We've heard it a million times. There's no one-size-fits-all solution to America's health care crisis. HSAs and other consumer-directed solutions are a good start, but they're not the magic bullet.
The logic behind consumer-directed health plans, of course, is that they would force members to begin acting more like health care consumers by giving them some "skin in the game." If people start thinking before running to the doctor or asking for the latest, greatest and, not coincidentally, most expensive drug, maybe we'll see utilization decrease a little. And maybe, just maybe, people will try a little harder to stay healthy.
These are well-intentioned, intuitively appealing goals. Unfortunately, for many people, this is where the argument for consumerism in health care ends. But I believe that if we focus solely on the potential behavior change, we're missing the bigger argument for consumerism in health care -- the "what if" factor.
They say necessity is the mother of invention, and when we take away co-pays for routine services such as doctor visits and prescriptions, we create a financial dilemma -- a need -- for the consumer. This is a need the free market can and will solve.
Why do I believe that? Because that's what happens in every other area of the economy. America is the most innovative country on the planet. We find a way to fix things that aren't even broken. If there's a better, faster, more efficient, less expensive way to deliver the same product or service, often while improving the quality, we figure out how to do it.
Last month, I said that health care isn't expensive because of health insurance; health insurance is expensive because health care is expensive. This is only partially true.
Health care is expensive, and we can't expect insurance companies to change this. But the current third-party payment system for less expensive items such as doctor visits and prescription drugs is, in fact, part of the problem. It shields consumers from the cost of care, artificially inflates prices, encourages over-utilization, and stifles innovation. Take away the co-pays, and you create a problem for the consumer, a problem that an enterprising, money-motivated individual will find a solution for. How? By asking what if.
What if there was a 24-hour in-and-out clinic near every emergency room where a nurse practitioner could treat 80 percent of the patients who otherwise would have used the emergency room like a doctor's office? What if these clinics were, instead, located inside 24-hour supermarkets? What if that same retailer offered generic drugs for $4 a prescription?
What if doctors had pre-paid practices and a patient could see them as many times as they wanted for a set monthly fee?
What if the amount employers contributed to their employees' HSA accounts was based on participation in a wellness program?
What if patients with chronic conditions such as high blood pressure or diabetes could upload their readings into their electronic medical records directly from the machines that monitor those conditions? What if their household scale could upload their weight? What if consumers also could upload their diet and exercise information to give their health care providers a more accurate picture about their day-to-day activities? What if workout machines at the gym automatically recorded their activity, the way slot machines do at a casino? What if, armed with this new information, doctors could make a diagnosis by e-mail? Think of the time and money that could be saved.
Consumerism, transparency, wellness, electronic medical records -- they seem to be unrelated issues, but they are not. They are all very closely tied together by the common thread of necessity. Necessity driven by the consumer, answered by the free market.
Managed care was never a bad idea; we just had the wrong people managing it.
Challenges are nothing more than opportunities dressed in work clothes.
From the May 2007 issue of Benefits Selling Magazine • Subscribe!
