Minimizing Our Returns
One reason we’re getting nowhere quickly in health care reform is that Bush is focusing primarily on health savings accounts and “consumer-directed health care,” which basically puts people in charge of making their own health care decisions. This is a ridiculously terrible idea for many reasons, not limited to the fact that 1% Of Americans Account For 22% Of Health Care Spending, and the top 5% account for basically half of health care spending.
These are the people that spend 10 months in the ICU, or have 23 vascular surgeries for peripheral vascular disease. These are not people that are trying to decide whether to get that lab test or that colonoscopy. These people are not using health savings accounts. So Bush is putting all his effort into these accounts, when, very likely, it might put a teeny, tiny little dent in health care spending. The wool’s pulled over his eyes for the giant elephant in the room.
I am sure that you are getting tired of my opinion regarding your “single carrier” health insurance. I can assure that if we had universal health care that it would be very unlikely that any patient would stay 10 months in an ICU nor would anyone receive 23 surgical procedures for peripheral vascular disease. The only way any country affords some type of universal coverage is some form of rationing of care.
I personally see nothing wrong with health savings accounts and allowing patients to be in charge of their health care decisions.
Look, a MSA is a high-deductible INSURANCE plan along with a tax-defered savings account. OK? so the choice the patient has is not which medical care to get, but how to pay for it: by spending cash against the deductible or not. So it functions like an old-fashioned pay-to-play plan (i.e. before HMO) with the added bonus that the cost of the insurance can come out of the savings.
BUT you need a fairly large income to make it work. I can show you fairly straight-forwardly that if you make less than about $35000/year, it’s functionally useless, as there is NO financial gain and there is a LOT of paperwork and IRS consequences.
In general, MSAs are not useful for the most needy part of the population. That doesn’t mean that there is no problem. If you combine a single=payer (universal type) plan WITH A DEDUCTIBLE AND CO-PAY, you get the benfits of both. If you also want to have an MSA, you can do that too.
And Dr. Thompson, if you don’t think there is already rationing of healthcare in this country today, let me invite you on a tour of the least prosperous 100 counties in the US: they’ve basically been rationed right out of the system. Also, please see the recent LA times coverage on Kaiser and the liver transplants. Long waiting lists are a democratic form of rationing, aren’t they?
Oh dear, my enthusiasm got the better of my typing. It should read:
That doesn’t mean that there is no SOLUTION.
And
Dr. Thompson, if you don’t think there is NOT already rationing
Sorry for the confusion.
John