One of the hazards of blogging is trying to be both relevant and current. For example, I've been mulling an idea for the last week or so about what I would do if I were in charge of reforming health insurance - no easy task, since its such a huge segment of the economy, so naturally it was taking me some time.
Well, I finally had the plan roughed out - only to find that the CEO of Whole Foods beat me to it (and probably did it a little better). So rather than reinvent the wheel, I'll just try to make it rounder by expanding on what he wrote.
"Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs)." I'm very much in favor of this one, as it puts control of health care costs squarely in the hands of the patient, who I believe is the one who should be in control. It has the effect of making patients very much aware of costs and benefits, which means they can make much better decisions about how their health care money should be spent.
Let me give you an example. When my wife and I were expecting our first child, we utilized her employer provided insurance (a very nice plan) to cover our expenses. We pretty much went with whatever the doctors recommended, and got everything done at the most convenient locations and times. No issues.
Fast forward to our current situation. My wife is now unemployed, so we are using my (government provided) health insurance, Tricare. Anyone who has been through a pregnancy in the last 10 years will tell you that you can expect the doctor to schedule two to three ultrasounds in the course of the pregnancy, in order to monitor the baby's development, as well as check for any issues that could affect the delivery (position of the baby, problems with the placenta or umbilical cord, etc.). Well, Tricare doesn't cover ultrasounds, except in "high risk" pregnancies (can anyone say rationing? But that's another topic.) We opted to get the ultrasounds anyway, and pay out of pocket.
Imagine our surprise when we got a bill for $1000 for the first ultrasound! Seems that the hospital where we had been going all along charges quite a bit for that particular exam. Once the shock wore off, we did a little research (which we should have done beforehand), and discovered that the hospital is the MOST expensive place to get an ultrasound. But there is a private diagnostic clinic near us that does the exact same thing (with more modern equipment, too - better images) for only $200.
So think about that - if we were spending $1000 per ultrasound when it was paid for by insurance, no wonder premiums are so high! There was no incentive for us to look at how much the service cost, because we never got the bill. But when we did, it only took a little bit of research on our part to find an alternative provider that actually gives better service for less cost. Market forces at work.
"Repeal all state laws which prevent insurance companies from competing across state lines." Another big one, here. Why should a policy be provided by an insurance company in one state not be valid in another? I can take my car insurance with me when I move - why not my health insurance.
This also ties in with the next point, which is "Repeal government mandates regarding what insurance companies must cover." One of the reason that plans are so much more expensive in certain states is because of the mandatory coverage that has been forced down our throats. For example, New Jersey mandates that any plan offered by a New Jersey employer MUST cover in vitro fertilization. While that's a boon to those who need that service, why should the rest of the people in the state pay for a health service they'll never use? Ideally, health insurance should be customizable the way car insurance is - when I buy my car insurance plan, I get to chose the coverage level and which items are covered, since I know my car and how much its worth to me. Shouldn't I get the same right when it comes to my own body and the maintenance it requires?
If done right (never a guarantee when Congress is involved), this would be a REAL deficit neutral way of reducing health care costs - repealing regulation costs only the paper and ink, while adding it (Congress' preferred method) means creating whole new agencies to manage and enforce those regulations.
Sadly, this is probably far too common sensical for those in Washington to embrace.