Guest Column: Ways to improve health care: The rebuttal | Columns


What follows is a brief commentary on each of the suggestions for improving health care put forward by Michael P. O’Neil in his recent letter (“10 ways we can improve health care,” The Sun Chronicle, Oct. 9). In quoting his suggestions I have abbreviated some of them.

“First, make all healthcare spending tax deductible.”

A tax deduction for healthcare expenses will not help a person who can’t afford to incur those expenses in the first place. And, if those expenses are instead covered by insurance and not out of pocket, there is no reason to make them tax deductible.

“Second, outlaw employer funded insurance. Make employers take the money they spend on insurance and give it to the employees as a pay raise.”

The group insurance provided by employers usually has a lower premium than does an individual policy. It is not likely that the amount of the projected pay raise would buy comparable individual coverage.

“Third, mandate that everyone over 21 years old get a health savings account.”

Proponents of health savings accounts unrealistically envision such accounts as being sufficient to cover all except catastrophic health care expenses and unrealistically assume that all households have the resources to create such accounts.

“Fourth, mandate that everyone gets catastrophic health insurance.”

Catastrophic insurance, which has lower premiums than most “regular” coverage, kicks in only after a huge amount (usually thousands of dollars) has been paid out of pocket. It is not a good choice for most of us who cannot afford to self-insure (pay medical costs up front). The idea that the combination of a health savings account and a catastrophic policy will cover one’s health care expenses is unrealistic.

“Fifth, deregulate insurance laws. Allow anyone to buy insurance over state lines.”

Experience has shown that an unregulated private health insurance industry can not and will not provide affordable and comprehensive health insurance for everyone who needs it (which means all of us). Competition among for-profit private insurers, whether intrastate or interstate, does not automatically reduce insurance premiums or guarantee good coverage. The healthcare market is different in nature from commercial markets.

“Sixth, insist that patients pay their provider directly out of pocket for all bills under $1,000, even if the patient will be reimbursed by their insurance company or the government.”

This complicates the payment process, creates unnecessary paperwork and works a hardship on patients with limited or unexpectedly strained resources.

“Seventh, mandate that doctors tell their patients what their procedures will cost up front.”

Such a suggestion usually assumes that the patient will have the time, opportunity and resources to comparison shop for a lower cost procedure. This is very unlikely in emergency situations or in rural and sparsely settled areas where there are few practitioners and facilities.

“Eighth, penalize anyone first applying for health insurance with preexisting conditions.”

Such persons are already penalized by having to pay higher premiums. Also, if they know of a preexisting condition but do not disclose it on the application, the insurer can void the policy. I note in passing that some people are born with preexisting conditions and others do not know of a preexisting condition at the time they apply.

“Ninth, provide financial assistance to those who still can’t afford good medical care.”

Medicaid and the Obamacare subsidies are two in-place examples of such assistance. A single payer system or “Medicare for all” would provide for everyone the equivalent of O’Neil’s proposed financial assistance.

“Tenth, mandate that Congress and all government employees live by the same insurance rules as everyone else.”

They already do. They must buy their health insurance on the Washington, D.C., Obamacare exchange. They do not receive free health care.

Since some of Mr. O’Neil’s suggestions border on the cryptic and all merit further discussion, I hope he will take the opportunity to provide us with a more detailed exposition of them.

The writer is a North Attleboro resident.

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Guest Column: Ways to improve health care: The rebuttal | Columns

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