Will Marre’s Radical Solution to Health Care

How does paying $25,000 a year for health care sound?  According to the Consumers Union that’s what the average family will be paying in 15 years if we don’t do something now (See Myths on Health Care in USA Today).

Some issues that impact our lives and our children’s future are so big that it takes an extended article to say what needs to be said.  Health care is one of these issues.  I worked in the health industry for eight years consulting with two multibillion-dollar hospital groups with sterling reputations.  I worked with many great people who wanted to do the right thing in the right way.  But our health care system is so goofed up and so internally competitive with doctors, hospitals, drug companies and insurance companies all hammering each other for a piece of the hurricane of money blowing through health care.  I use the term ‘hurricane’ because the money we spend is a storm of waste.

According to the Consumers Union, $500 billion/year is wasted in ways that frequently hurts our health instead of helps us.

I present my idea as an idea-starter rather than a complete plan. One thing for sure, tweaking the status quo will not work.  We need something far more radical….

Yes, according to our Congressional Budget Office, the biggest threat to American’s quality of life is…you guessed it…our bizarre health care system.  We all know by now that the U.S. has the most expensive, least effective health care system among all developed nations.  In the richest country in the world, we all too frequently see canisters in grocery stores asking for hand-outs to pay for cancer treatments for a child whose working parents’ insurance doesn’t cover treatments.

With 47 million uninsured and at least 100 million more of us increasingly under-insured, no fair-minded person can claim our current system works.  The cost of inadequate coverage has reached the ridiculous.

My own family’s policy, which is a high-deductible monstrosity full of coverage limitations, has increased in cost by 40 percent in the past 2 years.  And no we haven’t had any major illness or accidents.

Although there are many players in health care we could blame for contributing to our problems, the private health insurance industry is the one that is most problematic. That’s because our large health insurers are worried that their core business model is ill suited to help today’s consumers.

They have already spent $22 million trying to scare the public into thinking that socialized medicine is coming with its inevitable mediocre care.

Meanwhile Congress is coming up with some super-expensive half-baked compromise that is likely to make things more complicated, more expensive and subject to future corruption in ways currently unimaginable.  Either way, the middle class is likely to wither due to massive taxes or massive direct costs that may even be more than taxes.

What’s needed is something far more radical, daring innovation that revolutionizes health insurance as it reduces cost and complexity.

1. First we must bury the idea that health insurance is an “industry” or a business. The profit motive works great for giving incentive to commercial genius to create iphones but it gives incentive to all the wrong behavior when we’re trying to create an all citizen access to health care.This isn’t hard to understand.  Profit arises from the difference between premium income and overhead costs and health claims.  Thus insurers are rewarded for only insuring the healthiest people and paying as few claims as possible.  So that’s exactly what we get.  Today our health is brutally rationed by the insurance industry.  Increasingly numbers of people simply can’t get health insurance ironically because they need it.  We also get claims denied and benefits arbitrarily limited after we’re ill by armies of insurance company employees who earn bonuses by keeping payouts limited.  It’s called mis-aligned incentives.  The companies selling insurance profit the most when they deny me the benefits I thought I was buying.  That is unfixable.  No amount of regulation will match the problems that mis-aligned incentives cause.
2. Government cannot effectively administrate an expanded Medicare-like bureaucracy to cover all American’s in an effective way. Government bureaucracies grow proportionately less efficient and effective with size.  Costs will soar and service decline.  Government bureaucracies are exceptionally poor at promoting high operating performance because individual workers are not systematically incented to excel. We all know this.  I am not suggesting all government workers are lazy, rather that all bureaucracies, public or private, are poor at rewarding merit.
3. The solution is something new.  Something called Civic Enterprise. A Civic Enterprise uses the efficient disciplines of business to achieve social goals at the highest possible quality at the lowest cost.  This is achieved through totally aligning incentives.  Here’s how.A Civic Enterprise for American health care would function as an all citizen non-profit co-op we all own.  It would operate the way large corporations self-insure.  Every citizen would be eligible for a universal level of humane benefits.  Every person would have a deductible equal to 3 percent of their income so they would seek the lowest cost provider for minor sicknesses and injuries.  This would motivate low-cost, high volume free market providers like Minute Clinics to thrive.  (This 3 percent is not a tax.  It wouldn’t be a cost to people who didn’t get sick or injured.)The co-ops insurance benefits would be administered by regional centers whose employees would be incented to get the most people enrolled and well served with the specific treatments that conform to best practice guidelines.  Six sigma measures for quality and efficiency would be embedded into the system so co-op employees could earn substantial bonuses for providing excellent and timely service.  Good performers would be rewarded and poor performers weeded out. The main business driver would be to provide the best coverage to the most people to increase citizen health.
4. All citizens would have the opportunity to take online or in-person health education classes. Doing so would result in lower deductibles.
5. Funding would come from dismantling our Medicare bureaucracy and new health taxes on all products that contribute to poor health. These include manufactured food and beverages whose primary ingredients make us fatter, clog our arteries or trick us into thinking we’re hungry.  Also taxing polluters who contribute to lung disease and cancer also puts the tax on the modern sources of environmentally caused illness.

Yes of course there will be screams from the businesses that profit and prosper from promoting risky behavior, make fake food or foul our air and water.  These taxes are not anti-business.  They simply reflect the real economic costs of producing certain products.  Government’s legitimate responsibility is to tax private companies for the social costs caused by their operations.

In a market economy everyone needs to take responsibility for their impact on the health of the total marketplace and that means the impact their product or their production process has on society’s health.  It’s only fair.  So go ahead and make your cigarettes, Twinkies and coal plants, but you and your consumers must pay for the health consequences you are creating.  That’s as pure a market-based economy as I can imagine.

The bottom line:

Let’s all get on the same page.  If we align our economy and our incentives toward promoting health, self-reliance and taking responsibility for all our actions, we can solve our health care crisis.  We need to focus on performance rather than profit.  If we let business-as-usual cut off real innovation that we need, we’re headed into a Grand Canyon of quick sand.

What’s the best thing we can do? Get in our Senator and Congressman’s face and demand real solutions that improve effective care, universal access and hold down costs. ( Write Your Representative or Contact Your Senator.) Engage with the White House and President Obama in today’s Town Hall on Health Care Reform.

Postscript:
Some Things that Make No Sense

1. That we get health insurance through our employment.  It’s a burden to our economy and few of us work for companies that provide insurance.  Get employers out of the health insurance system.  We need to get our insurance directly and everyone should be covered.
2. Don’t pass a law requiring we individually buy health insurance from a private, profit-motivated insurance company.  None of them put my interest first.  Comparing this to mandatory car insurance is absurd.  I choose not to have a car.  I can’t choose not to have a body.  Enroll me in an effective non-profit Citizen Enterprise plan.

So what do you think?  The more constructive ideas that bubble up, the better our solutions will be.  So let’s hear your ideas.

You can also read some of your ideas/comments on my previous post, “Who Will Pay for Healthcare.”  Thank you for your insightful thoughts.

Engage with us by posting your comments/ideas.  Engage with us on Facebook and Twitter