Monday, September 1, 2008

my real healthcare plan

Everyone should take out a high deductible major medical policy to cover catastrophic stuff, big stuff, then have enough money available either liquid or line of credit, to cover that deductible should it be needed. Then we should pay out of pocket for our "incidental" stuff like sinus infections, bronchitis, sprained ankles, prescriptions, shots, checkups, etc. We could use a health savings account, use pretax dollars, and be able to "roll over" unused balances from each year if available. Then we would become better consumers of healthcare and not the entitled brats we've become. We would think more carefully about the MRI that's ordered, the prescription that's given, whether we should get generic, etc., and be responsible for our own healthcare costs. For families having kids, they might save up a few years' worth of savings from their good health to cover the costs of a new baby, and then the catastrophic plan would cover a premie with big needs or a high risk pregnancy. We would be more likely to have mom come move in with us, maybe we would even build on an addition for her and hire a nurse/aide to care for her at her home or ours, if we compared the costs of a nursing home and the heartaches of such an arrangement with this "radical" though time-tested method of caring for the aged.
Sure, you could go with the car insurance idea to decide how much insurance you could get for the money, but the idea of using the difference between the premium on your major medical policy and your "cover it all including prescriptions" plan to put into a health savings account with the ability to roll it over and even get interest on the money would help the elderly pay for their long term care since they've been paying into this for years and haven't been counting on the government to manage it, they've been managing it, and if they want to go to the Bahamas to retire to a seaside village "nursing home" and they can afford it, so be it.
I'm not political enough to know who's for this, if either of the candidates is, but I'm pretty sure it's not Barack Obama. 
As a physician, I should become more like our colleagues, the veterinarians, and know how much things cost and be able to give people a reasonable idea of how much things will cost and let them help in the choice. If there's a cost difference for the same procedure at one place vs. another, they should know. We would have a big element of change on our hands, both physicians and patients. For this generation, which has grown up saying "sure, go ahead, I've got insurance" to find out how much something is going to cost and decide if they should get it or do it, is going to be uncomfortable at first. It's going to affect malpractice because if I recommend something and the patient doesn't want to do it (like vaccines now!) then has a bad outcome as a result of choosing not to do it, I'm liable under the current system, even if I was adamant about them needing to do it or get it or whatever, and documented my advice. Maybe videotaping of consent will help this. You get taped turning down my advice. Now of course if my advice results in a bad outcome...I'm still liable and should be. And many things aren't black and white, and the definition of a bad outcome will have to be ironed out. Oh, so many things, but our consumer economy can get through it, we just have to quit being ostriches as far as how much things cost (physicians and patients) and be willing to present and accept options.
Unlike our friends the veterinarians, though, one of our options (at least currently) isn't going to be "or for this amount, we can put X to sleep". I'm a little afraid that time may not be far in the future, especially if humanist atheists are running the system. But I digress...