Health care costs are spiraling out of control, but why? That is the real question people and “experts” are not thinking about. The discussion seems to stop at “costs are too high; we need to intervene to lower costs or get care for everyone!”

I agree there is much wrong with our system. But it has developed as a hodgepodge series of government interventions and private sector compensations that has lead to our tangled, overpriced mess. In a normally functioning economy, technology will increase efficiency and quality of products and services. There is no utopian system where everything will be roses and ice cream for everyone, some will always have more or better than others.

The cost is high due to government interventions in the market. Taxation and regulations caused employers to find other ways to compensate employees (employer-paid health plans). These plans have become endemic and inefficient, but folks will continue using them because they are paying for them. Then there was Medicare, HMO/PPO creation and other regulatory pressures as more businesses started competing for government regulatory boons. It took time, but interventions in the marketplace have turned things upside-down.

The answer is real free market health care.. For some meat and short-term transition, I would propose something like the following. Those who want the added protection can purchase high-deductible catastrophic health plans, voluntarily sharing the risk. Then give tax deductions or credits for health care up to said deductible. This would put the onus of the everyday health care costs back onto the patient, where it belongs, which would make them more price- and quality-conscious. Doctors, too, would have to start competitively seeking patients through better pricing and service. This system probably would also decrease bureaucratic overhead, which would also contribute to lowered prices.

Market pricing discovery would occur and competition would drive down costs. Doctors would begin using technology, not as another thing to bill insurance, but to more efficiently treat the patients so they stay in business. Docs who don’t try to fix the problems would be more likely to fail, as clients would seek care that worked. Both patient and doc would be rewarded for good, moderately priced care. I think there would likely be an increase in the amount of charitable or discounted care for the poorest, but that is certainly debatable.

Tax deductions and credits for medical expenses would be incentive for some to seek more care than they otherwise would. But as it is now, patients are not rewarded for being price-conscious (in regard to insurance co-pays and such), and doctors are financially incentivised and distracted by having to bill for procedures and coding correctly so they can be paid for their work. More procedures generally mean more insurance money. It is part of the financial card game the doctors and insurance companies are forced to play, with cards in hand that have been stacked and restacked to favor various special interests.

We as a nation need to get beyond the emotional arguments going on about health care. There needs to be discussion about how we got here and the principles involved; we have a better chance to fix the problem instead of just adding more problems to the existing unjust system.

Dr. Shannon Grimes

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