Power to the patient

Recently much has been debated on the editorial pages of your newspaper regarding the one-payer system vs. the status quo. Neither approach is a long-term solution to the present crisis. The one-payer system is socialized medicine despite any claims to the contrary. To paraphrase Shakespeare, “A thorn by any other name is still a thorn.” The present system is a mishmash of rules, insurance companies interfering with the patient-physician relationship and bills for medical care that are impossible to read or figure out. The rules and regulations imposed by the government for Medicaid and Medicare are choking the ability of well-intentioned hospital administrators to expand services and work for the welfare of communities.

The solution takes the best from the free market experience and allows for patients to control their own health care future. Medical Savings Accounts (MSA) is a known concept the implementation of MSA’s has been at best spotty and poorly planned. The basic plan allows patients to put away a set amount of money pre-tax to pay for any care. The money left over at the end of a year can be rolled over to the next year or invested in a medical savings account for the future. The patient can do with the money what he or she wants as long as it is used now or in the future for medical care. Young people who do not have any medical problems can build up a great nest egg for future medical expenses, which may occur 20 or 30 years later.

If the money has been invested in a medical IRA this amount, at an average rate of eight to 10 percent, would be substantial. The patient then could bargain with the doctor or the hospital regarding the cost of their care and pay cash. Hospitals and doctors would have no problem accepting cash and choices would be in the hands of the patient and doctor. The patient would finally be in control. The patients would also have great incentive to take care of themselves and practice healthy lifestyles. Presently with insurance plans, Medicare and Medicaid, the patient has less incentive to practice a safe and healthy lifestyle because someone else, the healthy patient, is paying for their unhealthy lifestyle.

Advocates of big government (democrats and republicans) oppose this approach because over the next 20 to 30 years Medicare would be almost obsolete for 95 percent of working Americans (assuming 5 to 5 percent unemployment). Of course, the same people are not chronically unemployed. The insurance companies object because they would have to compete with the patients.

There are people who feel that the poor would be left behind in this system. The poor are not a homogeneous group. People move out of poverty in the free market system we have in this country. There are plans now for the poor and they would not change. Over time, as these patients move up the financial ladder, they will have their own plans.

One problem we all dread is the catastrophic long-term illness that very rarely attacks young people. Presently the system with private insurance may not cover the disease or the money runs out. Patients are forced into social security disability or Medicaid. This can be avoided by an inexpensive catastrophic insurance with a very high deductible.

Most working patients are able to pay back this deductible over a long period of time. Presently, many have to second mortgage their homes or borrow against savings before going onto social security disability. I would love to see this poor system eliminated. Of course, the social security administration in Washington would hate this.

The MSA is a positive, long-term approach to patient power and a renewed doctor-patient relationship. The present system and the proposed remedies will only prolong the agony of excessive government control and insurance company interference with a relationship that should and used to be sacred.

R. Davis Hart, of Surry, is a fellow of the American College of Osteopathic Surgeons.