Monday, November 05, 2007

Medical Competition

Continuing the debate on capitalism to the field of medicine, the question was raised, why has the free market failed to reduce costs in the US health care industry?

That is a large question, but I think John Stossel makes a compelling argument that the current health care system can, in some respects, occlude and stifle the free market in his brief article Control Your Own Health Care and the follow-up Medical Competition Works for Patients.

The first article describes consumer driven health care and mentions Whole Foods's use of Health Savings Accounts.

John Goodman, the ostensive "Father of Health Savings Accounts", provides a brief rundown of his views on our current political options in Grading the Candidates.

Back in February 2007, Mark raised encompassing issues in more detail that also compares plans and discusses practical difficulties: Universal Health Care and Health Care: What's the Current State?

Some deliberations on this topic couple government charity with mandating a more static market, but I wonder if this is necessary or if it's possible to consider these aspects more independently. Is it feasible for the government to be a source of charity while also maintaining a free market?

Of course, the free market is not a simple panacea. I think it is often easier to imagine, particularly in specific cases, that a government edict fixing prices could do a better job -- especially better than the patchwork we have now. The simple rule of such universal health care is attractive because it is so encompassing and absolute, and it seems to most directly match our morality. But its failures may not be so readily apparent and accounted for -- failures of wasted time, resources, innovation, responsibility, health and lives that might actually amount to a poorer system.

What do you think?

Kevin

Update 11/7: N. Gregory Mankiw wrote an interesting NYT article on 3 common health care statistics which are factual but misleading. Thanks to Jonathan Adler:

1. The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance.
2. Some 47 million Americans do not have health insurance.
3. Health costs are eating up an ever increasing share of American incomes.

According to Mankiw, these statements are "dangerous" because they are true, yet "don’t mean what people think they mean."

Update 1/1/08: MB provided an excellent summary of HSAs. The comments which follow the summary are also very educational. Thanks, MB!

10 comments:

MamasBoy said...

Regarding the update,Mankiw's explanation of 1 and 2 make sense to me, but I don't see how #3 isn't a serious problem. He seems to sweep it under the rug much too easily. Perhaps that is due to the short nature of the article. It could definitely be expanded upon. I honestly don't see the country getting all that much wealthier over the next several decades to accomodate such a large increase in % income paid toward healthcare. If anything, I see future decades as uncertain times due to the graying of the population and the fact that most of them haven't saved for retirement.

Regarding HSA's, my company went with one last year. I think they offer many very nice advantages over std insurance (like being able to pay for non-prescription medicine, acupuncture and other procedures with pre-tax money), however those benefits also come with a huge documentation burden. If I didn't think that my std. PPO option was going away next year, I would not have made the jump. I am several months behind in the required documentation and can easily see how a task like this could overwhelm a family in the middle of a medical crisis.

I'm undecided on the free-market, government provided healthcare question, but thanks for putting these resources together. It certainly makes sense to me that it isn't a true free market. The hospital networks in town really don't have to compete for my business because insurance companies set the prices and rapidly narrow the choices down for both me and my doctor.

MB

Kevin said...

MB,

Thanks very much for your excellent comment.

I found the explanation for #3 (that we are essentially buying better and more life) to be weak as well. It may make sense in terms of our expensive ER abilities to save lives, but not in terms of generally maintaining health. Paying more can be indicative of many problems including personal habits, ER instead of earlier prevention, what insurance covers, etc. I also share your concerns about the future.

So, I guess with HSAs the burden of documentation shifts to the patient. I imagine that it is to prevent abuse of the system but that sounds rough. What kind of documentation do you have to provide? Do you see any theoretical way the system could operate so that such documentation is not necessary or can be minimized?

I'm not wholly committed to any particular solution either. Any free market solution needs the right structure to thrive and health care is particularly complex in that it has become a social responsibility. My sense is that the optimum realizable solution centers upon a free market rather than government price fixing, but I'm open to evidence and arguments to the contrary.

Kevin

MamasBoy said...

Kevin,

Regarding making HSA's more user friendly, it would be nice to have the insurance companies handle the paperwork that they used to. I can understand there being an increase in paperwork where insurance companies are not involved (e.g., acupuncture, over the counter medicine), but there should be an option for folks to be able to hit the autopay button without having to document normal hospital transactions in the same detail.

That's about my only suggestion for the HSA reps who are not listening.

It's really not a bad idea overall. It's just that they use consumer language as an excuse to dump more paperwork on the sick, when their std. medical choices are still just as limited as before by what insurance will and will not cover.

MB

Kevin said...

MB,

I imagine the doctor would be responsible for the paperwork, not the insurance company, right?

I'm curious to see some studies that analyze the utility of the paperwork and how significant it really is in the case of HSAs, since they are more similar to using one's own money.

For some reason, I was under the impression that HSAs permitted a wider variety of medical choices but sadly that does not seem to be the case. There are still some benefits, but not quite as many as I had anticipated.

Thanks for mentioning that and sharing your experience.

Kevin

MamasBoy said...

Kevin,

HSAs make a wider variety of medical choices are tax deductible. The insurance company is still the one who negotiates discounts for folks, unless they are willing to fight for them. HSAs complement insurance, but don't replace it. The doctor still bills the insurance company and that relationship is standard. As is also standard, the insurance company passes on all the cost up to the deductible to the consumer. What is non-standard is that the insured now has a tax deductible account from which to pay the deductible and the obligation to track those expenses to justify the tax deduction. Depending on the HSA provider, this process is more or less painful.

MB

Kevin said...

MB,

Thanks for the summary.

I can imagine the insurance company negotiating discounts for services over the high deductible, but how would that work below the deductible since the patient would be the shopper and the payer?

I've read that some doctors might not submit HSA insurance claims due to the high deductible and the cost of doing the paperwork. Or perhaps they'll add a surcharge for it.

Kevin

MamasBoy said...

The insurance company still needs to be involved, because just like with low deductible insurance, they need to know how much you have spent so far and how close you are to meeting the deductible. Also, it is to their advantage to leverage their own buying power in your favor through lowered premiums. It prolongs how long your deductible will last and means they are less likely to have to pitch in. HSAs are really only different from a standard HMO or PPO in three ways. 1) It is required that the person have a high deductible plan. 2) The money in the HSA can be used tax free to pay for other items not normally covered by insurance companies, but still healthcare related. and 3) The healthcare consumer is now responsible for keeping track and documenting all purchases in order to justify their withdrawals to the IRS. For regular checkups and medical procedures the standard process applies to both HSA PPOs/HMOs and standard PPOs/HMOs.

I hope that is more clear.

MB

Kevin said...

Yes, you have been clear. Thanks, MB.

MamasBoy said...

Kevin,

Here is a great summary of HSAs after my clear as mud explanation. It doesn't get into documentation requirements, but hits the high points.
http://finance.yahoo.com/expert/article/millionaire/50127

MB

Kevin said...

Thanks for the link, MB. It condenses a lot of what I've read and provides some helpful links. The comments I've read thus far there are also very educational. Thanks again!