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Jewish World Review Aug. 10, 1999/ 28 Av 5759

Marianne M. Jennings

Marianne M. Jennings
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Ruining the finest health care system in the world -- SOME LOOK AT HMOS and say, "Why can't I sue them?" I look at HMOs and say, "Why do you need to sue them?" or, better yet, "Why are there HMOs?"

When it comes to health care, the rhetoric flies free and high while analyses carry the depth of a Monty Python dialogue. Policy wonks are hell bent on destroying the finest health care system in the world in the name of compassion accompanied by utter disregard of basic economics. The most harebrained reform ideas is government health care. Remember welfare programs and public housing and then taste the food at the national park monopolies. The only area of the federal government to show substantial improvement is the Postal Service because it has faced stiff private competition. Take the private aspect away from health care and treatment will feel like a stint in a national park: long lines, minimal choice, and austere conditions, all without the right to sue anyway.

Without understanding the issues or even the correct questions in health care policy, legislators provide blankets for coziness even as they ignore the missing bed. A patient's bill of rights is feel-goodism and fodder for the boy president and his sidekick father of the Internet. "Why can't I have a bill of rights?" Better question, "Why do you need a bill of rights?" "Why can't we control health care prices?" Better question "Why do you need to control prices?" "Why should insurers and doctors make a profit from the suffering of others?" Better question, "Why don't you care that Safeway profits by selling us our daily bread?" Best question, "What makes Safeway's bread good and reasonably priced?" Competition breeds quality and quantity which keeps prices down. It helps also that we buy our own bread without clearance from a carbohydrate control center.

It has been so long since there has been a free market in medical care that we are hard- pressed to think beyond the parameters of utilitarianism. To envision a restoration of the free market in medical care, one must understand few unassailable propositions. First, the United States has the finest health care system in the world. Changing it from its entrepreneurial roots will gut its quality. Canadians inquire about new drugs here, not vice versa.

Second, insurance is intended for the catastrophic, not the routine. If you cover Viagra, resources are strained for prostate cancer.

You couldn't afford home insurance if it covered light bulb replacement rather than just fires caused by faulty bulbs.

Third, tying medical insurance to employers creates a dependence and imposes costs on employers. Not only is coverage tied to one's job, employers, focused on costs, rely on low bidders with the resultant HMOs from hell.

Fourth, as a consequence, HMOs are inherently conflicted between their patients, primum non nocere and quarterlies.

Fifth, when someone else pays, you spend more.

Sixth, price controls drive up the cost of health care. Everything from cross-subsidizations to creative billings result when the prices permitted, such as under Medicare and Medicaid, do not cover costs for providers. The Hippocratic oath does not demand services for free nor is it particularly motivational to work to lose money. There is price-induced scrimping on care as well as long-term decline in the quality of those entering medicine.

Finally, full information on medical care is not readily available. Price, quality and even availability remain a mystery -- not the most efficient way to run a market. The result is guest physicians brought in like mechanics on a shift change.

These complex issues can be fixed without Hillary's gorilla of a plan or Ted Kennedy's banana republic plan. People First, a health care reform coalition, has synthesized some simple fixes. First, get insurance away from employers, thus eliminating the lapsed job and insurance problem, and into the hands of nonprofit religious, fraternal, professional and charitable organizations. These groups could self-insure or, in a market open with opportunities, accept insurers' bids for coverage for its members. Every organization, from community foundations to religious groups, could use the strength of numbers to command coverage for its members. Community foundations could cover the uninsured or provide vouchers for the poor to purchase their own insurance. Without the profit motive, we are rid of the inherent conflict of interest between costs and health care benefits decisions. If members question or object to coverage decisions under their plan or seek an experimental procedure not covered by the group policy, the self-proclaimed do-gooders could test their altruism and raise the money from their members.

Second, these organizations need immunity from lawsuits (just as employers have currently). You could sue the doc, not your foundation. In fact, foundations might provide price lists as well as quality ratings so that members can shop for health care services as they shop for VCRs at Best Buy prices or cantaloupes by squishing.

Third, to encourage insurance coverage, give a tax credit for the cost of the insurance premiums. Purchasers could choose whether they want a policy that covers just catastrophes or includes the routine oil changes/shots.

Fourth, expand medical savings accounts to allow the accumulation of funds, tax free, for medical expenses. With this incentive, high deductible indemnity plans would become the norm and without the requirement of coverage for every dip stick check, scrimping HMOs would disappear. Catastrophic health insurance could cost as little as $125 per month.

Ah, the free market at work. Ah, services available by price and quality ratings without government constraints. Ah, health care when our employers are not in charge. Ah, a bill of rights courtesy of the free market and government incentives. "Why hasn't it been done?" Better question, "Why haven't you demanded it?"

JWR contributor Marianne M. Jennings is a professor of legal and ethical studies at Arizona State University. Send your comments to her by clicking here.


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©1999, Marianne M. Jennings