Jacob Sullum notes in his Reason column that Republicans and Democrats alike promise to preserve the central problem in our health care system -- the consumer is not the customer.
Three-fifths of Americans, the share with employer-provided health insurance, are in the same situation. Since someone else buys insurance for them, using money they would otherwise receive as wages, they are in no position to shop around and typically do not know the true cost of their coverage. This disconnect between payment and consumption is one of the central problems with the health care system, contributing to insecurity, rapidly escalating costs, and the general lack of choice and competition. Yet both Democrats and Republicans insist on preserving it.
Transition to a consumer oriented health care system is not an impossibility. Start by dumping employers' share of health insurance costs directly into employee paychecks and deducting 100% of the health insurance premiums deducted from them. These should be pre-tax dollars. Next should be the implementation of health savings accounts. Health savings accounts would be used for routine maintenance like physical exams. Health insurance policies would protect against catastrophic illness. All pre-tax. These steps make the consumer the customer, not just for insurance, but for medicine itself.
The problem of insuring the uninsured could be handled by building upon Medicaid.
But don't hold your breath. Government leaders would prefer another middle class entitlement program that adds to the federal payrolls. The objective is to increase the number of people who vote for a living as compared to those who work for a living.
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