Friday, December 25, 2009

Health Savings Accounts - Christmas Parties

Men by their constitutions are naturally divided into two parties; 1) Those who fear and distrust the people, and who wish to draw all powers from them into the hands of the higher classes, 2) Those who identify themselves with the people, have confidence in them, cherish and consider them as the most honest and safe.

Thomas Jefferson, Letter to Henry Lee, 1824

This is the time of the year for Christmas parties. This year two sorts of Christmas parties will be taking place.

1) Gala self-congratulatory parties of those who believe in mandates imposed by those of higher intellect for the public good;

2) Doleful but defiant parties by those who believe in the good sense of people to make their decisions for their own good.

Mandate Parties

Mandate, def., An authoritative command, order, or commission, esp. a written one

The mandate parties now taking place are wildly self-celebratory and self-congratulatory, for the mandate-minded have prevailed. They are drinking to the health of the people and the health of the nation, which they have mandated. They have mandated health coverage for individuals; they have mandated health coverage for employees of businesses, large and small; they have mandated the contents of health plans, and the conditions of coverage; they have mandated physicians must have electronic records; they have mandated what surgeons can do; they have mandated how many resources a referring physician can deploy. And they have mandated a Medicare Commission for purposes of cost control, whose decisions patients won’t have the right to appeal.

Mandate mandarins are feeling very good about themselves, for they contend they have issued these mandates based on data, scientific evidence, and their own intrinsic wisdom for the public good. They feel they represent a national third party that protects the populace against predatory third parties and providers. They are the party of government. They insist government that spends the most and governs most governs best. The public at large are like innocent children. Ordinary citizens are basically ignorant about matters of money and science. They must be made dependent to shield them from harsh realities of money, disease, and death. The mandatites are the party of good intentions and function on a higher moral plane than others.

The Market Parties

Market, def. a place, open place, where goods and services are offered for sale.

The market parties are sad affairs this year, for they realize government mandates will marginalize them. Private practice and independent physicians are in disarray. They are threatened by reimbursement and decision-making cuts. To defend themselves, they have formed an American Association of Private Practice. This association is a sign of the times. The private belief systems – that the people are intelligent, capable of competent clinical decision making, will act responsibly when well-informed, know the value of money and what it brings, can function without third party intrusions, welcome choice and competition, prefer independence to dependence, are perfectly able to do their own health care shopping –have been discredited. They imagine a system this is genuinely transparent, competitive, and driven by consumers. They believe this system translates into greater choice, higher quality, and lower costs.

In the debate on how to reform the system, a debate conducted behind closed doors, market beliefs rarely entered the discussion or the public arena of ideas. As a result, the consumer-driven business model – health savings accounts linked to high deductible plans – received little mention from the mandate crowd or from the national media.

They were told one cannot trust uncertain markets emanating from individual patient-doctor exchanges at the point of care. One can only have faith in unequivocal collective mandates issued from above through regulated public exchanges.

Patients and doctors, it is said, cannot be allowed to make uninformed decisions, or direct contract between themselves. Patients partnering with doctors might make mistakes, spend too much money, and do things not scientifically-based with predictable outcomes. The government that governs least governs worst.

Raise you glasses high, you mandarins of mandates. This is your Christmas and your year. And, as for you, you market-minded party poops, you will have to wait for next November, which may precede a happier Christmas in 2010.

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