So What Can We Do?

I have spent a lot of time picking apart the liberal plan for reforming health care in the U.S. I do not have any confidence in a government that cannot run anything cheaply or efficiently. They are the last people I would trust to manage one sixth of our economy--I wouldn't trust them to do my lawn care. So, it's high time to talk about what can and should be done instead. Here are some ideas that would go a long way to lowering the cost of health care for everyone without a government takeover of health care.

1) Individual responsibility:

As with anything in life, when we are directly responsible for the outcomes of our decisions, we are better for it, individually and as a society. That responsibility includes being accountable for our life choices, the amount of risks we take and paying our bills. It seems like a no-brainer doesn't it? Unfortunately, we have gotten away from that thinking in reference to our health care. If I choose to have multiple sexual partners, why is it anybody else's responsibility to pay for the resulting medical problems? If I choose to drive drunk, or recklessly, why should others pay for my choices? If I choose not to pay my financial obligations, it affects my fellow customers and increases costs for everyone. Is that okay? Others are not responsible to carry our weight for us--that is selfish and immature. That is one aspect of personal responsibility that needs to be considered.

The other aspect is the erroneous idea that health care is a right. Health care is a business, not a right. That sounds cold and sterile, but it is the truth. Like any business, it most be operated to turn a profit and meet its obligations or it will cease to exist. No one owes you health care. In fact, health insurance came about as a perk, offered by employers that needed more leverage than just wages to entice employees into their fold. Employer-based health insurance is relatively new to our economy (within the last few decades), but it evolved very quickly from a perk, to an expectation, to a right. You have the right to seek health care anywhere you want, but with that right, as with any other, comes responsibility--the responsibility to pay for it. That principle holds true to housing, food, cars and gas. I don't have the right to food or a house--I do have the right to work for it and the responsibility to pay for it. We must recognize the difference.

Having said the above, that does not preclude the need for help. Sometimes we find ourselves in trouble financially due to unexpected medical expenses and in need of help. That can come in many forms and should come in the following order: 1) Self: exhaust your savings if you must, but meet your obligations. 2) Family: draw on your immediate and/or extended family for support as they are able. 3) Church: look to those organizations that are already set up and organized to help people. 4) Community and charitable organizations: fund raisers in your local area to help you meet your needs, or the assistance of those organizations already established for that purpose. 5) Government: the last resort. Every dollar you get from the government was taken forcibly from the wallet of a fellow-citizen. Americans are among the most generous people in the world and also the most willing to render aid. In our collective looking to the government to solve problems, we eliminate the opportunity to serve and help one another, to be involved in each other's lives. Government programs do not engender a sense of community, they sterilize and mask the challenges we face as individuals and families. The fabric of our society is weaker for it. I would much rather keep and additional $100 from my paycheck, that rather than going to taxes, I could spend any way I see fit. And when someone needed the help, I would have the extra cash around to do so. And if you are among those who feel that government programs are the way to go, then you go ahead and pay all the taxes you want to pay. I'm sure the IRS won't turn away your dollars. But forcibly taxing money away from one group of citizens to help another group of citizens, is not charity, it's socialism. Trust us to be wise in the spending of our money, including how and when we want to help our fellow-man.

Medical reform will also require a change in our thinking, in taking responsibility for our medical care. I am as guilty of this as anybody else. When we go to the doctor and we are told we need additional treatment, my first question is always, "Will my insurance cover that?" That is not the right question. What we should be asking is: What will that accomplish? Is it necessary? How much will it cost? Would it be cheaper for me to pay for it out of pocket? Will it be successful? What are the possible outcomes? How can we cut costs? What would you do, independent of the insurance company's influence? These are the kinds of questions that will return the responsibility for medical choices to us and to our doctors. We should be just as careful with the costs for our treatment as we would be if we were to pay every penny out of pocket. I guarantee that will change things. To that end, see number 2 below.

2) Health Savings Accounts and higher deductibles:

One of the most underused tools in our medical savings arsenal, is the HSA. Very few of us know the benefits and how easy they are to use. Part of the problem is that it's our responsibility to set it up and make it happen; no one will do it for you. We finally got around to it, determined what we would deposit in our account each month and the bank we worked with sent us a debit card that will directly access our account. It is our money and it will roll over from year to year, earning interest, if we don't use it all. Once we reach retirement, we can then use the money for whatever we need, not just medical expenses. And it is all pre-tax dollars. It is a great way to prepare for unexpected medical expenses and to benefit from your planning if you don't ever need it for that purpose.

The deductible on our health insurance is quite high, higher than I'm used to. We therefore funded our HSA to match our $5,000 deductible, which amounts to a little over $400/month. I realize that not everyone will be able to do that, but for those of us who can, it's a great benefit. And for those who can afford it, but choose not to carry health insurance, it's an excellent way to pay for their medial care with tax-free dollars.

