I’m not sure what you have in mind by “other than talking about it.” Quite a few members of Consumers for Health Care Choices are entrepreneurs who are actually investing their time and money in companies that provide services like these.

More to your point, though, is that you ask, “If we were willing to ration all health care by price and the patient’s ability to pay, without the benefit of health insurance.” Please keep in mind two things -

1. “Insurance” is not the same thing as “Third-Party Payment.”One of our members, the late Dr. Jim Pendleton, write an excellent paper on how an indemnity policy could be structured to reward shopping for most in-patient services.

2. People with extraordinary needs can be subsidized n a number of ways. One is to subsidize their insurance premiums, but another would be to subsidize their OOP spending. This could be done with a fully-funded HSA, for instance.

The question then becomes, what is the most efficient way to pay for health care services? Through an insurance mechanism with all of the administrative load? Or directly with cash at the time of service? I would opt for the latter.

Greg Scandlen

If we were willing to ration all health care by price and the patient's ability to pay, without the benefit of health insurance, then price (and possibly quality) would undoubtedly play a greater role in the health care market than it does now. I would never deny that. So that is what you are proposing, John. I ask it because some years back, in a debate in D.C., you denied that you were an advocate of high deductibles. You said you merely advocated the provision on price and quality to consumers so that they could participate more intelligently in their own care, and I agreed with that goal.

Here, too, of course, one might wonder exactly what role prices and quality might play, especially in view of the financial services markets where prices and "quality" have been being reported widely and yet so much mischief occurs. Or are we still believing that the market has worked well in that arena?

Now, exactly how, John, would doctors and hospitals present their prices (let alone quality) to patients for other than fairly simple procedures, like lasik or plastic surgery?

I have actually worried about this and made what I think is a constructive proposal (click here). Has anyone at the NCPA or the Galen Institute ever bestirred him- or herself to make a contribution towards this difficult problem, other than talking about it?

And, once again, should we ration all health care by price and the patient's ability to pay, like plastic surgery or Coca Cola?

Uwe

Yes, both can and must be preserved, provided three principles govern health care reform: (1) Health care providers should profit from good practice, innovation and efficiency. (2) Patients should have free access to health services. And (3), everyone should help pay for health services.

The fairest, simplest method for financing health care is through the existing tax-collection system, combining a flat payroll tax and a national retail sales tax on goods and services.

A Federal Health Preserve, modeled after the Federal Reserve System, should manage health services and establish fiscal and professional accountability in health care. The Federal Health Preserve would be an apolitical, independent governmental agency staffed by health and health-care professionals. It would set national health policy and goals, monitor and regulate health services and clinical research, establish peer-developed national health-care standards, set health services that everyone is eligible to receive, and determine payments for services. The agency would report to Congress and negotiate an annual budget to pay for necessary health services.

By itself, Congress cannot reform health care. Its approach is typically piecemeal and subject to crippling compromises. A nonpartisan commission should be established to develop a vision for health-care reform, enabling legislation, and an implementation plan.

j.waun@comcast.net

Yes, both must be preserved, and three principles should govern health care reform: (1) Health care providers should profit from good practice, innovation and efficiency. (2) Patients should have free access to health services. And (3), everyone should help pay for health services.

The fairest, simplest method for financing health care is through the existing tax-collection system, combining a flat payroll tax and a national retail sales tax on goods and services.

A Federal Health Preserve, modeled after the Federal Reserve System, should manage health services and establish fiscal and professional accountability in health care. The Federal Health Preserve would be an apolitical, independent governmental agency staffed by health and health-care professionals. It would set national health policy and goals, monitor and regulate health services and clinical research, establish peer-developed national health-care standards, set health services that everyone is eligible to receive, and determine payments for services. The agency would report to Congress and negotiate an annual budget to pay for necessary health services.

By itself, Congress cannot reform health care. Its approach is typically piecemeal and subject to crippling compromises. A nonpartisan commission should be established to develop a vision for health-care reform, enabling legislation, and an implementation plan.

John, this is not meant to be a plug, but if you would like to discuss Healthplace America, feel free to hit me back. As always, we appreciate the positive approach you are taking to health care reform.