Redesign health care, save innovation

By Mariannette Miller-Meeks

Universal medical care would require rationing. An indisputable economic reality, the question becomes: Who rations, the government or you?

Americans access the best, newest technology, rapidly adopting innovation with minimal delays obtaining state-of-the-art treatment. Yet amid all the abundance, some are economically prohibited or declined coverage for health insurance.

Economic recovery and global business competitiveness necessitate reform. Urgent, however, is careful deliberation before costly modifications force America to lose access to what most of the world envies. Intellectual discourse, dissolving myths and denial by all invested groups is needed.

Only mythically does a public option reduce costs through competition. Currently, health care competition is aligned to bring value to the government, employer or insurance company. True competition works, exemplified by laser vision correction. Prices started high, bargain providers entered and ultimately price settled where most deemed reasonable. Pay more for perceived quality or less if price is paramount.

True competition isn't realized through a public option. Insurance companies have cash reserves, pay taxes and market. Government agencies bear these expenses, permitting the public option lower premiums, while taxpayers subsidize hidden costs.

Mandating increased benefits and individuals departing to a lower-cost subsidized alternative would stress premiums. Small businesses would drop coverage. Private health insurance would collapse through unfair competition. Meanwhile, costs aren't contained.

Without deterring utilization, costs rises. Repeated, controlled, objective studies reveal overutilization is typical with minimal consumer payment. If lack of coverage was responsible for increased costs, why is Medicare reaching insolvency faster than predicted? Visits and services are bountiful without paying the entire cost.

Greedy providers alone don't account for increased cost. For example, cataract surgery in 1986 was $2,400 per eye and in 2008, $584 per eye despite a procedure without hospitalization and faster recovery.

Increasing numbers of seniors accessing care eliminates government cost savings.

While single-payer systems provide universal access for basic care, a 2007 essay in “Forum for Health Economics and Policy” indicated the poor under socialized medicine seem to be less healthy relative to the nonpoor than their American counterparts. Specialist care is traded for universal basic care, rationing by waiting.

Patients shouldn't defer necessary or critical treatment, but “gray area” care should be consumer decided. The Agency for Health Care Policy could be helpful in analyzing research and cost-benefit analysis. Benefit/value includes convenience, waiting time, traveling distance and discomfort - not merely disease resolution.

Design a system that provides everyone, regardless of citizenship or familial relationship, with accessible, affordable, and portable health insurance while maintaining innovation and encouraging healthy lifestyles. Bankruptcy shouldn't be a concern facing catastrophic illnesses.

Health care costs are tied to insurance. Utilizing auto insurance for each oil change and tire rotation would drastically escalate premiums. Instead, we choose deductibles and benefits; states mandate minimal coverage. Purchased nationwide, it dilutes the risk pool modified by location and driver history.

Health care economists predict policies covering 100 percent of catastrophic events after deductibles, including preventive and immunizations, could cost $200 per month for families by eliminating mandated benefits, purchasing tailored health insurance policies and varying deductibles.

Equalize tax treatment while incrementally phasing out employer deductions and tax credits for lower income and those with chronic pre-existing diseases.

Individual health plans accessed by debit cards empower individuals, regulate insurance with guaranteed renewal and provide choice. Maintain current innovative strengths, utilizing government to insure coverage of the needy, transparency of prices and prevention of fraud.

Combining the best of single payer without derailing profound advances achieved through our current system would afford 21st century solutions.

Mariannette Miller-Meeks is a physician from Ottumwa who was a candidate for Iowa's 2nd Congressional District in the 2008 election.