Having been in health care policy for a very long time, I have read literally hundreds of six-point plans, eight-point plans, and 10-point plans -- all developed by very sincere and earnest people who think if only the world would do as they say, it would be a better place.
No doubt they are right. If only the world would conform to their vision, and if only they could control people's behavior, many problems would be solved.
Unfortunately, that is the same chain of thought that led to Napoleon, Mussolini, Hitler, and Stalin. I'm not suggesting that health reformers are all little dictators (though some would like to be), but the whole notion that a single person, or committee of persons, can sit at a table and plan the future of hundreds of millions of people is offensive to the ideas of human dignity, freedom, and sovereignty.
So when a colleague suggested I come up with an alternative, I was reluctant. He told me it isn't enough to be the "Party of No!" I had to offer an alternative.
So here is my two-point plan to reform health care in America:
1. Give the money back to the people.
2. Get the hell out of the way.
Perhaps this plan needs some explanation, though it seems pretty simple to me.
Point No. 1: Give the money back to the people.
Every penny that is spent four our health care comes from us, the American people. There is no other source. The money is taken from us in the form of taxes, insurance premiums, or lost wages, but it is still our money. And it is supposed to be used for our benefit.
Over the years we have let insurance companies, employers, and government agencies use that money because we thought they would do a better job of spending it than we could. Turns out we were wrong. In fact, they have done a lousy job of buying health services for us. The services they buy are overpriced, inconvenient, and of questionable quality. And they take an administrative cut out of every dollar for doing it. It is simply not a good deal for us, and we could hardly do a worse job than they have.
Obviously some people do not have any money and need assistance to get the health care services they need. They, too, should be allowed to choose the services they prefer. They could be given vouchers to help them do so, rather than being enrolled in a government insurance plan like Medicaid.
Point No. 2: Get out of the way.
This is probably the hardest thing for the elite to do. Everybody's got an opinion about what everybody else should be doing -- for their own good, of course. There was once a time when it was considered rude to express those opinions publicly. No longer. Now perfect strangers feel entitled to tell everyone else what they should be doing.
If the stranger is just a person on the street, we can ignore him, or tell him to mind his own business, or punch him in the nose if he gets too insistent. But when it is the government doing the telling, our options are limited.
However, if we take responsibility for making our own decisions in health care, we have to be free to exercise that judgment according to our own values and priorities.
We have to be free, for instance, to spend our hard-earned money on the insurance coverage that is best for us and our families. That may or may not include coverage for in vitro fertilization or for counseling by psychiatric social workers. It should be our decision, not something mandated by the state.
We have to be free to choose the best level of deductible for our families. High deductibles mean lower premiums, and vice versa. We should make our own decisions on that trade-off.
For that matter, we have to be free to go without insurance coverage if we want to. We may want to take six months to finish our educations or start a business. Or we may need to skip coverage for a few months because the car's transmission needs to be replaced, and we can't get to work without that vehicle. Why should we need a bureaucrat to give us permission to make that decision?
In shopping for health care services, we need to be free to spend our money on the service that delivers the most value. If I have back pain, I might seek a chiropractor, but if your back hurts, you might prefer an acupuncturist, and someone else might seek a physical therapist. Who should care except the person feeling the pain? It's our backs and our money!
If I have heart disease I might want to go to a physician-owned cardiac hospital instead of the giant Medical Center. Why should Congress get in the way of that decision?
And on and on. Once we are spending our own money, health care providers will be eager to get our business. Physicians might offer weekend and evening hours so we don't have to take time off work. They might start seeing us at the time of our appointments instead of making us wait for an hour. If our kid is running a fever late at night, it might be worth paying $10 to e-mail the doctor to see what we should do, instead of running down to the emergency room. Or $20 for a phone call.
Some people have told me we can't allow consumers to have money to buy health care until we educate them about health care. But that's backwards. Once I have the money, I may pay to educate myself about choices and options.
My two-point plan would "reform health care" in ways none of us can imagine. And that is a very good thing. No one could have imagined the Internet and cell phones 20 years ago. Free people to spend their own money and make their own decisions and an entirely new world opens up. Just in time.
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