Let's start with some free market principals.
- As a consumer, I should not be required or compelled to buy healthcare insurance. It is that simple. Yes, we are compelled to buy auto insurance; as a condition of being able to drive on public roads. Yes, we are compelled to buy home owners insurance; as a condition of being able to finance the purchase of a house through a third party or a bank. Both of these scenarios specify insurance as a required term and/or condition of a contract or agreement. If I do not want to buy auto insurance, I can make the choice to not own and operate a vehicle on public roads. If I do not want to pay home owner's insurance, I can choose not to finance the purchase. I am still in control - I am still making the choice / decision.
- As a consumer, I should be able to purchase a healthcare insurance plan from anyone selling healthcare insurance plans; the healthcare insurance company of my choice. This means I should not be restricted to purchasing a healthcare insurance plan from my employer. I should be able to purchase healthcare insurance from anyone who wants to sell me healthcare insurance, just like I can do for my auto or home owner's insurance. The point here is to make healthcare insurance companies compete for my business. If my employer wants to offer a special rate plan that they have negotiated on behalf of all their employees, that is great as long as I can elect (without penalty of any kind) to buy a healthcare insurance plan from anyone I want.
So, the solution seems simple:
- Employers can make contributions to employee Healthcare Savings Accounts (as a benefit and/or additional compensation)
- Americans can purchase healthcare insurance plans from any healthcare insurance company; no restrictions
- Americans should not be required to purchase healthcare insurance plans from their employers
There's another benefit to an employer's healthcare benefit that needs to be taken into consideration: it's tax free! Why require an American to be working in order to take advantage of the tax benefit? Wouldn't it simpler, and just make all medical expenses tax exempt? That would give the same benefit, without coupling a person's healthcare to their job. And, this gives us our third principal:
- All healthcare expenses should be tax deductible. This means all healthcare insurance plan premiums, and all out of pocket healthcare expenses should be 100% tax deductible. In the free market, the laws of supply and demand drive prices. The theory is that competition will keep prices under control, much the same way the auto and home owner insurance industries work today. I will address pricing strategies later in the blog, but, I want to mention the impact of making healthcare expenses tax exempt. This point is about putting more money back into the economy. We do not want healthcare to appear to be discretionary, because for some people it is not. People with a chronic illness are going to be facing increased healthcare costs for the remainder of their lives. There is no reason to add insult to injury by also asking those people to pay tax on something that is not really discretionary. This is why all healthcare expenses should be tax deductible.
So, what's the role of government in all of this? Should the government just stay out of the way?
I do agree that the government has the right to tax me. I also agree that the government can choose to provide health insurance coverage using the taxes they have obtained from me (although this is a more detail discussion which we will not cover here). The government should not be able to compel me to purchase a healthcare insurance plan (as we established with the first principal). They can tax me and provide me with a healthcare insurance plan, but, they should not be able to compel me to buy a healthcare insurance plan. This is a very fine distinction.
Americans need Affordable Healthcare. The key here is affordable.
I saw an interview with Mark Cuban on the topic of healthcare costing / pricing. Mark was on Bill O'Reilly asking a very simple question: who is going to take less? Bill cut Mark off before Mark could explain. But, Mark was good enough to do a blog about this topic. In the blog, Mark makes the point that someone will have to take less in order to reduce prices. A hospital, for example, has to pay its doctors. If the hospital is required to reduce its price, where does that money come from? The doctor's pay? Mark has an excellent point.
Competition is the key to the free market. If a hospital charges too much, they should lose market share to a hospital that charges less. Of course, the quality of the product and the brand will come into play, but, the principal should be obvious; the free market at work. Mark makes the point in his blog that none of the healthcare companies have demonstrated a willingness to reduce their profit and thus their cost / price. I see Mark's point, but, I also know that high profit margins bring opportunities for competition. There are high profit margins in the supply chain somewhere, and that is where competition can make a difference. I think the way our government can help is to:
- Stay away from regulations that are impeding the free market
- Encourage investment in the healthcare industry by making capital easier to obtain; this is simple, let the healthcare industry offer tax exempt bonds in order to raise cheaper capital (this should attract investment)
My biggest fear is that healthcare costs will increase quicker than my income, making it impossible for me to take care of my own healthcare costs. I have a great job that pays well. But, I am not young anymore. Someday I hope to retire. And, at the same time, I dread retirement. If I retire or lose my job, I would be financially devastated all because I lost the genetic lottery. I'm not asking for anything. I want to be able to take care of myself and my family. But, I may not have the means to do so. Nothing is more frustrating or humiliating than to be in this position.
The point that I am trying to make is this: healthcare costs are not discretionary, because in most cases they are not planned. That is why everyone essentially needs insurance. That said, I am not advocating that we violate any of the principals that I have already articulated; that's why I started this blog with those principals. I am simply trying to illustrate how hard this problem is to solve. And, this is why I agree with Mark that we cannot simple repeal the Affordable Care Act (ACA).
If we were somehow able to spread the catastrophic costs across a larger pool of people, the impact on a single person would be reduced. Sound familiar? This was the premise that was used by the folks who put together the Affordable Care Act (ACA). Even still, wouldn't this be a good thing? Wouldn't it be good if people who require catastrophic healthcare would not be financially devastated by something that is beyond their control?
When a driver gets into too many accidents, the insurance company will drop them. Insurance companies will not cover floods; this coverage has to be purchased from the government. When a person is known to have a chronic or catastrophic illness (like Diabetes or Cancer), what do you think the insurance company will do? The difference here is choice and accountability. A bad driver gets dropped because of something they did. Floods are not covered because insurance companies perceive the coverage to be too risky. It comes down to risk management and profit. I have no issue with companies making profit. I just want to know what the equivalent to flood insurance is for the health insurance industry.
Mark says: "Whether its Medicaid or a new program, every single person in this country should be covered 100pct for chronic physical or mental illness and for any life threatening injury."
I have to agree with Mark. Keep in mind, the Americans suffering from these situations did not choose to be in these situations. There needs to be some kind of program that covers Americans for the times when things happen beyond their control. This is not for routine healthcare; this is for catastrophic healthcare that results from either losing the genetic lottery or being in some kind of accident. If we, as a society of Americans, cannot do something that benefits everyone equally, then what is the alternative?
I am reminded of a few lines from a famous story:
- Are there no prisons?
- Are there no workhouses?
- If they are going to die, then they should do it and decrease the surplus population ...