Thursday, March 23, 2017

To Solve our Health Problems, Turn the Individual Mandate on its Head

   Fixing our health-care system, as much as anything, means reining in the sky-high expenses. So, if we are are trying to think this through, if we were considering ways to reduce medical spending, one starting point would be to consider what the principles of economics say about how to reduce spending.
   When you open up that college textbook, what does it suggest?
   I didn't take economics in college. Wish I would have. But, I can still pursue this based on what I do know, and what I can see. Coming in, I can only think of two ways: (1) government caps; and (2) market competition. I find myself throwing out the first solution without much thought. Perhaps I might come back to it at a later date, but for now, I am not warm to government caps on health-care costs.
   So, I consider market competition -- and, as quick as I do, I remember yesterday I questioned whether capitalism was even appropriate for health-care. Market-driven systems, as a general rule, give one level of care to the rich, and a lesser level to the poor. With health care, that seems inappropriate. Everyone should have equal access to life, to staying alive, and to being treated so they can stay alive.
   So, if you are going to stick with a market-driven health-care system, you must find a way to extend it to the poor. Have we already achieved this? Is Medicaid and Medicare and government assistance the way to ensure everyone has equal access to medical treatment? Let the rich pay their own way, but let government pick up the tab for the poor?
   I wonder.
   I consider another thought I've had. The deeper the pockets of the person paying for a product, the more expensive the product will be. Government has as deep of pockets as anyone. It prints money, if it needs it. Following the principle of supply and demand, if there is a large supply of money available and you increase someone's ability to get at that supply -- if you increase the demand for that money, prices are going to go up.
   Put another way, if money is placed on the table, someone will sweep it up. And, the more money on the table, the greater their pleasure.
   So, suppose that instead of sending government and insurance companies in to help folks, we use government to hold down down prices. Up above, I suggested I know of only two ways to go about holding down prices: government and competition. I threw out government since it leaves a distaste in my mouth, but I warned I might come back to it.
   And, I'm coming back.
   What if we turned the individual mandate on its head? What if instead of requiring everyone to purchase insurance, we require every medical provider to give care to everyone -- at whatever price they can get?
    We already do this, in a way. If you go to the emergency room, they cannot turn you away. My system would kick out the insurance companies, and extend the idea that you cannot turn them away to any necessary health care, any non-elective procedure.
   Don't get me wrong. I'm still thinking this through as I type. I'm not sure it will work.
   Here's the system: You go in, you get the health care, and the hospital bills you for what it will. If you can pay what they are asking, you pay it. If you can't . . .
   A government arbitrator sets the price. The arbitrator looks at your ability to pay, and comes up with a price that is affordable. That's all the hospital or doctor gets. You can't get blood from a stone, 
   I wonder at creating a government arbitration office. This does seem expensive, and I am not a fan of big government spending. But, I consider that as an expense on the whole of the system, we already have insurance companies with millions of employees who together add up to a huge expense.
    While we jettison the insurance companies, let's move their workers -- just a part of them -- over to the government arbitration agency. That way, some of the lost jobs will be absorbed.
    And, we already have huge government expenses via Medicaid and Medicare. It might be that the expense of an arbitration board is less expensive than Medicaid and Medicare.
    That leaves only one thing not covered. How are we going to ease the new program in? If we just drop it into our society, not doing it gradually but all at once, hospitals and doctors and medical providers might be ran out of business. 
    Alas, I must go to bed. The rest of this problem must wait. No time as to so much as to edit this entry.

No comments:

Post a Comment