I suppose that the topic of American health care reform occupies too much of my mental energy, considering I am a fairly healthy person whose day job has nothing to do with the subject. Since I’m getting a MRI tomorrow, the subject feels even more urgent than it usually does. It’s not that I worry about paying for this procedure nowadays. Had I needed this procedure a few years ago, it would have presented an outright threat to my finances. My path to self-sufficiency was very dependent on my family having minimal medical expenses along the way.
How did we get in this mess of spiraling costs and how can we stop this madness? I think we can find inspiration in the world of transportation. To fix our health care system, we could try combining the best aspects of car insurance with a supporting public transportation-style structure. Imagine what transportation problems we’d have if car insurance had taken the same trajectory as health insurance. The price of almost everything related to car ownership would spiral out of control because car owners would be insulated from out-of-pocket price increases. Very few people would know the actual price of a gallon of gas. You’d just go fill up at the “in-network” gas station for your car insurance company, just for the cost of a co-pay or nothing at all if your deductible was satisfied.
If car insurance were like health insurance, most people without employer-sponsored insurance would be priced out of driving. The cost of providing this insurance would be so high for employers that it would dampen hiring and stagnate wages. Millions of people would have little to no access to transportation, except for vulnerable populations whose survival depended on the government letting them borrow a used car.
Next the government tries to partially rein in the system by opening a marketplace where uninsured people can buy car insurance. This reform reveals how expensive car insurance has really become. The press reports that the price of gas has swelled to $25 a gallon. Oil changes cost $500. Of course the public is outraged.
Thank goodness car insurance did not go the way of health insurance. Why not try making health insurance more like car insurance? Reduce the cost of health insurance by reverting it to what it originally was: protection against catastrophe. Then bolster this plan by creating a public transportation sort of public health infrastructure to deliver preventative care to all and comprehensive care to vulnerable populations. This could create a market where consumers respond to price, yet there is necessary care for all.
Health care is just as vital to our nation’s economy as transportation is. We have a vibrant, innovative market for cars, yet we also see the value in funding public transportation initiatives. Such a transportation-inspired plan would require that those who have insurance pay for office visits and prescription drugs out of pocket, but I think consumer awareness of these costs would help drive down the price. As for those with chronic conditions, they could have those specific conditions treated more cost effectively through a public health infrastructure.
As for the MRI I am getting on my leg tomorrow, I have no idea of what price will be billed. My out-of-pocket expense will be the same no matter which insurance-approved clinic my doctor chooses. The price still matters. If the clinic bills too much, they will declare that loss to pay less tax. If the price is good, I have no way of comparing price to recommend it to others looking for a deal. No one is looking for a deal, so the price for those without coverage is hopeless.
P.S. The vulnerable populations would be anyone who qualifies for Medicare and Medicaid coverage, and we would also cover the treatment of chronic conditions through expanded public health services.