Friday, October 2, 2015

Get Real School of American Health Reform

I belong to the “Get Real” School of American Health Reform.

I am a pragmatist. I believe the health care system represents American culture who want a mix of public and private options. It reflects its desire for choice of treatment and doctors and access to the best of the latest in technology, provided of course government pays for it if you can’t afford it . It represents a wide-spread suspicion of government, elitist politicians and socialist solutions. It wants universal coverage as long as other peoples’ money is being used, It wants to have its cake and eat it too.

As a member of T=the “Get Real” School, I envision three options.

• Health care markets - These markets are likely to remain marginal because they involve using your own money. But with the advent of employers offering health savings accounts and high premiums and high deductibles and unhappy doctors, the markets will grow and so will direct cash care, out-of-pocket expenditures, and the craving for personal, convenient, and timely care. Hence, we will see more concierge medical practice, direct cash ambulatory surgical procedures, and cash-only practices and clinics. We shall also see organizations like the Free Market Medical Association and self-funded businesses paying cash directly to providers to save money or to escape from employer mandates. But because Americans have long been conditioned to expect others to pay most of the health care freight and have become insensitive to the true costs of care and will switch to direct care reluctantly.

• Public-private mix - This is what ObamaCare is all about – a mix of “free” Medicare-Medicaid-Health Exchange plans, community clinics, intermixed with Medicare supplements, co-pays, out-of-network expenses, premiums and deductibles, commercial clinics, and out-of-country care. The public side –Medicare, Medicaid, and ObamaCare is growing – covering roughly 150 million of Americans and the employer-coverage side is shrinking, now less than 150 million. So is the knowledge that if you have the money, you can get coverage anywhere, here but anywhere else in the world too.

• Single-Payer - This is the dream of progressives who are fond of saying all developed advanced nations, i.e.. such as the United Kingdom, Canada, Austria, and Taiwan, have single payer systems. David Blumenthal, President of the Commonwealth Fund and Obama’s first director of HIT, is a leading advocate of single payer and says it would save the U.S $570 billion or thereabout. Bernie Sanders, a Democrat presidential candidate, makes similar claims. Sanders projects HT 676 (a single payer health plan) would cost $15 trillion over the next 10 years but would save $5 trillion in reduced administrative waste, pharmaceutical and device waste, and lower rates of medical inflation. I, one among many, am not impressed with government’s performance in reducing waste. If the past is any indication, government schools tend to be taxpayers’ debtor prisons.

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