Having that higher deductible has greatly changed my perspective on going to the doctor. It's not like we were running to the doctor every month, but since so much of that money comes out of our pocket, we are very careful how we spend it. We include cost factors when making our medical decisions, which makes us wiser consumers. It's funny how we weigh cost with every other decision we make when we make purchases, but got away from that when it came to our health care. We now do a better job of cutting costs where we can and seeking better prices when available.

3) Everyone should pay something:

Free stuff is great. Everyone loves free stuff. But as a consistent modus operandi in society, free stuff can be detrimental. We all know spoiled children who get everything they want, are never required to work and have no responsibilities. They are intolerable to be around. Our society has its share of "spoiled children" who have gotten so much "free stuff" that they are equally intolerable. I'm not talking about people who have fallen on hard times for a period; that could happen to any of us. I'm talking about the lifers, who expect society to provide for their needs; those who feel the world owes them a living. That way of thinking breeds a lack of responsibility, productivity and self-respect. It is very damaging to our society as a whole. It would benefit both the individuals concerned and the country if everyone was required to pay something for their health care. Even if it were only $5, that would accomplish several purposes. It would make people think twice before they run off the ER as their primary care physician--the most expensive medical care in the US. They would reconsider unnecessary office visits. It would give them the dignity of having paid for a part of their care. Anything they're told by the doctor will be taken more seriously when it hits their pocketbook. And for those who don't even have $5, we can figure something out. That's where the generous American spirit steps in and we help each other out.

4) Return medical decisions to the doctor and patient:

It is time for us to regain control of the relationship with our doctors. We have allowed our insurance coverage to dictate our care for too long. I have learned that my annual pap smear is generally a waste of money. The only man I've ever been with is my husband. At most, I would probably only need a pap smear every 3-5 years because I don't participate in risky sexual behaviors necessitating an annual pap smear. Because the insurance pays for it, it costs the system unnecessary money. On the other hand, my husband is at great risk for prostate cancer due to his family's medical history. We need to be pro-active and make sure he gets the proper screening, at an earlier age than normal, whether the insurance will pay for it or not. We must have a conversation with our doctor, like the one I listed above, and return the decision-making to where it belongs. The responsibility lies with the doctor to do his/her best and we make a decision together and live with the consequences. That kind of decision-making would also eliminate a lot of malpractice lawsuits. In fact, I heard once that the difference between doctors who get sued and those who don't, is three minutes. Those who don't get sued, spend an average of three more minutes with their patients than those who do. Nothing complicated about that.

5) Increase Medicare/Medicaid reimbursements:

One of the biggest contributing factors to the increasing cost of medical care lies directly on the doorstep of the federal government. The reimbursement rates of doctors who treat Medicare/Medicaid patients are ridiculously low. As in any business, if a customer doesn't pay or under-pays the owner, he must make up those costs elsewhere to keep his business afloat. Doctors have overhead just like any other business: employees pay, employee benefits, office space, office supplies, medical supplies, medical equipment and their whopping malpractice insurance premiums. The fact that they are running a business is not a measure of their compassion. Doctors perform more pro bono work than in any other business and they get little or no credit for it. In fact, most people don't even know they do it--and they do it because they are compassionate, not so they can go around talking about it. Every hospital in this country writes off millions of dollars every year in unpaid bills. How many of us think of that when we're complaining about the cost of the great care we get from our medical system? The government's refusal to pay doctors and hospitals a fair reimbursement costs all of us a lot of money. The next time you see your doctor, ask about it. You will be shocked. And in the end, it causes many doctors to drop patients with Medicare/Medicaid because they simply cannot afford to treat them anymore. The government compounds the problem of "the uninsured" through their short-sighted policies based on emotion, not sound economic principles. This is a glaring example of a well-meaning but inept government, whose good intentions don't always match the results.

6) Tort reform:

Any discussion of health care reform that doesn't include tort reform is just plain silly. Every doctor, because of the lawsuit happy society we live in, is required to carry malpractice insurance. Before your doctor ever starts making any money in any given fiscal year, he/she must pay the malpractice premium which runs anywhere from $60,000 to $150,000 per year. How many small business owners could handle that? The premiums vary from specialty to specialty and from state to state, but the costs of those premiums are, of necessity, passed on to the patient. Every time someone brings a frivolous malpractice lawsuit to court and every time the jury makes a ridiculous pain and suffering award, the premiums go up and so does the cost of your health care.

I am not suggesting that people should not be able to bring malpractice lawsuits, that's not what tort reform is. Tort reform, would not prohibit lawsuits. It would not limit the money required to right the wrong. It would cap the pain and suffering awards at say $2 million, for example, instead of $22 million. It would also require the loser to pay the court costs for both parties. So, if you have an ambulance-chasing lawyer, looking to get rich, who brings a frivolous case to court, they are going to make sure their client can pay them first. And if you have a gold-digger, thinking they are going to put the screws to the rich doctors, they either better have a solid, legitimate case, or be prepared to pay the legal fees.

