Health Care Reform – Market principles to deliver real reform – Part 2

Posted by Jason | Posted in Economics, Government, Health Care | Posted on 16-10-2009

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In the first installment on free market health care reform solutions, I spoke of the problem with using third party payer in respects to health insurance and health care purchases. The effects of changing that one aspect of the health care industry would vastly improve our current system and would result in more jobs, better care, and a booming economy. To take the free market concepts even further, we must now look at how the uniqueness of the health care  insurance model makes it much more expensive than other insurances, how obesity is driving up health care costs for the obese and the fit, and how the market has already taken some steps to address rising costs.

Health care insurance is a very unique insurance purchase when compared to auto, health, or any other insurance product. When you purchase home owner’s insurance, you buy it in case of fire, flood or burglary. You do not buy it because you know you are going to need your roof replace, a new furnace installed, or your carpets cleaned.  If home owner’s insurance was treated like health care insurance, you would have to pay astronomical prices for the insurance because the providers of the insurance would have to cover maintenance, and in some plans would cover elective improvements like a deck or a finished basement.

To make it even more absurd, when getting your insurance through your employer, not only is your rate based on the amount of maintenance you use or the risk of your decisions, but they are also based on other individuals that you have no control over. Imagine if you invest in a security system, fire detectors and fire retardant building materials in order to lower the risk of your house catching on fire. This would be similar to exercising, eating right and having regular checkups. Currently, your home owners insurance would be reduced because of the responsible actions  you took. Now, if home owner’s was ran like health care, your rate wouldn’t be based on your actions. It would be based on your group’s actions. If a member of your group moves to a high crime area, has no smoke detectors and has very old wiring, your rates would need to take into account his chances of a fire. As you can see, you are punished for actions you have no control over. This model punishes the responsible and rewards the irresponsible. The effect is higher prices for all and no encouragement for good behavior.

As stated in part one of this blog, this third party payer model leaves you with a vicious cycle of increases in the price of insurance and cost of health care. With the removal of third party payer, we would be rated based on our own individual risk and behavior. By removing the group, you now  have an incentive to be responsible. Just like you may install a security system in your house to get a decrease in your home owner’s premium, you would be encouraged to get your BMI down to get a break on your health insurance. You cannot expect good health behavior patterns when people are shielded from the effects of their own actions by the group. You will also have the incentive not to frivolously waste health care services. You would not submit a home owner’s claim every time you need a shingle replaced on your roof, because your premium would rise to cover the risk of another shingle needing replaced. Your risk rating would be worsened by your continual submission of claims. Similarly, you would not run to the doctor every time you get a headache, and if you did you would be more inclined to pay out of pocket to prevent your risk profile being negatively effected. Paying out of pocket is a good thing. It cause you to shop and demand better prices, which results in more competition.

As you can see, the health insurance model is unsustainable as is. It must be allowed to move into the model of every other insurance plan we know of. People must be weighed on their risk. They must be rewarded with lower premiums for taking responsible action, and they must be punished with higher premiums for being irresponsible with their health.

Not being accountable for  your actions in respect to your health has helped lead to a large number of our population being extremely unhealthy. Currently, over 35% of our population is consider obese, and the number jumps to 65% when counting overweight individuals. What’s worse is the percentage has been climbing year after year. In 1990, no state had a over 15% of it’s population classified as obese. By 2008, no state had under 15%. Colorado is the only state with under 20%. The majority of the states now have over 25%. Does it surprise anyone with data like this, that we have a health care crisis? Obesity leads to diabetes, heart disease, cancer, stroke, sleeping disorders, and countless other health conditions.  Ten percent of our yearly health care expenditure as a country is for obesity caused diseases. This is a huge burden on the insurance industry causing higher costs for us all.

Previously, we explained how rising costs come about. If demand is increased without increasing supply, then price go up. With the data presented in the previous paragraph, it is obvious the demand for health care caused by obesity would undoubtly drive up the cost of health care. Demand for drugs is driven up astronomically, because the treatment of these obesity related diseases last the remaining years in the life of inflicted. Our society has a very destructive pattern of treating diseases instead of removing the cause of the disease.

Now, I am not saying the government should step in and force people to get healthy. That is not needed. I am a freedom loving capitalist. If you want to fill up on Twinkies and Jujubes all day while reclining to the Jerry Springer show, have at it big boy. What I am saying is you pay for your actions. Do not expect those who make the tough diet and exercise decisions to subsidize your bad habits. If the free market reigned, third party payer would be gone, insurance companies would base your premiums on your risk and all the high fructose corn syrup lovers would pay for the medical resources they consume. You would quickly see the obesity rate decline, because the obese would be punished by higher premiums. With this decline, you would have insurance rates and demand on health care resources decline. Hey, didn’t we say earlier you have to decrease demand to lower cost. Well, voila, you just did it. Now you have a much healthier society both physically and mentally. The economic effects are too vast to even get into. Let’s just say everything has opportunity costs, and when we put more and more money into health care, that money it held back from other economic activities. With that money freed up, it can go into other parts of the economy that would more than likely improve our lives.

