Ezra Klein in an LA Times’ op-ed, outlining the Republican and Democrat approaches to the health care. Here is the Republican’s take on the situation, which makes more sense to me:
The Republicans are taking a very different approach. Their plans all proceed from the assumption that the problem in healthcare is that costs are skyrocketing because Americans overuse their doctors. This theory postulates that because Americans don’t feel the cost of every individual treatment (because it is being paid by insurers and the premiums are being paid by employers), they demand more treatment than they actually need, spending too much and lifting the price of healthcare. The answer to this problem is simple: Make us pay for care directly rather than for premiums.
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I strongly agree with the premise of the arguement that if a portion of the cost is shared by the patient, utilization will decrease and costs with it.
I have already witnessed this trend with my patients who have HSAs, combined with a high deductible plan.
My questions that I put forth the other day, http://www.howardluksmd.com/journal/hsas-and-shared-risk.html is what happens to the risk environment? What will the standard of care be if a patietnt refuses an exam due to cost…only to find out months later they suffer from a horrible disease that the aforementioned test would have picked up? How is the risk shared in that circumstance? What will the standard be when a patient refuses a test we feel is needed. This has happened to me and I found the documentation of the refusal nearly as onerous as the documentation of risks leading to surgery. There is no case law out there—that I am aware about regarding risk sharing in these circumstances. It’s coming… will be interesting to see waht the courts decide.
Neither side has the correct answer. Until the system itself is revamped and the Flexner anti-competitive measures removed, the current overly expensive, lack of access to care, lack of good healthcare system will continue to exist.
What Republicans are saying this?
Sorry Kevin, I don’t think it’s that simple. I’m a firm believer in multifactorial causation, so href=”http://www.cato-unbound.org/2007/09/12/david-m-cutler/use-a-scalpel-not-a-meat-cleaver/this makes more sense to me.
Not that you’re wrong, but administrative costs, CYA medicine, errors etc all contribute significant chunks as well IMHO.
What is needed is a system where only catastrophic care is covered by standard insurance policy. First dollar insurance coverage should only be available to the very wealthy should they choose to waste their money that way. For the masses, HSA’s or self pay would be the norm up to say five thousand dollars per year. For the indigent, public health clinics and rationed care should be the norm considering taxpayers foot the bill.
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