Kevin O’Neill: Tom’s and Kevin’s Excellent Adventure
July 20, 2017
If you listened to the show on Wednesday, July 19th, you know that Tom and I have embarked on an ambitious project. We’re going to design our version of a healthcare bill over the course of several shows. Why? Because nobody else has been able to craft something acceptable… and because both of us have a perverse idea of what’s fun. What do we plan to do with our proposal when we’re done? We’re going to make it the basis for saying “I told you so” for years to come.
For openers, we discussed anti-trust law and how it applies to health care… or to be more precise, how it isn’t applied to health care. For example, section 8.2 (e) of the Clayton Act says:
(e) Furnishing services or facilities for processing, handling, etc.
It shall be unlawful for any person to discriminate in favor of one purchaser against another purchaser or purchasers of a commodity bought for resale, with or without processing, by contracting to furnish or furnishing, or by contributing to the furnishing of, any services or facilities connected with the processing, handling, sale, or offering for sale of such commodity so purchased upon terms not accorded to all purchasers on proportionally equal terms.
In other words, the Clayton Act says charging different prices for the same service to insurance network purchasers vs individuals paying in cash is “unlawful,” yet that’s routine practice in the health care business.
The Clayton Act is but one example of common health care economics being at odds with anti-trust law, and these practices have become so common over the years that they have become accepted as standard. Can the mold be broken at this point? It can be broken. It is being broken. Check these organizations as examples:
Both organizations have a published prices for their services that apply to everyone whether insured or not, Atlas for routine care and Surgery Center for major medical procedures. If you take a few minutes to browse their websites, you will find that health care pricing does not need to be a mystery that only a medical records and billing professional can decipher.
As we consider principles that underlie our proposal, expect following the law to make the cut.
Today we agreed on the following goals, the big, broad, issues we want to address. The goals have a “mom and apple pie” tenor; but they are important because anything we propose must address each one.
The goals are:
- Provide access to quality health care for all.
- Put downward pressure on the cost of routine care.
- Put downward pressure on insurance premium prices.
- Address the pre-existing conditions issue.
Have we missed anything?
We’re going to discuss principles next. Principles are the boundaries. Once we agree on them, all aspects of the solution must stay in bounds. This is my opening list of principles. Tom is likely to add a few of his own; and, despite the obvious brilliance behind each principle, he might object to a few of them. Tune in on Friday for the debate.
- Purchasing insurance is a choice, but paying for medical care is a responsibility.
- Contrary to the belief of too many elected officials, most people are not too stupid to manage their affairs. People who sign leases, purchase homes, buy cars, feed their families on tight budgets, and perform dozens of other important tasks every day are eminently capable of managing their health insurance and health care.
- Uncoupling insurance from employment allows consumers to keep their policies as long as they pay premiums.
- Individual insurance plans can be tailored to life circumstances.
- Group insurance plans are, in most cases, economical.
- Poor people should have the same kinds of choices everyone else has.
- Non-insurance solutions (like Atlas MD) should be part of the solution.
- Healthy lifestyles can and should be rewarded.
- Nobody will be forced to buy or provide any products or services they consider unethical.
- Competition is good. Therefore all laws that protect competition (antitrust and related) must be followed.
- If there are restrictions or mandates, they must apply to Congress too.
- Design the solution for the benefit of most (percentage TBD) and deal with those who don’t fit as one-offs.
Tweet or post me your additions to the principles. We’ll include them if we like them, and we’ll make fun of you if we don’t.