Bringing Down Healthcare costs so easy a caveman could do it

If we want to bring down the cost of health care, it’s easy. What we lack is not the way but the will.

First, eliminate the federal requirement that hospitals have to treat any patient who shows up. That’s the place to begin. Get government out of telling hospitals who they have to do business with. There is simply no way to control the cost of health care if hospitals are obligated to provide healthcare to all regardless of their ability to pay.

How long would a mechanic last if he was required to fix every automobile anybody brought to his shop, regardless of ability to pay? He’d be broke and out of business in a week, and pretty soon there would be no mechanics for anybody. We’d all be riding bikes to work.

People need medical care, you will say. Right. People need to eat, too. How long would a grocer stay in business if he was required to offer food to everyone who walked in the door regardless of their ability to pay? He’d be broke in a week, and then nobody would have food.

There was no such emergency room law prior to the one Ronald Reagan - yes, that smaller government, government-is-not-the solution Ronald Reagan - signed in 1986. For the first 200 years of our life as a republic, hospitals through charity and charitable donations offered health care to the neediest among us, and did so without anybody having to order them to do it.

Most hospitals were started by Christians or Christian organizations, and will find a way to offer care to the indigent whether the federal government is standing over them with a cudgel or not. The American people, because of the spirit of Christianity, are the most generous people on earth, which they prove time after time when disasters hit anywhere in the world. Let’s not insult our own people by saying they are not generous and compassionate enough to help the needy with medical care.

Second, allow low-premium, high-deductible insurance policies. The higher the deductible, the lower the premium, and the more can be plowed into health savings accounts. This will enable Americans to build up reserves to meet the deductible in case of a major event as well as for routine medical expenses.

Health insurance should be for emergencies, not routine maintenance. We don’t expect auto insurance to cover oil changes and tire rotations. It’s there for accidents. And so health insurance should not be there for checkups but for major events.

If people paid out of pocket for all medical expenses up to a high deductible, they’d be much more careful about their use of medical services and they’d take better care of themselves in the meantime. The cost of medical services would come down as health care providers lowered prices to attract business.

Consumers would have an incentive to take good care of their own health and use medical services sparingly, because every dollar they save they get to keep. Right now, employees using employer-provided insurance have zero incentive to reduce the use of medical services. In fact, the incentive, perversely, is the other direction. Employees who make healthy lifestyle choices and rarely need medical care wind up with nothing to show for it, other than higher premiums to pay for other employees who don’t look after themselves.

Third, get rid of all government-mandated coverage requirements. A huge driver of the cost of insurance is that government regulators, including Benito Obama with MussoliniCare, require insurance companies to cover a host of treatments, whether the consumer has any interest in them or not. Let’s allow insurance companies to offer a range of packages and allow consumers, cafeteria style, to decide what kind of coverage they want. If they will never resort to acupuncture, why should they be forced to pay for it?

Highly paid lobbyists get state regulators to mandate coverage for all sorts of things, whether it’s psychiatric care or chiropractic care, that many consumers would not purchase if the choice was left up to them. That’s why regulators have to mandate them. Well, every such mandate increases the cost of insurance coverage to the consumer, who is being forced to subsidize treatments for other people that he himself will never use.

Fourth, allow insurance companies to sell insurance across state lines, just like auto insurance companies do. The competition for health insurance dollars will rapidly reduce the cost of insurance. Right now, a handful of insurance companies, through state regulators and lawmakers, can monopolize the health insurance business in a given state. The lack of competition unfairly drives up the cost of insurance. Competition brings prices down. Always has, always will.

Fifth, tort reform. Doctors pay exorbitant premiums for malpractice insurance. Of course, patients should be made whole for medical care and lost wages in cases of negligence or malpractice, plus a penalty of some amount - say 20% - but pain and suffering awards ought to be capped at a fixed amount (say $250,000 or $500,000), which can be indexed to inflation.

This will rapidly bring down the cost of malpractice insurance and lower the overall cost of health care. After all, doctors pass along the cost of their premiums to their patients. They don’t cover the cost out of their own pockets and the goodness of their own hearts. They’ve got to stay in business, otherwise nobody gets health care, period.

Sixth, allow individuals the same tax break employers get. If employers can offer employees health care as a tax-free benefit, individuals should be able to get an equivalent tax break for buying their own insurance.

After all, employers don’t buy auto insurance for their employees. Why on earth should they be buying health insurance for them? The only reason is that government in all its wisdom offers them a tax break for offering health insurance it does not offer for auto insurance.

