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<\/a><\/p>\nRebecca Frech writes about the shopping-around method for saving on health care costs here<\/a>. \u00a0We tend to imagine that because healthcare is a need costs must be immutable \u2014 the company wouldn\u2019t bill more than necessary, and what they bill must be what it costs, right?<\/p>\n Not so. \u00a0Without devolving into \u201cthey\u2019re just out to fleece us\u201d ranting and raving, one can certainly observe that any endeavor can be run more or less efficiently. \u00a0Competitive pricing isn\u2019t a cure-all, but it does add a measure of light and fire that can help keep things honest. \u00a0And thus it\u2019s top on my list of realistic, achievable steps towards health care reform that we could reasonably hope to pass in the next several years. \u00a0Here are my top three:<\/p>\n We make a lot of noise about price caps, fairness, cost-cutting, sliding scales . \u00a0. \u00a0. there are bunches of ways to manipulate health care costs. \u00a0But the most fundamental method, and the one that works very effectively across many different types of markets, is making your prices public<\/strong>.<\/p>\n We have the capacity to do this. \u00a0The uniform billing codes, and the prices to go with, are already on your doctor\u2019s computer system. \u00a0The server-space that once would have been exorbitantly expensive is now very affordable, and to make it even simpler, healthcare providers who use the going rate (say, the medicare reimbursement rate, or whatever suits) could shorten their list by publishing only the prices that vary from the standard they usually peg.<\/p>\n To effect real reform, it would be best to publish all prices \u2014 if the physician charges different rates to different insurance companies or to cash or payment-plan customers, all the different prices should be published.<\/p>\n What would the result be? \u00a0When you researched your physician or hospital, you\u2019d know in advance how prices compare. \u00a0When your physician proposed a test, you could find out in advance how much it would cost you, and you could check around for alternate suppliers for outsourced services. \u00a0You could ask intelligent questions like, \u201cHow does the information in a cardiac stress test compare to a pulmonary stress test, and would the less expensive one give us the info we need?\u201d<\/p>\n Other results: Providers who were charging significantly more or less than the going rate would have an incentive to adjust their prices. \u00a0Insurers would have an incentive to negotiate well, since business owners and individual subscribers could easily see how their bill would vary based on which insurance company they used.<\/p>\n Yet more results: Your local physician might choose to outsource tests currently done in-house, if doing so lowered prices for the patient without a significant drop in service. \u00a0Alternately, your physician might start doing more tests in-house because it turned out that it was really more cost-effective that way.<\/p>\n One thing I don\u2019t think would happen is patients making cost the only factor in health care decisions. \u00a0<\/strong>That\u2019s simply not the way American consumers behave. \u00a0Look at our purchases of cars, clothes, houses, food . . . all things we need. \u00a0Daily we choose quality or convenience over lowest-cost. \u00a0Publishing prices allows the market to regulate itself without inducing any artificial restrictions on supply or product quality.<\/p>\n We have an extremely complicated system of \u201chealth care\u201d spending accounts. \u00a0Assorted forms of tax-protected medical savings accounts are a powerful public policy tool, because people really are induced to save by the prospect of lowering their tax bill. \u00a0It works. \u00a0Under our current system, though, there are massive restrictions on who is allowed to have such account, how much money can be added, and how quickly it must be used.<\/p>\n If the goal is in fact to ensure Americans have the health care they need, the public policy emphasis needs to change from, \u201cWe\u2019re desperately afraid people will use this as a tax shelter\u201d to \u201cReally it would be nice if you\u2019d save money and pay your own bills, thank you. Or someone else\u2019s bills, that would be fine, too.\u201d<\/p>\n I\u2019d propose that the US move to a simple tax-sheltered medical savings account system that worked the way your imagination thinks such things work: You put money in, and then it\u2019s there when you need it. \u00a0No more rushing around on December 31 to quick buy a pair of glasses before you lose your contribution. \u00a0Over-contributing wouldn\u2019t be penalized, and under-contributing could be rectified by increasing the portion of your paycheck that went into the account when it became apparent your medical expenses were rising.<\/p>\n To avoid this turning into a massive tax shelter, I\u2019d propose we simply say that the funds can\u2019t be pulled out except to pay somebody\u2019s \u2014 anybody\u2019s \u2014 medical bills. \u00a0No putting money in when you\u2019re a 50-year-old senior executive, and then pulling it out to pay taxes on it when you\u2019re 80 and have a nice slim tax bracket. \u00a0When you\u2019re 80, you can use it to pay your medical bills or someone else\u2019s. \u00a0You can leave your leftovers to your heirs, and they can use it to pay their medical bills.<\/p>\n We already have the regulations in place to manage spending abuses, per the limits on the uses of existing medical savings programs and the restrictions on deducting medical expenses on your taxes. \u00a0The only change would be in lifting the complicated rules and limitations on how much we are allowed to save, so that Americans are encouraged to save generously towards their medical bills.<\/p>\n Tying health insurance to employment poses problems, but it also can be a solution. \u00a0A hybrid system in which affordable insurance is available either through one\u2019s employer or through an independent health care cooperative seems like a solution well suited to the US. \u00a0One of the advantages of employer-provided health insurance is that employees who would otherwise not spend the money themselves will elect to receive it as part of their compensation. \u00a0One of the disadvantages of the American system is that part-time employees and freelancers end up in a worst-of-both-worlds scenario.<\/p>\n Rather than the patchwork of subsidies and regulations that attempt to rectify this and do so poorly, consider simply making a partial health-care benefit part of the employee\u2019s compensation. \u00a0With a forty-hour week as a benchmark for full health care benefits, an employee working 30 hours a week would receive 3\/4\u2019s of the benefit \u2014 perhaps put into one of those enduring, genuinely helpful health care savings accounts. \u00a0And so on down the line, fewer hours means a lower total benefit, but at least there\u2019s a foothold being gained.<\/p>\n This would be a particular boon for businesses wishing to pay their employees fairly, but also wishing to employ part-time workers due to limited need for particular skills, or because the employee needs a lighter work week. \u00a0Likewise, certain professions and times of life tend to be ones when multiple part time jobs are easier to gather than a single full-time position; those working a full workweek would not be penalized simply because the week\u2019s work was divided among multiple employers.<\/p>\n ***<\/p>\n \u00a0<\/p>\n None of these are complete solutions. \u00a0They do, however, address existing problems in the US health care system in a way that is practical, achievable, and doesn\u2019t require radically changing what we currently have in place.<\/p>\n What are your thoughts? \u00a0If you were to shape the health care policy discussion for the next presidential election, what would you propose?\u00a0<\/strong><\/p>\n ***<\/p>\n Meanwhile, if #2 cheers you because you\u2019d like to be able to use your savings to help out someone with big medical costs,\u00a0Ella Frech would be way better off if she had a wheelchair that met her physical needs, instead of the insurance-company special<\/a>.<\/p>\n \u00a0<\/p>\n1. Published Price Lists<\/h2>\n
2. Quit the Mickey Mouse on Health Care Savings Accounts<\/strong><\/h2>\n
3. Partial Insurance Credits for Part-Time Employees<\/h2>\n