One of the most positive “solutions” that legislators might call upon themselves to make, would be to fully implement the concept of tax-exempt “medical savings accounts” that are owned, and controlled, by individuals themselves.
The hitch (for legislators) of course is the concept of “tax-exempt”, and the idea that individuals would control their own health care accounts, and thus their own health care.
Of course, it’s really not your money. It’s the government’s money. Politicians just let you hold it for awhile.
The real “cost” of health insurance comes from the insistence of “first dollar” medical plans, that pay for all medical care, either from “dollar one”, or for very low deductibles.
If something doesn’t cost you, you are not likely to fuss too much over the price. Most people today don’t question their doctors over the cost of the treatments or tests that are being recommended – why bother? Someone else is paying.
You also are not going to have the incentive to stay healthy, in order to avoid eventual medical costs, or to put them off. Why bother? Someone else is paying.
Why buy a used Volkswagen, when someone else will write the check for your shiny new BMW?
The REAL “health insurance” that most people REALLY need is “catastrophic” health care insurance – the kind that would cover the vast bulk of the kind of care in the catastrophic case so graphically painted by Dino in a different thread.
True catastrophic health care insurance is relatively inexpensive, compared to the kind of comprehensive, low-deductible, total-care plans that most employers offer, and that most employees insist on.
Why not? Someone else (the employer) is generally paying all or most of the freight.
Medical savings accounts have the potential to solve several rather “sticky” problems present in the health care financing debate.
The first is incentive. Since medical savings accounts are owned by the individual, and unused funds accrue over time to the benefit of the individual, each individual has the incentive to minimize expenditures, either by shopping for their health care options, shopping for their catastophic insurance, or by making lifestyle choices that minimize the need to spend the funds.
The account also provides a “buffer”, enabling individuals and families to purchase the much-less-expensive catastrophic and long-term care insurance, that will cover medical and long-term care costs once the individual’s expenditure has bypassed the established annual limit – say $10,000.
While this might seem like an unaffordable deductible, remember that the savings accounts accrue year to year – meaning that within a few years, an individual could easily have a comfortable medical nest egg to draw on for those less-than-catastrophic health care needs, or for a time of failing health.
Contributions to the savings account, the proceeds of which could also be used for purchasing catastrophic insurance, could be voluntarily withheld on a tax-exempt basis from each employee’s paycheck. Employers could also opt to offer a benefit of “matching” and employee’s contribution, or could provide a contribution outright to the employee’s individual account.
You could choose to additionally fund your account with “found” money, like a windfall, inheritance, lottery winnings, or whatever. Money paid in would be tax-exempt. Money paid out for legitimate medical or health-care expenses and insurances, would be tax-exempt as well.
Unlike some current tax-exempt withholding medical plans, there would not be a “use it or lose it” imperative. Use if if you need to, but if you don’t, the balance builds – plus interest – for some future time when perhaps you will actually need it. If you die before you can use it all, your heirs receive it as part of their inheritance – which they can choose to “roll over” into their own medical savings account.
Medical savings accounts are also employer-independent. You don’t lose them if you lose your job. You can work a job and contribute to them, or you can be self-employed (or un-employed) and contribute to them, or draw from them, as needed.
Another benefit is the sense of self-worth and confidence that accrues to an individual from having “money in the bank”. Even if that money is limited in use, as presently are tax-deferred retirement savings plans, there is still the knowledge that the money is “yours”, is there for when you need it, and is growing in value. That sense of security and independence alone would have a considerably positive effect on physical and mental health.
Such a plan might be tough on employers in at least one respect, since they won’t be quite so able to hold employee’s “hostage” to their benefit plans.
Even tougher on politicians and legislators, who won’t be able to curry votes by endlessly promising “more” benefits, payouts, and gimmes. No taxes collected means less opportunity to “skim” off the top for “administrative” purposes, or to fund other vote-buying “projects”.
There you have it. One “legislative” solution that, if properly implemented, would actually promote economic freedom and free-market solutions.
And what of the truly incapacitated, who can’t work, never did, and never will?
As we have it now, we already have a virtual plethora of “safety net” public programs already in place, that once less burdened by those who actually can care for themselves, will have more available resources to care for those who can’t. Since more people are shopping around and negotiating down the prices of health care, that care will be less expensive as well.
There are also private foundations and charities, many of which already provide free or nearly-free critical care for those without means. Americans are famously charitable and giving to those in legitimate need. The real challenge comes from those who seek to be “charitable” with other people’s money.
People of course need to know and have confidence that their contributions are being spent wisely and efficiently. Government is rarely if ever the best venue for such fiduciary responsibility. Millions if not billions of dollars of mis-purchased supplies, and fraudulently-paid claims paid in the wake of just about any disaster you can name (and long before Katrina), are testament to that fact.
There are also the medical professionals themselves, who are already often giving of their professional services on a pro-bono basis – and can continue to do so.
Hospitals are in fact required BY LAW to provide at least basic medical care to anyone who shows up on their doorstep, whether or not they can demostrate an ability to pay for those services. You can find exceptions, bad actors, and horrific examples where professional ethics were sidestepped of course – but that’s what they are, exceptions.
Some people will unquestionably mooch for the max. It’s up to someone to draw the line. Sometimes that line is drawn imperfectly. Giving the pen to a politician or bureaucrat is not the answer – their ability to draw is something less than the average person’s.
Much is being made of the number of people who, for one reason or another, are temporarily or permenantly without medical or health-care insurance coverage.
Compared to what? Medical insurance is a relatively new concept, that did not achieve widespread acceptance until the second half of the 20th century.
A hundred years ago, almost NO ONE had any sort of medical insurance, other than that offered by their church or mutual-aid society. People paid cash for their care.
Compared to the numbers, and percentages, covered by such insurances now, is there now a real “crisis” in health care insurance coverage? Where was the “high point”, from which we are theoretically now losing ground? What was the percentage then, compared to now?
Michael Moore’s ravings and factual cherry-picking notwithstanding, American’s enjoy the best medical services, options, and the highest level of overall access of anywhere in the world.
Some of it is very expensive, to be sure – but in most places elsewhere in the world, such care and services are simply not available to anyone, at ANY price. That’s why they come HERE.
Poverty tour? What a farce. We have the wealthiest (and the fattest) “poor” in the world. Most people in the world ASPIRE to have what the “poor” here take for granted.
Constantly telling us that “it’s broken”, simply won’t make it so.
