With the said, I have been working on with a company that recently launched a health discount program. While not insurance, this type of insurance does provide discounts on prescriptions, doctor and dentist visits. I know that these types of plans are not the long-term solution but at least they help those without any insurance or those underinsured. Please visit http://www.reassurancehealth.com and provide your thoughts/feedback if you think consumers would be interested in this product.

I have family in Canada, and they are terrified of getting sick with something more complicated than a cold – there IS rationing of health care under their system, and the elderly, disabled, and fragile members of a society will inevitably be considered “burdens” on their system. Just wait until the Baby Boomers hit peak retirement…as they age and require more and more expensive treatment, a total gov’t provided system won’t be able to afford all the treatment that seniors get today – voila, rationing! If it’s YOUR elderly parents or premature baby…tough luck.

As for Helen’s comment about how a consumer-driven health care system would *actually* work, it would *actually* work the same way we reasonably normal, reasonably well-educated, reasonably intelligent individuals manage to purchase goods and services every single day.

Somehow we seem capable of making a $20-30,000 dollar purchase every couple of years (cars), a $150,000 – $500,000 purchase every decade or so (housing, price depending on where you live), and daily purchasing decisions that add up to $10,000 – $100,000 in expenses every year (household purchases of groceries, utilities, good and services).

Since the vast majority of health care decisions and purchases are NOT made under emergency conditions, consumers would research various providers and options before making their health are purchases. The force of so many consumers calling, asking, and eventually purchasing will inevitably drive quality up and expenses down.

It has happened in EVERY other industry; why on earth wouldn’t it work for health care?

If enough consumers voted with their dollars to use providers that use electronic medical records…well, amazingly enough there will be a surge in medical providers who adopt such systems (with all the expense and disruption that is caused – same as in any other industry).

If you want better health care providers, you let people choose who they will use – and their choices may be based on skill, personality, environment, years of experience, etc. They “vote” with their dollars to use the providers that best meet their individual needs.

Let me be clear – business can still offer health care benefits, but they should just drop the cash they’d spend on insurance, into a health care saving account that the employee uses to purchase a wide assortment of medical and dental benefits. They are spending all that money on essentially individual policies ($300, $500, $700 per month, per employee)…let it go to the employee directly and have the employee purchase health care on their own.

Employees can save it, or spend it on health care services as they see fit. Every year money that’s not spent can roll over and be part of a larger pool of savings that is used when medical/dental expenses hit a speed bump of expense.

If you insist on government-funded health care, then have the gov’t drop $3,000 dollars per person, per year into health care saving accounts to pay for all but emergency or elaborate (cancer, debilitating diseases) care. Again, that money rolls over every year – an incentive to make BOTH good preventative decisions and good purchasing decisions (‘ya want more money in the account? Make better health choices).

Allow individuals (and families), self-employed, etc. to save additional amounts in personal accounts (again, keep the roll overs every year) and tax deduct the amounts they save.

In any scenario, put the funds on a debit card, and create restrictions that the money can only be used for health care expenses.

Catastrophic care (emergencies, cancer, etc) can be covered with insurance – which would likely be much less expensive since the overall cost of health care would decline with the innovations driven by consumer purchasing of less serious care. Consumers should still be involved in purchasing the catastrophic policies on their own, to again drive innovation and lower prices in that arena.

I know we are all so enamored of more socialistic policies with the ascendancy of The One (President Obama), but there is NOTHING in history to suggest that democratic/liberal policies lead to less expense or greater efficiency in any industry they touch.

Jason – you worked in the FBI…anyone there strike you as vastly superior in knowledge, education, drive, innovation or compassion that the hundreds/thousands of individual job seekers/entrepreneurs you’ve come in contact with in the years since?

Nope – didn’t think so. I’ve worked in, around and near government…and the idea that gov’t employees are somehow superior to average, ordinary citizens is ludicrous! They ARE hard-working, dedicated, color-within-the-lines kinda folks. People drawn to gov’t service aren’t usually doing it for the innovation and creativity they can bring to their workplaces. They keep their heads down, write the rules, and then follow the rules. They typically value steadiness, stability and security.

