Posted: August 01, 2009
Rundles wrap-up: A healthy alternative
My personal experience over the years is that when the government, any government, operates anything, it is inefficient, mind-numbingly un-consumer oriented, and too expensiveJeff Rundles
With all the talk of health-care reform going on these days, and the scary situation that most of this talk is going on in the United States Congress – where members seem more adept at being against what the other guys propose rather than embracing solutions – I thought I’d weigh in.
I’m just a guy. I have no political agenda, and no special interests lobby me. I am a purchaser of health insurance, a consumer of medical services from time to time, and, like many people, I worry about rising costs, and the prospect of having my access to health care limited. I am also in business, so I understand the burden of business owners in managing costs associated with providing health care.
And I’ll be honest: The idea of the government offering a competitive health-care plan to balance out the private sector, or indeed have the government run a single-payer national health-care system, appalls me. My personal experience over the years is that when the government, any government, operates anything, it is inefficient, mind-numbingly un-consumer oriented, and too expensive. And any time the government says it will cost X, 2X is more like what will actually occur.
In a conversation with a very smart friend the other day, he said he doesn’t believe the popular “conventional wisdom” that there are some 45 million with no health care and little or no access to it. As he pointed out, the elderly and the very poor have Medicare and Medicaid, or just outright charity at hospital emergency rooms. The rest of the presumed people without coverage fall into two categories: those who have decided not to buy coverage because it is too expensive for them, and illegal aliens, the latter group bringing up a whole other can of worms beyond health care.
Here’s what I propose, and I know it is simplistic, but it makes sense to me:
Since the issue is, apparently, more about affordability than it is about access, let’s change the rules. Health insurance, all of it, should be provided by private sector companies in competition, no Medicare or Medicaid. And rather than look at “group” coverage the way we do now – people in giant companies get better rates than those in smaller companies or as singles in the open market – make everyone eligible (which is everyone, once you settle on the illegal immigrant issue) in one “group.” In other words, we all get the largest group rate; no exclusions, no banning pre-existing conditions.
Then have each individual, or each family, buy a health-care plan that suits their own needs from any company they choose. If they are employed and their company offers to pay a portion or all of their premium, then deduct it from the paycheck and have it paid to the provider the person chooses. (If they can make direct deposits for each employee to whatever bank they use, then they can pay Aetna or Cigna or whichever with ease.)
I’ve never understood why a business owner, an employer, needs to be involved in administration of the health-care benefit at all; let the employer say, “I will pay up to $1,000,” or “$500” or whatever, and let the employees themselves deal with their provider. If an employee leaves the company, either voluntary or otherwise, they keep their health coverage at the same rate; no high-priced COBRA. And, health-care insurance premiums qualify as a tax deduction so the unemployed get the same pre-tax payment benefit that the employed enjoy.
On the administration side, a lot of money would be saved if the reimbursement programs of the insurance companies were standardized so the doctors didn’t have to go through different hoops with each company to get their fees. A nationwide electronic medical records program would go a long way in making the whole system much more efficient.
On the government side, there should be a few limited roles, and mostly in oversight. First, the government could subsidize the cost of insurance premiums for the poor and nearly poor, and establish rules governing eligibility. Once they get out of the business of administering Medicaid and Medicare, they should have the money to do this.
Second, a government/private industry council could be formed to make the allocation of subscribers fair; no one private health insurance company should be overburdened with the chronically ill or more elderly people than the next company.
Then it’s all a matter of competition; the better-run companies will get more subscribers.
There. I feel better already.
Jeff Rundles is a former editor of ColoradoBiz and a regular columnist. Email him at firstname.lastname@example.org.