing coverage, I see the free market offering coverage for conditions you get while covered (so they don't drop you when you get cancer).

The real solution is to get the government out of healthcare entirely. There shouldn't be any government provided healthcare, nor requirements forcing (i.e. enslaving) health care providers to provide services to anyone. When doctors are forced to help those who don't pay they shift the cost to those who do. Today doctors are turning away Medicaid patients so they don't have to shift the costs to others. Our country prospered without such laws for over 150 years and people got reasonably priced medical services. I even remember doctors making house calls in the early 60s.

Med student perspective...
Putting the purchase power for insurance back in the hands of consumers (not employers) would also help the people who are uninsured due to transient unemployment - if they can still pay for coverage, they have it. Lowering premiums based on healthy behavior sounds nice, but that should be up to the insurance company and competition.

People can make their own health savings accounts. I also don't like the idea of compulsory coverage, except it relieves the pressure on ED staff and finances imposed by EMTALA. But mailing in your proof of insurance with your taxes? Definitely paternalistic. How about keep EMTALA, but impose fines on those unable to provide proof of insurance at the hospital door? (Just like car insurance). AND collect on treatment, instead of allowing people to steal from hospitals and physicians, not to mention taxpayers?

Housewar, your article on patents was interesting. What's your beef with the AMA? It's not a union, and not every physician is a member. I thought their power was only influential. I also don't think nurse practitioners or pharmacists have the educational background to provide the same level of care.

You had me, then you lost me
Paulson's on the right track, but there's still too much paternalism in his recommendations.

From a policy perspective, get rid of the all the requirements and incentives to purchasing health care through an employer. That means health benefits would be taxed, but offset by a general tax decrease. The idea being, as Paulson suggests, employers will pay you an extra $10,000/year instead of buying you a $10,000 insurance plan.

Paulson is also correct about unnecessarily seeing a doctor for things pharmacists, practitioners, etc., can handle. In a nutshell, we're talking about limiting the AMA's power, which is basically a glorified cartel that artificially limits supply and creativity in order to elevate prices in the name of promoting consumer safety.

Tort reform is a great idea.

Medications? Get rid of chemical patents. Another government enforced monopoly intended to artificially limit supply to benefit special interests at consumer expense. Conservative circles have never been open to getting rid of patents, but they should be:

http://www.dklevine.com/papers/ip.ch.9.m1004.pdf

Compulsory coverage? Forcing providers to cover everyone? Health Savings Accounts? Blah Blah Blah. More government paternalism. Let me keep my money, and stop putting hurdles in my path, and I'll take care of me and my family myself.

If Healthcare is a right ..
.. then, shouldn't Food also be a right?

Hey, most people can live for years without Healthcare, but not more than a few weeks without food.

Try this argument the next time you debate someone of the "Healthcare is a right" pursuasion. The results can be quite comical. Caveat: actual results may vary!

I've found it to be particularly useful when someone starts off with the complaint "of all the developed countries, America is the only one without FREE healthcare". I usually agree (with a suitably mournful tone), and then suggest that we also provide free food for everyone. I'll throw in some serious sounding stipulations, y'know, not, like, caviar or anything .. just basic food. [some gratuitous hand gestures are required here, to show that you are a fair-minded progressive].

Then sit back, and enjoy watching how quickly the argument unravels. To speed it up, throw in a few comments such as "but it's kinda hard to, like, y'know, produce the food". Pretty soon, your, um, victims will have the Govt feeding all of us with Govt grown food. But would it taste any good? Would it, like, cost less?

Oh, you mean, like, Public Education, where the Govt levels the playing field [strike a righteous pose, while saying this .. after all, what could possibly be wrong with THAT].

Here is the [greatly] simplifying assumption that you MUST make: Ignore the fact that the Govt provides equally BAD education to all, at a high cost.

But they wouldn't do that to Healthcare, would they?

Real health care reform
I was excited to read your suggestions until the end; I do NOT want my records on the internet and I do NOT want DC deciding "best practices". Either I trust my doctor or I find another one and it is up to ME to decide what "practices" are best for me after listening to my doctor and doing whatever research I do. My records on a card in my possession may be OK as long as I can access it to review the accuracy and content of the info.

First, take insurance out of the hands of employers and back into the hands of individuals.
Second, make Health Savings Accounts available to everyone, Medicaid and Medicare recipients included.
Third, no mandated coverage, only high deductible policies for major expenses and no exclusion of pre-existing conditions.
Fourth, tort reform where the loser pays all legal costs and class action is abolished.
Fifth, allow insurers to discount premiums for verifiable healthy choices.
Sixth, explain these options in clear terms with cost comparisons.
With payment made at time of service, the huge burden of claims paperwork is eliminated and fraud reduced sugnificantly. Patients will make clearer choices with the cost of services factored in as it should be in any purchase.

All these options will actually reduce costs immediately as well as over time with competition. It will also save providers significant time to redirect towards patient care rather than complying with government and insurance regulations. We all win!

Fix it don't replace it
Mr. Paulson, after spending 6 months researching health insurance plans to pick one that would work for my husband and I in retirement we learned a lot. We learned that we did not have a choice after all. The insurance companies can deny coverage or inflate premiums using a formula obviously devised by a lawyer and a two year old child.
Fix what is broken, do not hand my health care insurance needs to the Federal Government where I have even less choice.
Your comments are spot on. Could you get appointed Insurance Czar and appointed quickly?
I don't want to pay for a useless government funded insurance plan on top of a ludicrous energy plan on top of a useless stimulus plan.
By the way, go out and walk or swim or dance, anything to exercise and don't waste your time watching or reading anything put out by mainstream media sources. You'll be healthier in mind and body.

Hmmmm.. Let the people decide?
The Washington Post reports that 350 former staffers and retired members of Congress have been hired by the health-care industry to lobby in the fight over health reform.

The industry is spending $1.4M a day on the battle.

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