Wednesday, March 16, 2011

Health Care and Liberty

This is a Paul Revere moment, a wakeup call. Deval Patrick and the Massachusetts State House are legislating a fundamental change in the funding of health care. In the process, basic freedoms are being stripped from the citizens of Massachusetts, and the population is unaware.

What is being ordained in the name of cost control is a payment system known as capitation, or global payment. The State/Insurance Industry consortium will mandate that the healthcare provider is given a lump sum payment for each patient, from which the cost for services for that person will be deducted. The healthcare provider keeps what’s left. The less spent on that person, the more the provider earns.

To the consumer, healthcare is still “free”, as insurance pay for it all. There still remains reason for the consumer to expect unlimited services. Under capitation, the responsibility for saying no to the consumer is passed downstream from the government or insurer to the healthcare provider, setting up a new perverse incentive in which the patient-provider relationship is potentially more adversarial. Consumers have to worry about whether decisions made for their healthcare are more about the provider’s bottom line than their well being.

The medical community in Northampton worked with capitation some twenty years ago, as Blue Cross / Blue Shield trialed a system called the Western Mass. Health Plan. It failed, as neither the physicians nor the patients tolerated it. Now we’re back to the future.

What is now far more dangerous is the erosion of individual freedom brought about by this healthcare payment reform. The citizen’s sovereignty over basic decision making that intimately affects the individual and family is stripped away. Imagine if access to food in Massachusetts was organized in the same way by mandate of the state government. The supermarket gets $400 per month to feed your family. The owner consults expert guidelines and makes food choices decided to be in your family’s interests, and keeps what he does not spend on you. No American would tolerate this usurpation of authority in our daily lives, and yet the citizens of the Commonwealth will be forced to accept this in our medical decision making. By putting the healthcare provider on the hook for this money, the “local expert” will make the healthcare choices, perhaps in conflict with the unique needs of each individual and family.

By this new legislation put forward by the Governor, he has arrogantly assumed that the state does have the right to appropriate self governance in healthcare. The cadre of government experts and paternalistic academics that have crafted this approach presume that the consumer is incapable of making reasoned decisions about the best way to spend limited health care dollars. This is not nearly my experience as a practicing physician for over 25 years. Once given good information, I have seen that individuals are great at making decisions that work for them and their families.

The Governor is proud that this new legislation is a partnership between the government, Insurance, and healthcare industries. Strikingly missing from this discussion is the input and partnership of the citizen. I have been at many professional forums about healthcare payment reform given by government, academic and insurance experts. In all of them, the citizen is simply fodder for the system, subject to processing. None of these discussions are premised on the primacy of a free and informed individual at the core of controlling health care decision making and the control of healthcare costs.

It is the consumer’s money that pays for health care. Whether the insurance premium is paid for directly or is part of the employee compensation package, the dollars spent are ours. The government subsidized systems such as Medicare, Medicaid, or the Massachusetts Commonwealth Care and Connector, are paid for by our taxes. Creating a health care financing system that puts the consumer in charge of the dollar, rewards frugality, and protects against disaster is not difficult. Using a combination of healthcare savings accounts and catastrophic insurance, consumers shop for the healthcare they want, and keep the money they do not spend. This has already been done statewide in Indiana.

If we in Massachusetts cede control over aspects of our lives, either out of a lack of vigilance or inaction, then we deserve to lose our freedoms.

I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them.” Thomas Jefferson.