Back in the good old days, when Mom took me to the Doctor she paid right there and then if she couldn’t afford to she made arrangements with the doctor to pay at a later date or to bring a chicken by, just kidding about the chicken. If a prescription was called for same story she paid, but if the prescription was too expensive she would have asked if there were a less expensive drug or an over the counter drug that might work. The point here is that Mom knew how much she was spending along the way. 

When we went to third party pay 3 things happened:

1)    The patient no longer knew how much a doctors visit, a test or a prescription cost.

2)    Doctors no longer new how much a test or a prescription cost. They didn’t even know if the insurance company would pay for the test or prescription.

3)    The doctors had a new office expense to add to the fees, they have to bill the insurance company.    

This caused an escalation in health care costs for the simple reason that the doctor and the patient no longer cared about the cost of tests or prescription, but the doctor had to roll his billing expenses into patient fees. This also had the affect of turning the Health Insurance Company into the bad guy because the doctor and the patient were not paying attention to the covered services and prescriptions. These are all un-intended consequences of the third party payer system. The proposal to implement a single payer system will do nothing to resolve these issues. I believe that it will exacerbate these issues by limiting the care a patient may receive. If a patient and their doctor define a course of treatment that is not allowed under single payer rules there is no way around it.   

The proposed solution is Health Care Savings Accounts (HCSA).  HCSAs allow a patient to save money in a special account tax free up to a set amount a year, let us say $2,000 for fun. Any funds that remain unused would remain accumulate in the account earning interest, a healthy 30 year old could accumulate $10,000 in 5 years, that is enough to cover the deductible on the catastrophic care policy. When patient is treated he can use a Special Debit Card that automatically generates a claim and deposits the funds directly into the providers account. In this case the patient/good consumer is using their own funds to pay for the treatment, and I think most of us with limited funds would ask the doctor questions like:

1)    Do I need this prescription or can I use a generic form.

2)    Do I really need that MRI or will an X-Ray or ultra sound provide the same information.

3)    Do I have to come back every 2 weeks for the blood test or can I come back every 4 weeks?

Does this a sound like we are asking people to be responsible, Heck Yea! But I think most people want to be responsible, they want to take an active role in their own health care.        

What about the poor you ask, well Government (you choose the level, local, state or federal) make available a health care debit card with a limited amount let say $2,000 per patient. Same story though, use it wisely when it is gone it is gone (of course that is not true Uncle Sam will make more money available on a case by case basis). When people understand that they have limited access, most will be more careful on how they use it. Limits can and need to be implemented generic drugs when available because  the patient is not spend their own money. 

The idea is to put health care management back in the hands of the patient and doctor, just like it was in the good old days…