There is NOTHING out there to suggest that they are any smarter, capable or dedicated than I am. There is NOTHING out there to suggest that they should be trusted with making health care decisions for me or mine. NOTHING. Why on earth would you entrust your most sensitive information, and literally life-changing decisions about the health care of your family, to a bunch of gov’t bureaucrats??? Crazy, crazy, crazy.

Talk about releasing an explosion of creativity and innovation in health care? Consumer-driven care would do it, not gov’t provided.

I haven’t even touched the issue of paying for all this gov’t gravy, or the taxes it will require. Entrepreneurs already pay close to 50% of their income in taxes…and now you want more? Sorry – no society has ever taxed its way into prosperity. None.

Higher taxes drive down innovation, creativity and entrepreneurial activity. California is a real bellweather here – watch and see what happens over the next 12 months. Their ballot initiatives to raise taxes in the next couple of months will fail miserably. Their budget is unsustainable – they need to encourage economic activity…not punish it through higher taxes. I’m generally against higher taxes because they DON’T WORK to improve the overall quality of life for a community/country – they reduce it.

You either believe in human nature as essentially self-interested (see: Adam Smith, see: Bible), where humans make decisions that benefit themselves (and then by extension, benefit the entire community (see: Adam Smith)…or you believe that humans are some form of enlightened or pre-enlightened creature (see: Thomas Jefferson, and every New Age guru out there) dedicated to living the most enlightened, selfless life imaginable.

Which kind of human do you see in your neighborhood?

>> When you have a large percentage of a talented, entrepreneurial population tied to an employment lifestyle they can’t leave, just because they need benefits,

I remember in my first “real” job, I made about $10.50 an hour. I was a clerk at the FBI. Benefits were great, including really nice vacation and sick leave.

Just about everyone in that position was TRAPPED. TRAPPED! Many I worked with (who made more than I did (not hard to do)) could not go anywhere in that small Idaho town and make what they made at the FBI and have all the perks… health insurance, lots of vacation, etc. WE WERE TRAPPED.

I see it every day… a friend of mine is bored out of his mind, TRAPPED in a job that offers him perks he can’t get anywhere else (because he has been there for so long). Would love to leave but can’t give up the perks.

This is the “employment lifestyle” you are referring to…

>> it’s the best way to squash a nation’s creativity.

This is sad. It’s demoralizing. And it’s true… you and I have talked about this before… what if there were health insurance option that were appropriate right now… how many of the formerly trapped people would finally go do their own thing?

I’m guessing this is the single thing that is keeping so many great minds from moving forward. It’s scary, of course, doing your own thing… but imagine what kind of creativity we would have in this world if we weren’t all so TRAPPED…. !

For those who worry about taxes going up if we change how healthcare is covered, consider this: When you have a large percentage of a talented, entrepreneurial population tied to an employment lifestyle they can’t leave, just because they need benefits, it’s the best way to squash a nation’s creativity.

I predict that when healthcare is affordable and available to all, this country will see an explosion of entrepreneurship and innovation the likes of which we haven’t experienced since the industrial revolution. And since small business employ the bulk of workers in the US, the operative phrases are “new tax base,” “expanding economy,” and “job creation!”

I have friends and colleagues who live in Canada and are very happy with the system there (and some have had life-threatening illnesses). I have friends who work for doctor’s offices here in the US and bemoan how insurance companies regularly deny every submissions expenses, hoping – it seems- that no one will bother resubmitting. Also, I’m tired of the US lagging behind all the industrialized countries in terms of infant mortality rates. Sheesh, we’re the richest country in the world and we can’t keep our babies healthy. It’s just wrong, and a big symptom of a broken system.

So, yes, I’m for finding new solutions, even if they are not perfect. Thanks for the post, Jason!

Here’s my point: CIGNA, like most corporations is oriented toward the short-term bottom line. They will not make provision of an adequate supply of Case Managers a priority, even though this function tends to save money in the long-term. It is key to them to show their customers they have this service in order to keep their accounts and gain new ones. It is not important to them to robustly fulfill the obligations inherent in this service. Their customers are the employers and not the patients. It would seem that government involvement, rather than providing or subsidizing healthcare directly, might be effective in taking over Case Management functions.

