Reform on the sly.

The LA Times published a fairly lengthy piece today on Administration efforts to advance the cause of separating health insurance from employment. For conservatives, the answer to this separation (of course) rests on personal responsibility and "ownership" of one's own plan as opposed to third party control of the system. Thus, the Health Savings Account has been born:

Emboldened by their success at the polls, the Bush administration and Republican leaders in Congress believe they have a new opportunity to move the nation away from the system of employer-provided health insurance that has covered most working Americans for the last half-century.

In its place, they want to erect a system in which workers — instead of looking to employers for health insurance — would take personal responsibility for protecting themselves and their families: They would buy high-deductible "catastrophic" insurance policies to cover major medical needs, then pay routine costs with money set aside in tax-sheltered health savings accounts.

The idea appeals to me - as an individual (I actually hunted around for an Archer Medical Savings Account a few years ago - but they were hard to find and difficult to establish in NC at the time). Why did it appeal to me? Because I am healthy, confident in my own ability to research both health and insurance issues, and I have a number of friends in the medical field on whom I can rely for guidance. Is that the case for those most urgently in need of health insurance, however? There's the rubbing point. The information society is a wonderful thing...if you're part of it. There are still plenty of people out there who either don't know how, don't have the time, or don't have the tools to access enough information to take advantage of something like this. Viewed from this perspective, I would call it a useful step forward - IF it is coupled with other measures. I don't know what those measures should be - it's something I haven't really looked into very deeply.

The articles continues, interviewing those who support HSAs:

Supporters of the new approach, who see it as part of Bush's "ownership society," say workers and their families would become more careful users of healthcare if they had to pay the bills. Also, they say, the lower premiums on high-deductible plans would make coverage affordable for the uninsured and for small businesses.

"My view is that this is absolutely the next big thing," said former House Speaker Newt Gingrich, whose consulting firm focuses on healthcare. "You are going to see a continued move to trying to get people involved in the process by owning their own health accounts."

...and the critics:

Critics say that Bush's vision represents wishful thinking at best, and at worst, a perilous new direction in national health policy.

"One danger with this is that people will not get needed care because they want to save a few thousand bucks," said Rep. Pete Stark (D-Hayward), a leading lawmaker on healthcare.

"Healthcare isn't like buying a Chevrolet," Stark added, disputing Bush's assertion that individual patients can be empowered to control costs. "You can go to Consumer Reports and read about the new Malibu, but if I asked you to describe a regimen of chemotherapy for someone who has colon cancer, you'd be out of gas.

"We are talking about highly technical services that 99% of the public doesn't even know how to spell the names of," he said. "Secondly, there is no uniformity within the medical community as to what services ought to be used. It's a 'by guess and by gosh' sort of practice."

The article concludes with a few notes on my favorite subject of late: using the information revolution to empower the consumer. However, market-based systems only work if consumers have the tools they need to make informed decisions:

In a recent article in the New England Journal of Medicine, Frist called for what would amount to a healthcare information revolution. Within the next decade, he said, patients should be able to gain online access to performance rankings and prices for doctors and hospitals.

"Increased access to more accurate information about care and pricing will make possible … the transformation of the healthcare system," Frist wrote. "Whether selecting their physician, hospital or health plan, consumers must be able to choose what best meets their needs."

[....]

His vision of an empowered patient calling the shots may stand little chance without a new information infrastructure.

Gingrich acknowledged: "You can't have an informed marketplace in a setting where you don't have any information."

Here are a couple of the suggestions for a national system, as presented by Physician's for a National Health Program and Just Health Care. Both offer programs on the opposite end of the spectrum from HSAs.


Update:

In the NY Times today, a new study reviews the connections between personal bankruptcy and health costs:

Policy analysts say these findings underscore the limitations of the
nation's current system of providing health insurance largely through employers.
Some argue that even for those with insurance, benefits can be
ephemeral.

"You can lose it because it's tied to employment," said Joseph
Antos, a health policy researcher with the American Enterprise Institute, who
said people were also at risk if their employers went out of
business.

Healthcare