US Health Care Reform

When I heard that the health care reform bill passed, my stomach did a slow flip.

Not because I’ve checked my brain at the door and I toe one party line or the other. I think both the Democrats and the Republicans have it wrong.

No bill in front of Congress thus far has addressed the root cause of escalating health care costs in the US. It’s really quite simple.

Health care costs a lot because it doesn’t cost enough.

I know, I know, that doesn’t make any sense… but if you think about it, it will. Let’s consider the MRI. Costs for MRIs vary around the world, but they tend to be pretty pricy in the US, especially if your health insurance picks it up and you have a doctor that doesn’t want to be sued, so he or she sends you to the most advanced MRI lab within miles. It might cost your insurance company twice as much as the older MRI down the street, but it’s more advanced. It’s better. Right? Well… maybe. There are certain times when adding 5% resolution to a scan will actually help in your diagnosis, but most of the time, the cheaper MRI would work just as well. It doesn’t cost 5% less. It’s costs 30% to 50% less.

But you don’t know that. And unless your doctor has an ownership stake in that expensive new MRI machine, neither does your doctor. All anyone thinks about is, “what’s the best care possible?” Not what is the most logical decision for this patient’s care.

We’re all so removed from the cost of our treatment, we demand the best. Yet this is practically the only time any of us behave this way.

I don’t demand the best car. I look for a car with specific features that are important to me, then agree to pay a reasonable price. I drive a used Infiniti. It’s a really nice car, but it cost me less than a brand new tricked out Honda Civic (and has more and better features)… and a heck of a lot less than a brand new fully loaded BMW.

My Infiniti has all wheel drive, just like the BMW… but it’s not quite as good at redistributing power. But it cost 20% of what the BMW cost. It has heated leather seats, and when you live this close to the Arctic circle, that’s a nice win. But it still cost 20% of what the new BMW cost. I get to work safely, even in blizzard conditions.

What if those types of decisions were applied when you needed health care?

Don’t say, “Well, my insurance pays for it, and I pay premiums, so I deserve the best!” If everyone goes to the fancy MRI (when only 5% of us need it), we all pay more premiums. If half of us go to the less expensive MRI, we all pay lower premiums. If most of us go to the less expensive MRI, the operator of the fancy MRI suddenly has incentive to do what can be done to lower their costs and prices.

In a market where the consumers feel no immediate impact from the costs they are incurring, there is no incentive to keep costs low.

Don’t get me wrong, there’s a lot going for health care in the US. I’m glad I live here. Still, there’s a lot wrong with health care, and the bill passed this weekend will fix none of the major issues. Costs will continue to escalate.

We need to return to bearing more of our own health care costs. Our grandparents didn’t expect free health care when they were young. Why do we all expect it now?

The solution is simple. Higher deductible plans. Higher co-pays. Tax sheltered savings for medical costs. Yes, I know these things are available to some people now, but it’s the exception, not the rule.

I’ll save my rant on mandatory coverage for another day.


  1. Kaja says:

    But that is one aspect the bill does. It cuts unnecessary costs, the unnecessary costs you have just explained.

    And as for the mandatory coverage, in my opinion, it will work better than how the system operates now. Someone who is uninsured gets sick or has something happen to them that sends them to the emergency room and then later we find they are unable to pay the bill. What ends up happening? Those who are insured foot the bill indirectly from higher medical costs and premiums.
    .-= Kaja´s last blog ..Health Care Reformed | We Are Now Officially Living in the Soviet Union =-.

  2. greenlants @ Free Microsoft Points says:

    You know I think I’m going to leave a short comment on this one, and not the looong comment I want to lol. All I will say is when you go to a hospital for a week, and you get the bill for the drugs you took that ONE week, and it’s $50,000, something needs to be done. Maybe not what they did, but something. I think what they did though was horrible…they can’t even run the DMV, Post Office, or anything else that deals with society correctly, so how are they now controlling what happens to our bodies?!? o.O

  3. Daniel says:

    Nice story man. I stay out of the loop a lot, but I have been keeping up with the Health care issues a bit, and I agree with you.

