Skip to content
This site is not affiliated with or endorsed by TriMet transit in the rose city...maybe even Rose City Transit

2011(?) speech

Fiscally responsible, consumer-controlled health care for all

Note: for my current thinking see A bottom-up approach to health care

It seems clear that America's health care system is badly ill.

It is a system where much time and effort is spent by providers and patients getting insurance companies to pay for procedures, partly since there is an inherent conflict of interest--more claims mean less net revenue for the insurer (and "non-profit" doesn't mean "charitable").

Where I've seen multiple clinics offer much cheaper rates to cash customers, quite possibly not as a goodwill gesture (assuming that a lack of insurance results from a lack money), but because they find dealing with insurance that much of a hassle.

Where providers are sometimes encouraged to perform extra or more expensive procedures in order to boost revenue, and get away with it because the patient isn't the paying customer.

Where time and effort is spent dividing everyone up into little groups based on employer, age or other status.

Where employers are discouraged from creating good or better (e.g. full-time instead of part-time) jobs because doing so would increase their health insurance burden.

Where employees who are lucky enough to have employer-provided insurance often don't have a choice of carriers as a result of a desire for volume pricing, and switching company-wide can be burdensome.

Where top-down efforts to control costs are disliked and problematic.

Where a study by the American Journal of Medicine found that, even considering private insurance, over 60% of all bankruptcies involve medical costs.

Where millions of citizens have trouble getting care, and often let problems go unchecked until they worsen and are costlier to treat, causing much productivity to be lost and creating burdens for society.

Where people who do have insurance aren't shown the actual costs of procedures and, therefore, aren't encouraged to pick options that are the best value and save money.

Where care is fragmented among different providers who don't know what others have done or are doing, causing the need for patients and providers to spend time and hassle duplicating information and creating the potential for bad interactions.


The question is what to do about it? Government-run health care can have its own problems. People don't like having only one choice--especially when that choice is the government--and worry about being denied care and instead left to wither and die. There are also fears of innovations being stymied and costs not being controlled.

Congress' requiring the purchase of insurance may be good-intentioned, hoping that costs will be brought down by adding more people to insurance risk pools and that more people will be covered, but assumes that the insurance model is the right way to go and may not address root problems. It is viewed by some as a dictate and may not be legal.

Instead, why not give everybody an account that they can use to pay for their care directly?

They could use the money to pay for their choice of insurance plans or, I think even better, pay for care as they go.

Patients would be put in the driver's seat as consumers, and encouraged to find lower-cost or better treatment options. At the same time, they could pick the options they want and need instead of being limited by insurance.

Innovative options such as ZoomCare and Tigard's Affordable Health Clinics would pop up as entrepreneurs could easily connect with customers who have money to spend.

Governments, like Oregon's doctor-governor, who believe they can provide good care could compete, too. To ensure fairness and consideration of costs, they would have to be treated just like a non-profit and have all funding come from participants' accounts.

Eliminating insurance would also allow better patient/provider relationships since a third-party would no longer dictate.

Detailed medical costs would become transparent, which can be the basis for further reforms. Casinos in Atlantic City as well as Safeway have found that much care is used by a small number of individuals and, with personal encouragement, can be avoided.

People who spend wisely or are healthy and have funds left at the end of the year could be rewarded with a portion of the remaining amount in cash. People who suffer costly catastrophic medical issues could be required to pay co-insurance for additional care or borrow from future years' funding. They could also use traditional third-party insurance, what are now high-deductible health plans.

Funding would come from the money now spent on public and private insurance and care. There would be an employer tax that would replace their health care spending; tax breaks could also be reduced to lower the need to increase the overall tax rate.

Unlike a system where all doctors and clinics are government-run, the status quo of private practices would be respected and not disrupted.

Employees who now must use an employer-chosen provider would have the freedom to choose their own.

Employers who now provide good health plans could be allowed to opt out along as the care provided meets coverage standards. However, the goal would be to provide a better value than employers and employees are now able to get.

Make it Oregon-wide, recognizing that with campaign contributions and lobbyists Congress is unlikely to act, and giving the state a much-needed unique economic development incentive. Employers and unions would no longer need to bargain over care, and more and better jobs would result since adding employees would no longer mean also adding to the company's health insurance burden.

Now, many instead give out additional work as costly overtime, which limits the amount of citizens employed and causes other problems. For example, instead of working snowplow drivers to fatigue and exhaustion, ODOT could potentially distribute the work to a higher number of workers on-call and at regular rates.

To ensure the state doesn't become a charity for the entire nation, there would be a waiting period or buy-in fee for new residents. If charged to the employer, the fee could encourage the hiring of established Oregonians.

It would reduce the need for lawsuits, as people would no longer need to fight for care or get their health damage taken care of (though when somebody is recklessly negligent, they should have to pay).

The need for malpractice insurance could also be eliminated by recognizing that mistakes happen and having the state pay for claims, but fining and revoking licenses of those whose errors are more than mistakes. Specialized courts much like tax and bankruptcy courts have been suggested, and following best practices could be required.

Further money could be saved by forgiving student loan debt of those who charge lower rates.

It would recognize that health care is essential as education, that everyone will need it eventually to survive and thrive, and that there is little connection between having a job and needing care.

But unlike government-run education, participants would have options and providers would be free to innovate.

In addition, the state could also create universal medical records. Either have a statewide database or personal encrypted storage devices. Not only would this help coordinate care, it could also be used to look for fraud and uncover disease and other trends.

By Jason McHuff,