As you can see, both the first part and the second part of this blog really come down to one change. That change is removing third party payer. That one aspect of health care has caused this entire disaster we are now debating. The government cannot fix this by throwing more money at the symptoms. The free market is the only thing that can fix our health care system. It is the only thing that can fix any of our societal ills. Even though the government and the third party payer issues exist, the free market has already taken action to address issues with rising health care costs.

Let’s take a look at the regular doctors visit. Because of the demand for doctors, typically you have to schedule a doctors visit a few days out. When you do go to the doctors, you sit and wait in the waiting room. Then you sit and wait in the treatment rooms. Finally, when the doctor comes in, you see him for 15 minutes, and you’re done. This isn’t all just to have fun with you. This is because of the demand for the doctor’s services. The free market saw this an opportunity and developed the concept of walk-in clinics at your local pharmacy. These clinics are staffed by nurses that can take care of common illnesses. These nurses are schooled enough to address these issues and do so without the same cost of having a highly skilled doctor. Unlike government, the free market allocates resources based on the most efficient use those resources. When the power of the free market is released, it will create a plethora of solutions like this. Consumers will have many more choices and will be the beneficiaries of that horrible “profiteering”. Just remember profits are derived by someone developing and providing a solution to a need. Without that profit motive, that need would go unserviced.

While listening to the debate on health care, the problem seems so vast and complex. We really just touched the surface of the revolution  you would see if the free market prevailed. I did not even get into the disastrous effects the intrusion of the federal government has already wreaked on the health care industry. Hopefully, I’ve provided some food for thought and helped you realize just because a problem seems huge doesn’t mean that the solution has to be. The solution presented here is very simple, but the benefits are more than I can even touch on. As in any debate, seek the truth and use your logic and reason to come to a solution. Problems are exacerbated by those who think things are so complex that it requires “government experts” to fix it.

P.S. I’m sure as the debate progresses, I’ll have more topics to write about. Please provide feedback. Ideas are weak when not challenged. If you disagree, challenge my ideas, so I can either strengthen them or discard them. If you agree with them, share them with others.

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Comments (4)

A couple things I think you missed, and I’d like your take on them here or in a future post: Genetic disorders (and by extension) pre-existing conditions.

Unlike a car that comes off an assembly line, with each car being identical to the one before it, each of our bodies are completely different… we are all born with things that are out of our control. While your example of obesity is considered a lifestyle choice, there are some whose bodies are predisposed to be larger than others… there are those who have a higher risk of heart disease and all that stuff.

In your scenario, how does insurance get an accurate risk profile? Are complete medical histories and genetic testing required? How do you address the inevitable issues of privacy when you are talking doctor/patient confidentiality?

In car insurance, if I switch carriers and I have a bad driving record, I’m going to pay a higher premium. Would you envision a similar setup in a free market system? If I’m already sick, I’m going to pay a big markup for insurance?

I have no doubt that the free market would find a way, but I disagree with you in the sense that I believe it is a very complicated issue. As you correctly note, health insurance is different from other insurances. Each human is unique.

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John, I knew this was coming. It is an awesome question, and you are right in one respect. This one issue complicates the health care issue more than anything else.

It is similar to the abortion issue. Personally, I do not believe in abortion. I believe life begins at conception, and there for aborting that life is murder. Immediately, proponents of abortion site the small circumstances that tug at the emotions in order to defeat the consensus on the larger argument, i.e. incest, rape, etc.

Principles and values should apply in all circumstances. Just because applying it in one instance is hard, doesn’t mean the principle is wrong. I planned on eventually writing a post on this topic, but I will work on it sooner, since my one and only commenter has asked. Stay tuned.

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Jon has a point. However if a person will/can do the things they have controll over, say: eat healthy, excercise, regular check ups, “preventive maintenance”. That for one should give a person a boost in the right direction. Of coarse the genetics of some people have them pre-wired to develop certain illnesses as Jon stated. What do you do? Of coarse there’s no one shoe fits all health care plan. That’s where capitalism (as I know it) works best. A little competition never hurt any industry. Correct?

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Guys thanks for the challenge. I am working on my response. Unfortunately, I usual write at 4am, because I have to work at my regular job during the day. I forgot to mention though, that I do not take these issues lightly. I have dealt with them myself. My son has cerebral palsy, and I have a niece with severe autism. She is 10 years old and is fed through a feeding tube.

So believe me when I say, I don’t take this stuff lightly. The free market works in all cases best. That is what I was trying to say earlier. I guess it would have been more forceful with my own experience. Principles are not principles if they don’t always apply. It is when we make exceptions and think we can outsmart principles that we end up in the mess we are in now. Hopefully, I’ll have time to formulate my reply over the weekend.

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