  4. desen says:

    Thank you very much again

  5. Ashley says:

    “Our grandparents didn’t expect free health care when they were young. Why do we all expect it now?” really a serious question to go with. But nowadays i think health insurance becomes one of the obligation for all humans.

  6. jinnie @ gist says:

    Today’s life is very busy and competitive and full of stress, strain and rush. So we don’t have time to take proper food and that’s why our health becomes worse and most possibilities to become mentally weak. So we have to take healthy food which provides us basic energy and stamina. This post provide the essential information about healthy food and diet, so we will easily maintain healthy food and diet in our daily routine to keep us healthy.

  7. JOe says:

    Nice post. Totaly concure

  8. Sonny @ Sumo Costumes says:

    Im not sure on the legislation in the USA but here in France doctors can charge themselves out at the rate they want if you dont have insurance. So if I was uninsured and I broke my leg skiing for example, he could in theory charge me $20,000 for the operation if he wanted to…realistically this wouldnt happen but getting charged 2 or 3 times the going rate isnt unusual, especially for foreigners.
    .-= Sonny @ Sumo Costumes´s last blog ..About Us =-.

  9. Cynthia says:

    I don’t think that we should count how much it would cost, because USA is the richest country on the earth but in the same time, you can find thousands of Americans with bad teeth or without them they cannot afford to go to a doctor. The health system must be changed.
    .-= Cynthia´s last blog ..Florida Motorcycle Insurance | Florida Motorcycle Accident Lawyer =-.

  10. James says:

    Cynthia, that’s an interesting statement you lead with. How can we ignore how much it costs? Not to put too fine a point on it, but a lack of concern for how much our health care costs is what got us in to this mess in the first place. We must consider the costs. Who is going to pay for it?



    Yes. We are. I don’t know about you, but especially on tax day, I am VERY concerned with how much it costs. I wish you were, too.

    As for millions with bad teeth, this is generally self inflicted. I know when I have had cavities, it was because I was not being diligent enough to prevent them. I brought it on. My fault. No one else’s.

    Now my teeth are in very good health. No cavities. Clean teeth. Again, I brought this on… no one else. And it was cheap, too. How much is a tooth brush and a tube of tooth paste?

  11. Great blog post. The new Health Care Reform Act does come with heavy penalties as well. The penalty for those who do not maintain coverage is as follows:
    $95 in 2014
    $495 in 2015
    $750 in 2016
    And will be indexed for the further years.

    These amounts are cut in half for individuals under 18 years of age. The House Bill amendments retain the regulatory structure but change the fine amounts from $495 to $395 (in 2015) and from $750 to $695 (in 2016).
    So, get health coverage by 2014 or you’ll be paying for it.
    .-= Mark Anderson´s last blog ..Providing health insurance for your college graduate =-.

  12. James says:

    Mark – that’s actually a provision that I support in this bill… but there’s another piece that scares me. As a species, we keep pushing the envelope in health and medical science. What happens when a kid is born with a genetic marker that is tested when he’s three days old, and it’s now a part of his medical record that he has an elevated chance of getting prostate cancer during his lifetime. Does Junior now pay higher health care premiums for the rest of his life?

    This is, to me, the biggest issue we face, and we’re not doing anything about it.

    If we don’t address it now, people will begin genetically testing unborn children, and selectively aborting. Natural childbirth will fall out of favor for in vitro fertilization, so people can test the fetus in a test tube before deciding whether or not to carry the baby to term. Genetically, we will begin to lose some of the variation we carry as a species. All of these things should be at the top of the debate, but they are rarely discussed.

  13. lynne @ gchq jobs says:

    Sounds like to really have the right idea about this. I’m in the U.K so we don’t know a great deal about U.S healthcare, but it’s almost amazed me how much you guys have to pay.

  14. Kim says:

    I read a long (about 5-7 pages) article on Time’s April 2010 issue about “Health Care Reforms”, Don’t understand why this issue is criticized and discussed so much.
    Kim recently posted Body Building HGH

  15. Kandy @ Halloween Angel Costumes says:

    For sure the health system needs to be changed. I wonder what happens if people cant pay up? and honestly most people cant so people are always stuck paying off debts that should of been covered by a better health care system

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