Furthermore, I must go back to the personal responsibility idea. Doctors are not gods--they are imperfect people doing the very best they can with the limited information they have. They know much, but there are still vast amounts of information yet to be discovered. Nonetheless, we expect them to have all the answers and never make a mistake. Do we hold ourselves to that same standard? Stuff happens. Doctors cannot control the human body, they cannot foresee every complication or problem that may arise in treating a unique and very individual patient. Complications and mistakes are not malpractice. It's part of life. We need to recognize that fact and accept the idea that something could go wrong. That doesn't mean it's the doctor's fault or that there has to be someone to blame. Malpractice is when someone is incompetent, willfully negligent or grossly under-trained. If lawsuits were brought, rightfully so, in just those cases, they would be few and far between.

This is actually an area where the government could be useful. Tort reform would severely reduce the number of frivolous lawsuits and thereby reduce malpractice premiums out of the stratosphere. As the premiums go down, so goes the overhead and the costs passed on the to the patient. Furthermore, if doctors weren't in constant fear of being sued, they wouldn't practice defensive medicine. When doctors are practicing defensive medicine, they order twelve tests instead of the necessary one, out of fear they might get sued. So, to cover their behinds and because the insurance will pay for it, we spend millions of dollars per year on unnecessary tests, etc. Once again, that increases the costs for all of us.

7) Tax deductions for pro bono care:

There are a few bad apples here and there in the medical world, but most physicians are very caring, concerned and conscientious practitioners. Unheralded, doctors do a lot of free work for those that simply can't afford it. At present, they are not allowed to use that as a tax write-off. Why not? It's charitable work. That doesn't stop doctors from doing it, but why not encourage it? Doctors are slammed with high income taxes, which includes the "income" they use to pay malpractice premiums. I think it would encourage even more pro bono work, if they could also get the tax benefits. We have plenty of economic history to prove this principle--as taxes go up, charitable donations go down and vice versa. It doesn't take a genius to understand that.

8) Cash discounts:

Try negotiating with your doctor about the costs of your care. Most doctors are willing to offer you a discount for full payment on the day of service. It is cheaper for them to take a discount off the top than it is to go through the hassle of filing a claim and waiting, waiting, waiting for reimbursement. It will save you money and will save him money.

9) Open insurance up to actual competition:

The current health insurance system is really weird. "They" keep talking about the fact that we need "choice and competition". I agree. But creating a government form of insurance (i.e. Medicaid) has done and will do nothing for the cost of insurance. That's not real competition. Let's look at auto insurance. It's required for all drivers to carry minimum coverage and the insurance industry has adjusted to compete for those policies. You can go almost anywhere in the country to find an auto insurance policy that will meet your needs in terms of cost and coverage. You can't do that with health insurance. Health insurers won't insure individuals, which makes it almost impossible for small employers or the self-employed to get affordable health insurance. You are also not allowed to shop outside of your state for health insurance. That restriction limits the competition and therefore the price. If an employer is shopping for employee coverage, he is usually limited to just two or three insurers within his state. That's not real competition. And it usually leads to the biggest insurer driving out the smaller ones. If the competition were opened up nationwide, the best companies, who provided the best coverage for the best price, would rise to the top. The other companies would either improve their coverage and costs or they would go out of business. Good old American capitalism would do more for the insurance marketplace than any government program ever could. Surely those same capitalists can find a way to make insurance available to the self-employed and small businesses.

Government meddling has caused other problems here as well. Over-regulation in individual states has raised the costs of health insurance for everyone. That has come about as state governments have legislated more and more coverage mandates (for example, some states have mandated coverage for elective procedures such as sex changes or prescription coverage of Viagra). What that means is that the minimum policy is required to have more mandated coverage. Insurance companies base their premiums on their perceived risks of a payout. Each mandated coverage item therefore increases the premium for everybody. Again, that limits competition and makes it hard for insurance companies to provide the kinds of policies that would sell like crazy in the marketplace. If we, as the consumer, could actually buy some minimum coverage, like catastrophic coverage at a minimum price and have the flexibility to actually purchase the coverage we need, that would change the whole health insurance landscape. But because of government regulations, that cannot be done right now. Another example of governmental good intentions with short-sighted policies.

In the end, there's very little that the government can or should do. I'm not a business major, I'm not a economist, but I am a pretty smart consumer. These things are common sense ideas that would encourage the government to pass tort reform, de-regulate the insurance industry and let the marketplace do it's thing. These changes, coupled with an increased infusion of personal responsibility when it comes to health care, could solve most of our problems. We live in the greatest country that has ever existed on the earth. It is filled with brilliant and generous people, full of ideas who love to face a challenge and solve a problem. Let's not look to the government, let's look to ourselves. We, the people, need to fix this and help our representatives understand that the best thing they can do is get out of the way. I certainly haven't covered every possible fix and I would love to hear other ideas. Maybe this is the kind of thing we should be discussing with our government representatives.