Analysis: Real Health Care Reform

Published February 1, 2008

Insurance with first-dollar coverage is not the same as health care, much less health itself, and it certainly does not encourage individuals to use less costly solutions to their health problem(s).

Our current system encourages and pays for care when we should be encouraging people to lead healthy lifestyles and seek information and alternatives rather than immediately seeking health care services.

Any approach to solving our health care problem(s) must involve reducing the demand for health care services. The only way to do this is to help individuals become informed, fiscally aware, and responsible for their own health care decisions. Separating people from costs leads to wasteful spending.

So, let’s get started. How can we solve the real problems besetting U.S. health care?

Lifestyle Changes

Inappropriate lifestyle decisions that increase the need for health care services must financially impact individuals. We now know and can measure the cost of obesity, smoking, sedentary lifestyles, excessive drinking, and willingness to ignore medical advice regarding chronic diseases and conditions. The health care system should not be responsible for the economic impact of all these bad decisions.

The simplest approach is to provide health insurance discounts to people who practice healthy lifestyles by maintaining proper weight, refraining from smoking, and so on. Reduced co-pays and deductibles can also be incentives.

Some insurance policies already provide opportunities for such discounts. This must become the norm. We can save hundreds of billions of dollars in this way if we want to.

Real Insurance Market

Linking health insurance to employment is now a major problem. Employees are locked into non-portable plans chosen by their employers. The change needed is simple: Provide employees with health care insurance premium support, and let them do the shopping.

If millions of employees are let loose on the market, the market will respond, big time. Employees will make choices based on their needs and interests, and portability will give them freedom if job-change opportunities occur.

Many more insurance packages will emerge, and large-scale adoption of health savings accounts or medical reimbursement accounts with high-deductible policies will spur further improvements. This will move us away from first-dollar coverage and turn health insurance more toward catastrophic protection–which is the real purpose of insurance, after all.

Tort Reform

The tort system has likewise perverted health care delivery. Even the teaching of medicine has been affected. “Defensive medicine” is the result of this incredible aberration of the health care system.

This epidemic is unique to America. Too much is done to and for patients because of fear of lawsuits, and patients suffer as a result. The entire system suffers. Some communities are facing tort-induced shortages of medical specialists.

The cost of defensive medicine most likely exceeds $200 billion annually. Alternatives to the courts must be established for patient injuries, and non-economic awards must be limited. Science, established protocols, and good sense must drive the health care system.

Taxes, Mandates

Income tax unfairness is a political embarrassment. Who can be for anything but equality in the taxation of health insurance premiums? Unfair taxation makes logical and intelligent decision-making nearly impossible.

This problem can be solved overnight: Give all citizens the same opportunity to purchase health insurance with pre-tax dollars.

Health insurance mandates are another political embarrassment. Why do state legislators place themselves between the majority of their citizens and the self-interest of a few? No more study is needed. Mandates increase the cost of health insurance and create more uninsured citizens.

The biggest political embarrassment is our elected officials’ willingness to push many of society’s basic social problems onto the health care system. Unwed teenage pregnancy, infant death, illegal drugs, HIV/AIDS, and gun violence are only a few of the social issues that have tremendous impact on the delivery of health care services and their costs.

The extent and the cost of these problems make us a worldwide laughingstock. Yet we dump these problems straight on the health care system, then complain because they drive up costs. These are not true health care costs. Elected officials need to wake up to this fact.

Research Agenda

Federally funded research must be altered to place more emphasis on health care delivery. It is clear that basic and applied research is needed to better understand and treat human disease and impairment. However, federal research could help more people and have greater economic impact if more investment were aimed at improving the delivery of health care services.

We still pay too little attention to rationalizing the choice of treatment options and utilizing the least-expensive but equally effective treatment. In fact, it seems physician autonomy in patient decision-making is honored more highly than providing cost-effective care.

Physicians must understand their long-term autonomy is impossible if they are not fiscally responsible today. Less-costly options deserve more attention in the treatment decision-making process, as in recent discussions about cardiac stents versus use of drugs and exercise.

The structure of health care delivery organizations also needs attention. Managed care in its many forms has saved this nation untold billions. We must continue to search for the best structures for delivering high-quality, cost-effective care.

Using Sense

Implementing these steps will reduce our national health care bill by hundreds of billions of dollars. Only then can we rationalize the delivery and financing of health care in our nation.

The continued circus of calls for new programs to cover this group or that group, the shifting of costs from one group to another, and lobbying for new diseases to be covered must stop. Every new initiative complicates health care delivery and costs the nation more money. The politicians create, and then the politicians complain.

It is time to refocus our attention on the basic issues that matter–to reduce costs, eliminate our basic problems, and work to bring all Americans into a rational and effective system.

Stuart A. Wesbury Jr. ([email protected]) is a professor emeritus at Arizona State University and former CEO of the American College of Healthcare Executives.