Make health care inexpensive again: Harry Browne shows how pols have ruined medical insurance

Of course, that's not how they describe what they're doing. They claim to be exercising compassion when they propose to force insurance companies to include mental illness in every health-insurance policy.

Politicians love to posture as friends of particular groups – women, children and people suffering from a particular disease – by forcing insurance companies to cover some medical procedure that's important to a target audience. But every time the government (state or federal) forces insurers to include another benefit in your policy, your premium has to go up.

So it isn't surprising that over three decades the cost of health insurance has risen spectacularly.

Depending on the state you live in, your health insurance may be priced to include mandatory coverage of chiropractors, acupuncture, naturopathy, marriage counseling, abortions, drug abuse, alcoholism, treatments to stop smoking, cosmetic surgery, weight loss, wigs and other hairpieces, Christian Science practitioners, and dozens of other possibilities.

I have nothing against any of these treatments. But it makes no sense for the government to force you to pay for such coverage if you'd prefer a cheaper policy. Just as when you buy a computer or a cell phone, you should be able to select and pay for only the features you need and want – not what the politicians think you need.

As the politicians keep pushing up the cost, every medical interest group suffers. So most of them go to Washington (or the state capitol) to lobby the politicians to provide relief by forcing insurers to add their favored treatment to the mandatory coverage – pushing the price up further.

It may be hard to believe, but back in the 1950s health insurance cost just a few dollars a month for most people – and it was available to virtually everyone, including people with pre-existing conditions.

The percentage of people covered grew steadily from the 1940s. And by the early 1970s, almost 90 percent of Americans were covered by some form of insurance. Then the politicians went to work to load up policies with mandatory coverage of all sorts of conditions that may be of no use to you. More and more people decided that insurance had become too expensive and decided to risk being uninsured. By the 1990s coverage had dropped to under 70 percent of Americans.

In addition, many employers decided health coverage was too expensive. In 1980 fully 97 percent of the companies with 100 or more employees provided medical coverage. By 1995, only 77 percent were doing so.

The growing number of uninsured people gives politicians more ammunition for more programs to force more costs onto insurance companies, and to push the price of insurance still higher.

The cost of insurance is only one area where the politicians have ruined our health-care system.

You may have noticed that they're also pushing for a "Patients' Bill of Rights" – supposedly to give patients certain privileges in dealing with health maintenance organizations.

No one is pushing for a "Bill of Rights" to protect patients against doctors – or against druggists, supermarkets, computer stores, or interior decorators. So how did HMOs become so powerful and dictatorial that their customers need protection?

Nearly 30 years ago, Congress passed the HMO Act of 1973 – which subsidized HMOs and gave them a preferred position among employers. The Act was finally repealed in 1995, but by that time HMOs had become thoroughly entrenched as the centerpiece of employer-sponsored health programs.

Once again, the politicians are seizing the opportunity to save us from their own handiwork.

The solution to all today's medical problems is to get government out of health care.

These are the kinds of solutions that show real compassion for the sick and the vulnerable.

you should be able to select and pay for only the features you need and want – not what the politicians think you need.

Dumb idea. This presumes you can select the diseases you get and the types of injury you'll have from the accidents you plan to have.

But, of course government should not dictate what you pay for with your money. All that Bush is proposing is that mental health care be given parity with physical health care. If you don't want insurance coverage don't pay for it. But if you do want it and you want to include mental health coverage then that should be your right. Now, many policies do not have---or they do have limited---mental health coverage.

Medical insurance at first was called "hospitalization" insurance and was catastrophic insurance because the cost of routine medical care was affordable for most people. As third party payments started paying for more of ordinary as opposed to catastrophic health care, the costs of all care increased and became unaffordable to most middle income people.

I have researched and thought about the health care problem for over 25 years and I believe third party payments (Insurance, Medicare, Medicaid and the host of other federal/state programs) has devasted the relationship between patient and doctor, skyrocketed the cost of care beyond reason, and taken medical decisions out of the hands of most people. Yes, it has also funded a very high tech medical care system that some would argue has caused more problems in the long term than it has solved. Current arguments assume higher tech is better and do not calculate the huge costs of errors that send the entire system reeling off in the wrong direction and the profound economic and social costs of the making health care an adversial relationship driven as frequently by legal threats as by the good of patients.

Current arguments for covering mental health care are political rather than scientific and given the fact that we know very little about biologic and social determinants of human psychiatric behavior and even less about the short and long term effects of psychiatric drugs we are very likely to do more harm than good establishing these therapies accross the whole population though insurance payment decisions. In my opinion such coverage has already led to disasters such as medicating a huge number of school children with ritilin for non-medical reasons. If people had mental health insurance in the 1940's, think of how many more lobotomies would have been conducted. The lack of such coverage limited this disastrous but at the time medically progressive therapy to those in public institutions and those few who were wealthy enough to pay privately.

Financial considerations outweigh humane and even scientific ones too often in medicine today. A clear example is the way the drug and medical complex fought against accepting the findings that ulcers had a bacterial cause rather than a lifestyle cause (acid caused by diet and stress). The lifestyle treatments required longterm therapy with powerful and expensive drugs which earned large profits for drug companies while not helping, and probably harming, patients. Such large profits will always disrupt and defeat the health promoting purpose of medicine. What protects against this is the personal and financial doctor patient relationship which is destroyed by third party payment system.

There is no simple solution but I believe the best approach is to restore as much as possible a doctor patient relationship based on "do no harm" principles and reciprocity. If I could dictate a policy prescription, it would be to reinstitute catastrophic health insurance defined as kicking in after medical costs reach a percentage of income or some dollar figure with an enlarged public health system for those financially unable to pay for medical care. All people, not just old people or pregnant women or people in other narrowly and politically defined categories would be eligible for public care on a sliding scale based on income. This would also have the benefit of severing health care from employment and putting medical privacy issues back in the hands of doctors and patients.

Dumb idea. This presumes you can select the diseases you get and the types of injury you'll have from the accidents you plan to have.

There are certain types of behavior which would make one person more susceptible to certain physical ailments. People who refrain from drinking and smoking, and who are not overweight, should not be forced to pay for medical treatments for people who do.

Since I do not drink or smoke and I am not overweight I'd like to be able to buy medical insurance from a company which only insures people like myself. This would not only reduce my premiums but it would also offer a financial incentive to others to change their behavior.

While it is not entirely possible to predict the diseases one may succumb to it is possible to reduce the likelyhood.

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