Patient power
In today's bureaucratic health care system, the patient's major role is to sign the forms that authorize one large, impersonal organization to release funds to another, argue John Goodman and Gerald Musgrave. Government, through Medicare and Medicaid, buys close to half the health care provided in America today. Most of the other half is paid for by insurance companies, because the tax laws encourage people to rely on first-dollar health coverage from their employers. When health care appears to be free or very cheap, people buy more than they would if they were paying the full cost. The resulting casual attitude toward shopping for health care drives up prices, which drives up insurance premiums, which creates hardship for business and those without insurance. That spiral eventually harms all users of health care. The Goodman and Musgrave solution is to restore power and responsibility to individual consumers. If individuals are allowed to deduct the cost of their own insurance, they will have a stake in finding the best insurance value. Most consumers will discover that high-deductible insurance is a far better buy than low-deductible policies because the cost of handling small claims exceeds the benefits. Goodman and Musgrave propose that consumers be free to set up tax-free medical savings accounts to cover routine medical expenses. Since the money in those accounts would be the property of individuals, they would have an incentive to spend wisely on health care. The money not spent would accumulate tax-free interest that could be used to meet health care and other needs after retirement. Thus, medical savings accounts are a way of privatizing Medicare too. The result of this proposal would be a cost-conscious private system of competition and innovation. At the center would be the consumers, whose freedom of choice and responsibility would bring to the medical marketplace the value, innovation, and efficiency found in other markets. Goodman and Musgrave's message is that just as government planning failed so spectacularly in the communist world, so it will fail - indeed, already has failed - in America's health care system. "Play or pay" government schemes and full-blown national health insurance would only aggravate the worst problems of the current system. Patient Power demonstrates that market-oriented reform is the only way out of the mess. It is the comprehensive survey of health care.
