It is time to put the patient back in control of their health care. Over seventy percent of Americans’ health care is paid for by a third party, either by the person’s employer or by the government through Medicare, Medicaid, Obamacare, and the Veterans Administration. This fact, coupled with the lack of price transparency and competition among providers and hospitals, isolates patients from the true cost of health care and limits the ability of patients to make their own health care decisions.
There are solutions, however, that put patients in charge of their own health dollars and their own health care decisions.
Half of all Americans receive their health care benefits from their employers or their spouse's employer. This is a cost of doing business, yet companies receive a substantial tax write-off for providing these benefits. The United States is unique in having this employer-paid model and at the end of the day, it is the U.S. tax code that drives health care financing for millions of Americans. Employers don’t provide food or housing for employees. It would make more sense for employers to pay their workers higher salaries and have the government give employees the same tax deductions that companies are now taking for their health care.
Health insurance reform is necessary and a person’s concept of health insurance must change. When a patient says that they have good health insurance, what they really mean is that their insurance covers many different things, for example glasses, hearing aids, and routine medical treatments. Health insurance should function just like auto and home-owners insurance. A person should have a catastrophic health insurance plan for major medical expenses, coupled with a tax-advantaged health savings account for day-to-day medical expenses.
Private health insurance is now controlled by individual states, as is provider licensing. To increase competition and bring down costs, insurance and licensing should be offered on a national basis. Likewise, telehealth was a tremendous benefit to patients during the COVID-19 pandemic. Telehealth should be expanded and should be available nationally, with no state restrictions.
Provider and hospital price transparency should be mandatory. There is no way a patient can be an informed consumer of health care without having access to cost comparisons. Providers, clinics, and hospitals should compete not only on quality but also on pricing.
Patients who require a large amount of medical care, high-cost patients, and patients with pre-existing conditions should be managed in high-risk pools. This will accomplish two things. It will ensure these people have their health care needs taken care of and it will lower insurance costs for everyone else. High-risk pools have a bad reputation simply because they were never adequately financed. Costs of high-risk pools need to be socialized and could be covered by either a small fee on all insurance premiums or through the general tax fund.
Medicare, government-controlled insurance for seniors, is not financially sustainable in its present form. Life expectancy when Medicare became law in 1965 was 70 years of age. In 2024, life expectancy is 79 years of age. The age for eligibility for Medicare should gradually be raised. Seniors should be means-tested with premiums based on income and net worth. Finally, seniors need to be treated with respect and should be given a generous tax credit for health insurance in a resurrected private market.
Medicaid began in 1965 as a safety-net health insurance program for the most vulnerable in the U.S. It was designed as a temporary plan. It has expanded tremendously and now is used for not only health insurance, but also for transportation, housing, and food assistance. The program now includes medical and maternal care for able-bodied 18 to 64-year-old people. Medicaid should be returned to a welfare entitlement for the most needy in the U.S., should be temporary, and when possible should have a work or community service requirement.
Waste, fraud and abuse should be diligently monitored with frequent eligibility and financial checks in both Medicare and Medicaid.
Many people in the U.S. are concerned about “information asymmetry” in our health care delivery system. The argument is that providers have much more knowledge of medical care and patients are at a disadvantage because of their lack of information. Yet, this is the situation any time a person consults a professional specialist, regardless of whether that specialist is an attorney, a dentist, an auto repair person, or any other professional. Americans are some of the most savvy shoppers in the world and are very accustomed to using second and third opinions.
We essentially have two choices when considering the future of our health care delivery system. America can go down the road to a single-payer government-controlled system that allows unseen bureaucrats to make more of our medical decisions. Or we can push our elected officials to enact the above recommendations and give patients the ability to make their own health care decisions.