Health Care Here. How might it change?

“Last week, Curmudge, we agreed to focus this week’s dissertation to points of view and suggestions.  As I recall, we were going to extend our earlier discussions of health care elsewhere and see if there were ideas worthy of bringing back to the U.S.  But considering health care’s political sensitivity, it would require a king philosopher to make sweeping changes.”

“The term, Julie, is philosopher king.  That’s a guy with the knowledge and judgment to know the right thing to do and the authority to get the right thing done.”

“Surely you’re not going to pretend to be a philosopher king!  The knowledge you once had has petered out, and the only authority you have is over what you select from the salad bar when you eat lunch at the hospital.”

“How about my pretending to be an advisor to a philosopher king?  Years ago my job title was ‘advisor,’ but my boss was no philosopher king.  My job went away when he shot the messenger.”

“And if you had a job, that could happen here.  Shall we begin with some broad, general recommendations based on our recent studies and observations?  Then we’ll get to specifics later.”

“Let’s start with a recommendation for a philosopher king who holds an unshakeable belief in government-sponsored health care.”

“But, Curmudge, that person couldn’t really be a philosopher king.”

“True, but he undoubtedly thinks he is.  He should look carefully at the French Securité Sociale and the British National Health Service.  These programs have desirable features that might be adopted elsewhere.”

“Agreed, but now let’s return to the colonies and consider our general recommendations for health care here:

The patient’s well-being should be the focus of the system of care.  In a highly complex society like the U.S., health care is too complex to be the subject of comprehensive laws and regulations promulgated for individuals on a nationwide basis.

Any government should be able to afford any health care system that it sponsors.

The concept of ‘entitlement’ should be eliminated; it soon becomes enshrined as a ‘right’.  Then ultimately, as in Europe, any attempt to reduce an entitlement will be fiercely opposed by those who have become accustomed to its benefits.

Bureaucrats should not make health care decisions for individuals.  These decisions, in the form of rules, can have tragic unintended consequences.

Health care should be allowed to operate in a free market.  Prices should not be administered; they and outcomes should be transparent.

Innovations in health care practice, devices, or delivery should not be discouraged or inhibited, as discussed earlier.

Payments for non-critical health care encounters should not require third-party involvement.  Health insurance should return to its former ‘major medical’ or ‘hospitalization’ role.

Any health care system—national or local—should include a ‘safety net’ for those who truly need it.  This should be in concert with the Triple Aim of providing the best care for the whole population at the lowest price.”

“Well, Julie, shall we move on to specifics?  We should be careful to cite references.  Fictional characters are a lot like parrots; we can only speak those words that we have learned from someone else.”

“We already provided one specific suggestion in our discussion of Clayton Christensen’s book back on June 3, 2011.  ‘Employers who directly manage their employees’ health care use a combination of high-deductible insurance (to protect against catastrophic illness) and health savings accounts (HSAs). The employer puts before-tax money in the employee’s HSA; the employee can also add (before tax) to the account. The employee pays for health care out of the HSA up to where the high-deductible insurance kicks in. Upon retirement, the employee can keep any funds left in the HSA.’  Christensen also described a variation on this system for the uninsured (unemployed) poor.”

“Here, Julie, is a similar approach that also gives the patient the option of deciding how he will spend his own money.  This was in legislation proposed by Congressman Paul Ryan and was described by John Goodman: ‘Suppose the government offered every individual a uniform, fixed-dollar subsidy (tax credit) for the purchase of health insurance, say $2,500 for every adult and $1,500 for every child.  A two-adult, two-child family, then, would get $8,000.  The credit would be refundable, so that it would be available even to those with no tax liability.  If an individual chooses to be uninsured, the unclaimed tax credit should be sent to a safety net agency in the community where the person lives — in case he generates medical bills he cannot pay from his own resources.’ “

“I think I’ve got it, Curmudge.  If health care is perceived to be free, it will be undervalued and overused.  These approaches give the patient the freedom to make efficient decisions with his own money.  Couple this with price and outcomes transparency and we’ve removed some of the chaos from health care.”

“There are more suggestions to be discussed, Julie, including some pertaining to Lean in hospitals.  If you leave town on vacation, don’t stay away long.”

Kaizen Curmudgeon