Friday, March 29, 2013

Healthcare Reform Endgame
Only a consumer-driven healthcare system with bullet-proof ideal medical savings accounts will align all the stakeholders’ incentives.
Stanley Feld, MD, FACP, “Obamacare’s Deception,” Repairing the Health System, crrp://
The obvious, which is not so obvious, and the simple, which is not so simple.
The Practical Cogitator, 1959
The health reform endgame is obvious.
The endgame will be consumers and voters agreeing to spend  enough of their own money to shop for  and choose what they want  using health savings accounts  with high deductibles  for routine care but catastrophic ceilings to protect against economic losses and with subsidies to protect the poor.
While this may be obvious, it is not simple.
Progressives would oppose it.  For them, the endgame is a government-run system that is “free” but with regulations and an accompanying bureaucracy directed by them  to control that expense and to perpetuate their political power.  
Health-savings accounts  would take health-care decision-making out  of the hands of government and place it in the hands of consumers.  HSAs would disempower government.  These accounts would puncture the illusion  that health care is, or ought to be, “free’,  and that anything short of that noble goal is a moral failure.  
HSAs would put the onus of choosing what is the right care in the consumers’, employers’, physicians’, hospitals’, and health plans’, and health suppliers’ camps, for they would have to cater to consumers and to prove to them what they is provided at the right place, at the right time, for the right price.   Consumers, not government, would know what is “best.”
Universal HSAs would not happen overnight – or even in a decade, or perhaps ever.   Government dependency is a powerful and appealing sedative,  as all utopias are.  Universal HSAs would require a number of painful steps.

·         The government and voters coming to the conclusion that the present health law is dysfunctional,  does not protect consumers,  and is unaffordable.

·         Acknowledging that informed consumers are in the best position to shop for what is best and affordable for their own personal  care.

·         Creating an analytical system,  with stakeholders participating  at all levels,  capable of delivering objective information  on transparency and quality, but letting the consumers make subjective choices of what fits their personal health and economic interests best, given the resources at hand.
Tweet:   The ideal ultimate endgame in health reform would be for consumers to own health savings accounts allowing them to choose their own care.



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