How American Health Care Killed My Father
David Goldhill, The Atlantic, September 2009, page 38
This article profoundly effected my views on the health care debate. I wasn’t happy with either side of the debate, but wasn’t sure how a better plan would look. It’s an extremely complex issue. I like David’s ideas very much.
When it comes to the current debate about health care/insurance reform the Republicans on the right are disingenuous, crazy and blinded by their hatred for a black president. The proposals on the left are merely Band-Aids and do not address, nor will they fix, the causes of our medical mess.
The problem is not just that millions of Americans lack health insurance. Nor will tort reform be enough to appreciably reduce costs. We need a new system; a new health care paradigm. Employer-provided health insurance creates job lock, and pay-for-service increases cost with no regard for outcomes.
In this brilliant article, David Goldhill proposes fundamental changes to the way we pay for medical care. He argues that we should create a system that will put consumers in charge of health care, and how that care is paid.
The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.
We should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans—indeed, all Americans should be required to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives.
Every American should be required to maintain an HSA, and contribute a minimum percentage of post-tax income, subject to a floor and a cap in total dollar contributions. The income percentage required should rise over a working life, as wages and wealth typically do.
All noncatastrophic care should eventually be funded out of HSAs. But account-holders should be allowed to withdraw money for any purpose, without penalty, once the funds exceed a ceiling established for each age, and at death any remaining money should be disbursed through inheritance.
All of the health-care interest groups—hospitals, insurance companies, professional groups, pharmaceuticals, device manufacturers, even advocates for the poor—have a major stake in the current system. Overturning it would favor only the 300 million of us who use the system and—whether we realize it or not—pay for it. Until we start asking the type of questions my father’s death inspired me to ask, until we demand the same price and quality accountability in health care that we demand in everything else, each new health-care reform will cost us more and serve us less.
Read the article and let me know–in the comments–what you think.