posted on August 31, 2009 09:45
By: John F. Munger
August 28, 2009 - 4:22PM
Regardless of federal actions, Arizona can be a national model for health care reform.
By simply fixing what needs to be fixed, and not creating huge bureaucracies, bankrupting the state, or intervening between doctors and patients, we can solve the principal problems of rising costs of care and accessibility of care for all.
First, to finally control costs we must reinvigorate consumer cost decision-making, which is the most fundamental pressure favoring lowering costs. Medical consumers make few cost decisions and simply pass the medical bill to their insurer. Yet, in medical procedures for which consumers are compelled to make cost decisions for medical care that is not generally covered by insurance, such as for corrective laser eye surgery or cosmetic surgery, costs have dropped drastically in the last 20 years because of competitive forces.
The first steps
Arizona should empower consumer decision-making and competition in medicine. First, on the supply side we should allow Arizonans to competitively select any health insurance program available in any state, rather than limit Arizonans' choices to a few programs selected by our regulators. On the demand side, we should invigorate consumer decision-making by requiring that all medical and pharmaceutical providers quote their prices on a public Web site each month for public comparison.
Just as insurance companies give safe driving discounts and nonsmoking discounts, they will soon start to provide hot lines to help people select several reasonably priced alternatives for medical care or products as well as "good decision-making" discounts for insureds who act rationally in selecting reasonably priced care. Consumer choice will be enhanced. Prices will begin to decline.
In addition, Arizona should adopt a simple tort reform measure that, as with contract-related litigation today, requires that parties losing medical malpractice actions pay at least some reasonable portion of the winners' attorney's fees. Used by the English for centuries, this creates risk and causes all players to carefully analyze their case before they file, and would substantially reduce the number of frivolous medical malpractice actions, and medical costs, in Arizona.
Finally, Arizona could reduce medical costs by requiring that medical insurers give discounts to consumers who allow their medical records to be transmitted electronically via a secured system, thereby reducing costs of care. Again, no requirement - just a consumer option.
Reform the coverage
Adopting these three simple measures would drastically reduce medical costs. In turn, that would improve accessibility of medical care to more people. But we can easily do more.
Arizona should require that all insurance policies be portable and not tied to employment. We must allow individuals and associations to create groups in order to negotiate favorable health insurance not tied to employment.
We should require that all persons with pre-existing illnesses be accepted into medical insurance pools. Persons with pre-existing problems caused by their own lifestyles, such as obesity, smoking, dangerous activities or hobbies, or who repeatedly did not follow medical recommendations of their doctors, could be required to pay a limited additional premium for their lifestyle choices and the burden they cause to the health care system. But persons with pre-existing illnesses not based on lifestyle choices, and who follow reasonable medical directions, would not incur any additional premium.
Finally, we must assure that all those remaining who still cannot afford health insurance have easy access to our state Medicaid program and KidsCare for children. With both programs, the main problem is that people simply do not sign up until they need medical care - but, in reality, most do have coverage once they need it. But we must constantly re-evaluate our entry levels to assure fairness.
Arizona can solve the problems of rising health care costs and accessibility by simply fixing the problems that need to be fixed. Let's do it now!
John Munger of Tucson is the chairman of ImagineArizona.com, a public policy organization that promotes solutions to Arizona's public policy issues.