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Free Marketeer's Healthcare Scheme Would be Chaos

Cheryl Clark, for HealthLeaders Media, February 28, 2013

Goldhill's remedy for the country's ills comes in two parts. For catastrophic care, what he defines as "crises that are major, rare, and unpredictable," there would be government-run universal coverage, much like homeowner's insurance that pays when your house catches on fire.

For everything else, non-emergent care, preventive health and elective procedures, each person in the country, including seniors or their designated decision makers, might receive a sum of money to spend, say $5,000, or $8,000, like an accumulating health savings account, based on what would ordinarily be spent on healthcare a year anyway. 

Or maybe we'd just eliminate the billions in premiums paid by employers and employees from their paychecks, or the Medicare payroll taxes that revert to Uncle Sam.  In other words, he wants to take insurance companies, Medicare and Medicaid largely out of the picture.

The idea that Medicare or Medicaid can force higher quality from its qualified providers because it pays them, or that health plans select providers who perform better is lunacy, Goldhill says.

"I would argue that anyone relying on their insurer to pick the right hospital for their specific treatment, is kidding themselves," he says.

In Goldhill's new world, each person would get to spend their thousands the way they wanted directly each year, or save it until they needed it, for services by the providers they wanted. No "surrogates" or middlemen would dictate networks of care to get in the way, Goldhill says.

Only then, when consumers become direct payers for their healthcare, can they have the market force they need to demand accountability and transparency in the quality of the services they receive, he argues. Today, when someone else is paying the bill, consumers don't impose the same level of scrutiny, saying in effect, "if it's paid for, I must need it."

"How do you introduce the type of dynamic accountability and discipline we have in everything else?' he asks.  "You do it by forcing providers to chase customers, like they do in every other industry," Goldhill says. "And you take the functions that we now give insurers and Medicare and you give them to  people who are actually putting up the money and receiving the service," Goldhill says.

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5 comments on "Free Marketeer's Healthcare Scheme Would be Chaos"


Wayne Wasden (3/17/2013 at 4:06 AM)
Ms. Clark, You should be ashamed of yourself. Your liberal sermonizing has been placed in stark comparison to individual empowerment, accountability and responsibility. Mr. Goldhill has simply stated facts and the truth about how markets and human nature work. Last I looked market forces continue to work extremely well in the U.S. system, especially when they are not tinkered with or controlled by people who view themselves as wiser than the consumer. It is also a sad fact that this discussion for a significant change to a tried and successful way of doing business will never be elevated because of those who currently exercise control over market forces. And a single payer systems does not significantly alter the incentives so clearly dominating behavior. There is no more broken system than the U.S. Healthcare System with it's incentives clearly exposed and articulated by Mr. Goldhill. Ms. Clark, with all you clout and contacts, do all you can to move this discourse to a higher level. Bravo Mr. Goldhill

MayoVictim (3/6/2013 at 5:03 PM)
There's a simple solution to the US healthcare system. It is just to adopt a European style single payer system. The Europeans have better healthcare outcomes. It costs much less than the US system and when I lived and worked in the UK and Europe I never heard anyone in the medical industry complain about their remuneration. Of course the AMA and their handmaiden in congress have a done good job demonizing what they label as "socialized Medicine" but I can tell you that from my personal experience as a patient and worker in the healthcare industry it's way better than what we have in the US. I'll now wait for nonsense comments about waiting lists and death panels.

MBRose (3/1/2013 at 1:46 PM)
Bravo Mr. Goldhill! Perhaps by thinking far outside the box of 'standardized care' schemes and shaking up the illness healthcare system currently worshiped in this country, true life changing improvements might happen. Maybe the 'Tippong Point' has finally been reached and society will move forward in handing the power for self-care back to the individual and out of the hands of insurance companies and physicians, who have NOT improved outcomes or increased longevity and quality of life in decades...but have become some of the wealthiest and most powerful individuals and corporations in the process. Change, big change, never happens easily or smoothly. Yes there might be some missteps along the way. However it is time to do something differently...anything differently. We have followed this insanity for far too long, doing the same kinds of things over and over again, expecting improved outcomes and results. Isn't that the definition of insanity? Yet we have bought the bill of goods, hook, line, and sinker each and every time! I say bring on a bit of chaos and let real change begin to happen.