By Tom Brown
In the United States we are approaching 20% of GDP spent on
healthcare. This is the greatest in the
world; double what many developed countries are spending, with no worse life
outcomes.
It is too much! And it is growing faster than the economy.
It is highly significant for people with middle class
incomes or less, and not simply a chosen expenditure.
Employees only pay a portion of their insurance costs yet
they often decline to take insurance for themselves or for their dependents.
Clearly health insurance adds to the cost per employee, more
so than employment taxes, and it is reducing hiring.
It definitely adds to the cost of living even if the
employee doesn’t buy the employer offered insurance, since the public sector
pays for necessary health care for the uninsured, or it is somehow paid for as
more costly deferred care.
And it definitely adds to the cost of products we make and
services we offer, so we are less competitive on a global basis. And it adds to
our public budget to support insurance for seniors, poor people and veterans.
We must reduce it
Obama care will not reduce health care costs sufficiently, or
perhaps at all.
Offering health insurance to all will not reduce health care
costs even considering reducing future health care costs of an individual
because of preventive care according to reported Medicare studies on the effect
of preventive care.
Reducing health care costs significantly means changing the
system for:
--greater use of clinics where a cheaper person than the is
the first contact of the patient
--greater use of generic drugs
--less defensive medicine including imaging and lab work
--pre-approval for non-emergency treatment and drugs, where
the payer looks at the patient’s overall health, life prognosis and treatment
history
--use of treatments and drugs with the lowest calculated
cost benefit
--giving everybody a financial incentive to minimize their
health care costs
--giving everybody an incentive to have a healthy lifestyle
--the end of group insurance, where some people pay too much
and others too little, and the ones paying too much do not know
Obviously there will always be individuals who can afford to
pay for costly treatments or what is called concierge care themselves or to pay
extra for insurance to do so.
Ideally the individual will choose his insurance trading off
copays and maximum out of pocket costs and HMO network coverage versus using
any provider and even tax deductibilty.
In that sense, private insurance companies would seem to be
a good way of creating a variety of offerings for this transition.
Also it would seem valid to allow an individual’s dedicated
health savings to reduce that individual’s insurance cost by matching the
deductible to the savings amount at the beginning of each year, and charging
accordingly.
It is clear that this is not simply a discussion about
Medicare. It is about health insurance for corporate employees, poor people,
working families, self-employed people, veterans and retirees. Most, by the way
get subsidized health insurance, including a tax subsidy.
All health care costs must come down.
Everybody should have some access to health care. All tax subsidized health insurance including
insurance offered employees and company retirees should operate with the same
rules and principles.
No one should be advantaged or disadvantaged by the size of
their employer, and whether they are full time, part time or self-employed.
Finally, no one should be able to game the system by not
being insured. You need to have minimum insurance yourself or pay a tax to have
access to a high risk uninsured individual insurance program to insure that
need treatment will be paid for.