Let’s get employers out of the health-care-providing business and let them give the money they spend on premiums to their employees in the form of raises. I flat out guarantee you that employees who are spending their own money will be more frugal about the choice of insurance products than their employers are.

If ObamaCare is shot down by the Supreme Court, as it certainly should be, the possibility of major health care reform will be sitting right in front of us. We can preserve the status quo, which nobody likes or should like, or we can make reforms that will reduce costs and improve access to health care for every American for decades to come. It will be time to choose. Let’s choose wisely

Good ideas, every one, and implementing even one of them would bring down the cost of health care by itself.

The only one I have a quibble with is #1. I would retain the requirement that an emergency room stabilize a patient before transfer anywhere else.

Amen!!! The last time I was in the emergency room, for a tetanus shot, the nurse seemed quite agitated that an illegal with “an arm that hurt” was taken in before me.

I fell into a bed of rusty nails (don't ask). I went in, poured peroxide all over my bleeding right side self then noticed a hole in my right arm.

My sister, an RN, FORCED me to go to the ER. Said she was picking me up and I had no choice (I didn't want to go).

While we were in the waiting room, the nurse looked out and said “you're still sitting here?”. I was taken in immediately.

To your second point. Is a $10,000 per person deductible enough? That is what I have had to go to to manage my costs. Even at that they went up. At the rate they are increasing I won’t be able to pay for long.

How high do you think the deductible should be?

We’ve been screwed by both parties... even Reagan.

I remember when I was a kid we paid for everything but major medical out of pocket and dad was a federal employee and he thought he had it good then.

Things aren’t out of hand, they are out of control and the genie isn’t going back in the bottle.

Thanks Ira, I’ve been looking for something like this. ... What if we give DR.s, hospitals and drug co.s etc. decent tax breaks for goods or services given to the poor... would’nt they deserve it !

“Good ideas, every one, and implementing even one of them would bring down the cost of health care by itself.

The only one I have a quibble with is #1”

I don’t. My wife has two diabetic children. My brother died of throat cancer in the 1990s. I have spent a lot of time in south Florida ERs. One reason any visit to one is a minimum of 4 hours is the amount of illegals who treat it like a primary care doctor. There’s nothing the staff or hospital can do about it either. They are required by law to see them no matter how frivolous the cause seems to be. We all pay for them. If the other solutions were implemented maybe the illegals could afford to go to a walk in urgent care clinic. I guarantee you most of them would figure out something else to do if the hospital could refuse them without insurance or means to pay.

Great article - thanks for posting it.

I’ve been an MD since ‘84, a shrink who often worked in general medical or emergency or public sector venues over the past 25 years. I’ve seen it all. The Feds got their nose into the tent with Medicare, with predictable results. It’s been downhill since then. I remember how it was growing up. IMO, the Feds are guilty of committing gross negligence and malpractice in their pursuit of power and self-enrichment.

My wife is an emergency room nurse. The stories she comes home with at the end of a grueling day would leave your mouth hanging open. She has a good heart, but hates putting up with the entitled, nasty riff-raff that abuse the system the Feds have mandated. She came from the Third World years ago, looking up to America, but just shakes her head now.

We’re both likely to retire early from professions we could have practiced indefinitely. The Feds are the reason, with or without ObamaCare.

I don’t understand why the government has to be involved in any phase of our health care except for low income people who could be covered by states using federal block grants which they would be responsible for administering.

Eliminate Medicare totally. Would save billions of dollars which could be directed elsewhere. Eliminate HIPAA, carve outs and pre-cert requirements except for hospital cases. Let everyone everywhere get whatever coverage they want on their own. Blue Cross for instance should have one company, not fifty. Have never understood why health coverage has to be so much more complicated than auto or other types of insurance.

They are required by law to see them no matter how frivolous the cause seems to be.

That's not true (at least under Federal law, I don't know if there is a Florida law that applies). EMTALA applies only to emergency treatment, and a hospital's obligations under EMTALA end once a patient is "stable."

She has a good heart, but hates putting up with the entitled, nasty riff-raff that abuse the system the Feds have mandated.

That is the very reason I let my certs expire 4 years ago and never looked back. Your wife must have a remarkable constitution to be able to suffer the fools.

Consumers would have an incentive to take good care of their own health and use medical services sparingly, because every dollar they save they get to keep.

Unfortunately, there are very few people these days capable of that kind of long-sighted thinking. Just look at the markup on "convenience foods" to see proof.

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