I was just inspired by John Stossel’s piece “Competition Would Save Medicine, Too.” The debate over healthcare reform throws around terms like single payer and HMOs. We can avoid socialized medicine with managed care. But these solutions ignore a basic economic reality that dooms them to poor performance: the people benefiting from the service are not paying for it directly. Let’s touch on some motivations that drive all of us:
When I spend my money on myself, I care about price and quality.
When I spend my money on others, I care much more about price than quality.
When someone else spends his money on me, I care much more about quality than price.
When someone else spends her money on others, I don’t care too much about price or quality.
If I pay directly for my medical care, I want to ensure I get quality treatment at a reasonable price. If my insurance company is picking up the tab, I still want quality treatment, but why should I care about the cost? The company, on the other hand, is very concerned about the cost, but less interested in how well I’m treated.
I understand that certain medical treatments are beyond the cost of most people absent insurance. But it’s the nature of medical insurance that needs fixing. Insurance is supposed to protect us against large, unanticipated expenses. Auto insurance helps you deal with the bill for an engine overhaul, but not the normal maintenance of oil changes. Homeowners insurance will help you rebuild after a fire, but won’t repaint your kitchen if your kid takes a marker to the walls. In the same way, health insurance should cover the expenses related to serious illness and injury. It should not pay for every doctor visit and prescription related to your summer cold, or your child’s sore throat.
If our policies didn’t cover every little thing, their cost would plunge. Then most of us could afford to insure against the really costly stuff. What about the others? Before the age of Medicare and managed care, many doctors volunteered to treat poor people, and were very flexible regarding payment for those of modest means. (I hope to touch on the history of medicine pre-1965 in a future blog post).
So what’s the best answer right now? In late 2003, the US government established the Health Savings Account (HSA) program. To participate, you must buy a high-deductible insurance policy. Accompanying the policy (which costs much less than most traditional policies), you fund your own savings account with tax deductible money each year. It’s essentially a IRA that you can withdraw for medical expenses at any time without tax penalties.
Unlike earlier plans, the HSA is not “use it or lose it.” You keep any money left over at the end of the year. If you’re fairly healthy, your HSA can turn into a nice retirement fund. Since you pay for most expenses with your own money, there’s an incentive to shop around for both doctors and pharmacies. This competition should be beneficial down the road if more people utilize HSAs.
Whether we embrace socialized medicine or managed care, we ignore the basic human motivations that prevent us from getting what we need at an affordable price. As Stossel says, competition provides us with the food and cars that we want and need. There’s no reason it can’t give us medical care as well.