I certainly think the current system is broken. I personally would like to see so-called health insurance just plain outlawed — but, after all, those companies employ a lot of people, so what to do with all those employees would be a whole other problem. I have not been able to think of a solution that I think has any likelihood of succeeding in this country. Possibly we should try having the federal government become the insurer of last resort — all of the health-insurance company employees could just be declared government employees now? — though I am not optimistic about the outcome. Besides, as long as so many in this country are obsessed with opposing rises in taxes (why, I always wonder; why is it so important to be so greedy and so selfish?) nothing that is seen to raise taxes will be supported. So it is more likely we will limp and lurch along until the system collapses, and then cobble something together from the pieces.

By the way, I have experienced the health insurance system from many sides. I spent 11 years without health insurance while I had young children — it isn’t true that “one way or another, we end up paying for” the uninsured; we ourselves — that is, my family, not my community or my society or my country or whatever the other “we” is supposed to be — paid for all of it (including my daughter’s normal prenatal care and birth costing 20% of our gross income), and we got no discounts, and we didn’t declare bankruptcy. More recently, I experienced our paying for COBRA to keep me in particular covered while my husband was unemployed for 15 months, because my health had collapsed and once coverage lapsed I would be unable to regain it due to “the exclusion of pre-existing conditions”. Once again, we paid for all of it and we didn’t declare bankruptcy; we just burned through all our savings and maxed out our credit cards. I have also, just last year, experienced our health insurance being changed, not by our choice, *four* times in one year, including the final two months during which we were trying to acquire private health insurance after my husband was laid off and the health insurance company in question used delaying tactics and actual lies to try to push us over the 63-day limit into “the exclusion of pre-existing conditions”. Yeah, they’re *not* nice people. Fortunately, my husband found a new job and our coverage by yet a fifth health insurance company began 1 day under the limit. I have also experienced malpractice, several times, for none of which I sued. In fairness (and real gratitude), I have also had my life saved several times.

Maybe my experience is unusual, but I think maybe not. From that experience, the best changes I would like to see are: no health insurance companies (no middlemen, I suppose); better-trained doctors — most of them are not actually very good; many, many, *many* more doctors, so that each doctor has only a few patients, and each visit lasts a long time and approaches the widely-disseminated and completely-unrealized ideal of the doctor genuinely helping you to manage your health; therefore, very different, much less expensive, much more practical medical training; probably a separation between doctors who practice in hospitals and doctors who practice in offices, with completely different training; a separation between doctors and pharmacists, so that doctors no longer prescribe medication, but only people with real training in the use of drugs (which is *not* doctors) are allowed to prescribe; and computerization of medical records, with also, doctors required to *know*, backwards and forwards, the *complete* records of *every* patient they see. And I would like to see the social status of doctors drop to something more realistic, something like that of car mechanics. Unless, of course, they get a *lot* better at what they do.

By far the best solution would be to have both government and businesses get out of the health insurance business entirely.

If businesses didn’t have to provide health insurance benefits, the cost of almost every good or service would decline.

If individuals were responsible for purchasing health care services, the costs would decline significantly and the quality levels would rise (basic laws of capitalistic supply and demand).

Businesses and governmental organizations who currently pay for health care services for employees/beneficiaries would provide cash payments to individuals, who in turn would purchase services (debit cards, etc.) on their own.

Elderly, incapacitated, mentally unfit individuals (Medicare, Medicaid recipients, perhaps) would be the only exceptions. In that case, purchasing co-ops could be formed to advise and support such individuals.

Such a move would definitely reduce costs, increase quality and innovation, and provide employment for an entire new business/employment specialty – health care advisers. They would operate much as independent insurance agents currently do.

We somehow manage to comparison shop for car insurance and car repairs…home purchasing assistance and home repairs – why not health services?

Radical? Yes, certainly. Effective? Definitely. Possible? Not with current administration (or with most others)!